Is gabapentin (Neurontin) safe to use during breastfeeding?

Gabapentin Safety During Breastfeeding

Gabapentin can be used during breastfeeding with appropriate infant monitoring, as the relative infant dose is low (approximately 2.34%) and no adverse effects have been documented in breastfed infants. 1

Transfer into Breast Milk and Infant Exposure

• Gabapentin is secreted into human milk following oral administration, with a milk-plasma ratio of 0.86 2, 1
• The relative infant dose is approximately 2.34% of the maternal dose, which is well below the generally accepted safety threshold of 10% 1
• The absolute infant dose is approximately 3% of the children's therapeutic dose for gabapentin 1
• Infant plasma levels have been measured at approximately 6% of maternal plasma drug concentration 1

Safety Profile

• No adverse effects attributable to gabapentin have been noted in breastfed infants in available case reports 1
• Gabapentin is considered compatible with breastfeeding, though with a less documented safety profile compared to older antiepileptic medications 3
• Monitoring of the infant for potential adverse effects is advisable when the mother is taking gabapentin 4

Recommendations for Clinical Practice

• When prescribing medications for breastfeeding mothers, consider:

  • The benefits of medication use for the mother
  • The importance of continued breastfeeding for the infant
  • The potential risk of infant medication exposure 5

• To minimize infant exposure:

  • Consider timing doses before the infant's longest sleep interval 6
  • Monitor the infant for any signs of sedation, poor feeding, or other adverse effects 4

Comparison to Other Anticonvulsants

• Traditional anticonvulsants like phenytoin, carbamazepine, and valproic acid are generally considered safer during breastfeeding due to more extensive clinical experience 4, 3
• Newer anticonvulsants including gabapentin have less data but are generally considered compatible with breastfeeding with appropriate monitoring 3

Important Considerations

• Use reliable, up-to-date resources like LactMed when prescribing medications for breastfeeding mothers 6
• The FDA drug label notes that gabapentin can pass into breast milk, but does not specifically contraindicate its use during breastfeeding 2
• The benefits of breastfeeding often outweigh the theoretical risks of medication exposure through breast milk 4, 6