Adderall Use During Breastfeeding
Mothers taking Adderall (amphetamine/dextroamphetamine) should refrain from breastfeeding, as the FDA drug label explicitly states that amphetamines are excreted in human milk and mothers taking amphetamines should be advised to refrain from nursing. 1
Primary Recommendation
The FDA-approved drug label for amphetamine provides clear guidance that amphetamines are excreted in human milk and mothers should refrain from nursing while taking these medications. 1 This represents the most authoritative source for prescribing decisions.
Evidence Supporting Caution
Drug Transfer and Excretion
- Amphetamines are definitively excreted into breast milk, creating direct infant exposure through breastfeeding. 1
- The pharmacokinetic properties of amphetamines allow transfer into breast milk, though quantification methods and comprehensive data remain limited. 2
Potential Infant Effects
- Infants born to mothers dependent on amphetamines show increased risk of withdrawal symptoms including dysphoria, agitation, and significant lassitude. 1
- The American College of Obstetricians and Gynecologists recommends monitoring infants for irritability, insomnia, and feeding difficulties when mothers were taking amphetamines during pregnancy, suggesting these effects could extend to breastfeeding exposure. 3
Emerging but Limited Contradictory Data
A small 2024 pilot study (N=13) found normal neurodevelopment with no significant adverse effects in children exposed to amphetamine stimulants during breastfeeding, suggesting potential compatibility. 4 However, this study is extremely limited in sample size and cannot override FDA labeling guidance.
Clinical Decision Framework
Given the explicit FDA recommendation to refrain from nursing:
- Discontinue breastfeeding if amphetamine therapy is medically necessary for the mother. 1
- If ADHD symptoms are mild to moderate, consider non-pharmacological interventions during the breastfeeding period. 3
- Consult with the infant's pediatrician before making any decision to continue both medication and breastfeeding. 5
- If the mother chooses to continue both against FDA guidance, arrange for close monitoring of the infant for irritability, insomnia, feeding difficulties, and developmental concerns. 3, 4
Important Caveats
- Most available safety data on amphetamines and breastfeeding comes from recreational methamphetamine abuse rather than therapeutic ADHD treatment, limiting applicability. 4
- The decision carries medicolegal implications given the explicit FDA contraindication to nursing while taking amphetamines. 1
- Very few drugs present clinically significant risk to breastfed infants, but amphetamines are specifically identified as requiring cessation of nursing. 1, 6