Wellbutrin (Bupropion) and Breastfeeding
Caution is advised when using bupropion (Wellbutrin) during breastfeeding due to its presence in breast milk and rare reports of seizures in breastfed infants. 1, 2
Transfer into Breast Milk and Infant Exposure
- Bupropion is present in human milk and has been detected in the serum of infants exposed through breastfeeding, although typically at very low or sometimes undetectable levels 2, 3
- Limited data (21 cases) shows that the average daily infant exposure to bupropion and its active metabolites is approximately 2% of the maternal weight-adjusted dose 3
- The drug and its metabolites can be detected in infant urine, confirming systemic absorption even at low levels 4
Safety Concerns
- While generally no adverse events have been reported in most cases, there have been at least 2 documented case reports of seizures in breastfed infants whose mothers were taking bupropion 1, 2
- One case report documented seizure-like symptoms in a 6.5-month-old infant exposed to both bupropion and escitalopram through breast milk, with symptoms resolving after supportive therapy 4
- Infants may have higher susceptibility to the epileptogenic effects of bupropion and/or its active metabolite (hydroxybupropion) compared to adults, even at serum concentrations below the therapeutic range for adults 4
Monitoring Recommendations
If bupropion is needed during breastfeeding, the infant should be carefully monitored for potential adverse effects, particularly 2:
- Vomiting
- Diarrhea
- Jitteriness
- Sedation
- Seizures or seizure-like activity
Ensure the infant is gaining weight appropriately and meeting developmental milestones 2
Alternative Considerations
- For treatment of depression during the postpartum period, sertraline is often considered first-line therapy due to minimal excretion in breast milk and low infant-to-maternal plasma concentration ratios 5, 6
- Sertraline is generally recognized as one of the safest antidepressants during breastfeeding 6
Risk-Benefit Assessment
- The decision to use bupropion while breastfeeding should weigh the developmental and health benefits of breastfeeding against potential adverse effects on the infant 3
- Untreated maternal depression can negatively impact the emotional development of children, which must be considered in the risk-benefit analysis 7
Practical Recommendations
- If a woman is already taking bupropion with good effect before breastfeeding begins, maintaining the lowest effective dose while monitoring the infant carefully may be appropriate 2
- When feasible, exposure may be reduced by avoiding breastfeeding at times when drug concentration in milk is expected to peak 6
- For women initiating treatment during the postpartum period, consider sertraline as a first-line option before bupropion 5, 6
Remember that while the absolute risk of adverse events appears low, the potential for seizures in breastfed infants cannot be dismissed and requires vigilant monitoring if bupropion is used during lactation 1, 2, 4.