Wellbutrin (Bupropion) and Breastfeeding
Wellbutrin can be used during breastfeeding with caution, but requires careful infant monitoring due to rare but serious risks, particularly seizures. 1, 2, 3
Safety Profile During Lactation
Bupropion is present in human milk and has been detected in breastfed infant serum, though typically at very low or sometimes undetectable levels. 1, 2, 3 The average daily infant exposure through breast milk is approximately 2% of the maternal weight-adjusted dose. 3
Documented Adverse Events
- Two case reports have documented seizures in breastfed infants whose mothers were taking bupropion, though the direct causal relationship remains unclear 1, 2, 3
- Generally, no adverse events have been reported in the limited available data (21 cases total) 1
- The FDA drug label specifically mentions postmarketing reports of seizures in breastfed infants, though the relationship to bupropion exposure is uncertain 3
Clinical Recommendations
If bupropion is needed for treating postpartum depression or ADHD during breastfeeding, maintain the therapeutic dose while breastfeeding and monitor the infant carefully. 2 This recommendation comes from the American Academy of Pediatrics via recent ACOG guidelines. 2
Specific Monitoring Parameters
Monitor the breastfed infant for: 2
- Vomiting
- Diarrhea
- Jitteriness
- Sedation
- Seizures (most critical)
Additionally, ensure the infant is: 2
- Gaining weight appropriately
- Meeting developmental milestones
Risk-Benefit Considerations
The decision to use bupropion during breastfeeding should weigh the benefits of treating maternal depression or ADHD against the small but serious risk to the infant. 3, 4 The FDA label emphasizes that "the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for bupropion." 3
When Bupropion May Be Preferred
- Consider bupropion as an alternative to stimulants in the perinatal period, particularly for individuals requiring treatment for co-occurring depression 2
- Most antidepressants are compatible with breastfeeding, and priority should be given to effectively treating the mother, often with medications that were effective during pregnancy 4
Important Caveats
The evidence base is extremely limited (only 21 published cases), making definitive safety conclusions difficult. 1 The two seizure reports, while concerning, represent rare events in the context of likely much broader unreported use. 3
Do not discontinue breastfeeding unnecessarily - wrongful discontinuation of breastfeeding due to medication concerns is a common problem that deprives infants of breastfeeding benefits. 4, 5 The actual risk from bupropion exposure through breast milk appears low based on pharmacokinetic data showing only 2% of maternal dose reaching the infant. 3