Is it safe for a breastfeeding mother with Attention Deficit Hyperactivity Disorder (ADHD) to take Adderall (amphetamine and dextroamphetamine)?

Restarting Adderall While Breastfeeding at 1 Year Postpartum

Yes, it is safe to restart Adderall while breastfeeding at 1 year postpartum, particularly if the medication is required for your daily functioning. 1

Primary Recommendation

The American College of Obstetricians and Gynecologists establishes that treatment with ADHD medications should not be stopped if they are required for the daily functioning of the breastfeeding person, as the magnitude of documented risks is very low. 1 This consensus prioritizes maternal quality of life and functioning, which directly impacts both mother and child outcomes.

Safety Profile During Breastfeeding

Amphetamine Excretion in Breast Milk

• Amphetamines (the active component of Adderall) are secreted in breast milk, but the clinical significance at 1 year postpartum is substantially reduced compared to early infancy. 2
• While some older literature suggests caution with amphetamines during breastfeeding 2, more recent evidence from 2024 shows normal neurodevelopment with no significant adverse effects in children exposed to amphetamine stimulants during breastfeeding. 3
• The relative infant dose (RID) and actual exposure decrease as breastfeeding frequency naturally diminishes after 1 year of age. 1

Infant Monitoring

Monitor your infant for: 1

• Irritability or unusual fussiness
• Sleep disturbances or insomnia
• Feeding difficulties or changes in appetite
• Appropriate weight gain and developmental milestones

At 1 year of age, these effects are easier to detect and manage compared to younger infants. 1

Practical Strategies to Minimize Infant Exposure

Timing and Dosing Approaches

Consider intermittent use on an as-needed basis to maximize your functioning while reducing overall infant exposure, taking advantage of stimulants' rapid onset of action. 1 This strategy is particularly feasible at 1 year postpartum when breastfeeding is typically less frequent than in early infancy.

Time medication administration strategically:

• Take Adderall immediately after a breastfeeding session 1
• Schedule the longest interval between dose and next feeding when possible 1
• At 1 year, many children receive substantial nutrition from solid foods, making timing more flexible 1

Dose Optimization

• Use the lowest effective dose that maintains your daily functioning 1
• Standard adult dosing for Adderall XR starts at 10 mg once daily in the morning, with titration in 5 mg weekly increments up to a maximum of 50 mg daily 4
• Morning administration minimizes sleep disturbances for both you and your child 4

Alternative Considerations

If Concerns Persist About Amphetamines

Methylphenidate may be preferred over amphetamines for breastfeeding if you and your physician decide to switch medications:

• Methylphenidate is secreted in only small amounts in breast milk with RIDs <1% 1
• It is generally not detected in breastfed infants' blood 1
• No adverse effects have been reported in breastfed infants exposed to methylphenidate 1
• The American College of Obstetricians and Gynecologists specifically recommends maintaining therapeutic doses of methylphenidate during breastfeeding 1

However, switching medications should only be considered if your current Adderall regimen is not well-established or if you have specific concerns. 5

Non-Stimulant Options

Bupropion could be considered as an alternative, particularly if you have co-occurring depression, given its favorable safety data in the perinatal period. 1 However, bupropion is not as efficacious as stimulants for ADHD treatment. 1

Risk-Benefit Context

Risks of Untreated ADHD

The functional impairment from untreated ADHD can significantly impact:

• Your ability to care for your child safely 1
• Quality of parent-child interactions 1
• Your overall mental health and well-being 1
• Management of co-occurring conditions like postpartum depression or anxiety 1

Documented Medication Risks

The pregnancy-related risks (preeclampsia, preterm birth, low birth weight) are not relevant at 1 year postpartum. 6 The primary consideration is breast milk transfer, which carries minimal documented risk, especially with reduced breastfeeding frequency at this age. 3

Clinical Decision Framework

Proceed with restarting Adderall if:

• You require medication for daily functioning 1
• You can monitor your infant for the listed adverse effects 1
• You implement timing strategies to minimize infant exposure 1

The evidence strongly supports continuing or restarting ADHD medication during breastfeeding when clinically indicated, with the understanding that maternal functioning and quality of life are critical outcomes that benefit both mother and child. 1, 3