Is it safe to take Adderall (amphetamine and dextroamphetamine) while breastfeeding?

Taking Adderall While Breastfeeding

Adderall can be continued during breastfeeding if it is required for your daily functioning, as the documented risks to the breastfed infant are very low, though infant monitoring is essential. 1

Primary Recommendation

The American College of Obstetricians and Gynecologists states 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 recommendation prioritizes maternal quality of life and functioning, which directly impacts the ability to safely care for the infant. 1

Safety Profile During Breastfeeding

• Amphetamines are excreted in human milk, and the FDA drug label advises mothers taking amphetamines to refrain from nursing. 2 However, this conservative FDA position must be balanced against current clinical guideline recommendations. 1

• The actual infant exposure through breast milk is typically low, and the relative infant dose (RID) decreases naturally as breastfeeding frequency diminishes over time. 1

• Very limited published data exist specifically on amphetamine use during breastfeeding, with only 21 documented cases in the literature. 3

Critical Infant Monitoring Requirements

You must monitor your infant carefully for the following signs:

• Irritability or unusual fussiness 1, 2
• Sleep disturbances or insomnia 1, 2
• Feeding difficulties 1, 2
• Appropriate weight gain and developmental milestones 1
• Agitation or significant lassitude (as seen in infants exposed during pregnancy) 2

These monitoring requirements are non-negotiable if you choose to continue breastfeeding while taking Adderall. 1

Strategies to Minimize Infant Exposure

Implement these practical approaches to reduce the amount of medication your infant receives:

• Take Adderall immediately after a breastfeeding session to maximize the time interval before the next feeding. 1
• Schedule the longest interval between your dose and the next feeding when possible. 1
• Use the lowest effective dose that maintains your daily functioning. 1
• Consider intermittent use on an as-needed basis to maximize functioning while reducing overall infant exposure. 1

Alternative Medication Consideration

Methylphenidate may be preferred over amphetamines for breastfeeding mothers. 1 The American College of Obstetricians and Gynecologists recommends maintaining therapeutic doses of methylphenidate during breastfeeding, as it has a relative infant dose of less than 1% with no reported adverse effects in breastfed infants. 1 This represents a potentially safer alternative if medication switching is feasible for your ADHD management.

Risk-Benefit Context

The functional impairment from untreated ADHD can significantly impact:

• Your ability to care for your child safely 1
• Quality of parent-child interactions 1
• Overall mental health 1
• Management of co-occurring conditions 1

These maternal risks from untreated ADHD often outweigh the low documented risks to the breastfed infant. 1

Important Caveats

• Stimulant medications may decrease milk supply, which is a practical consideration for breastfeeding continuation. 4
• The information regarding amphetamine use applies only to therapeutic use and does not apply to non-prescribed amphetamine use in persons with stimulant use disorder. 5
• Most medications are compatible with breastfeeding, and discontinuation is often wrongly recommended due to fear rather than evidence. 6

Clinical Decision Algorithm

Proceed with Adderall during breastfeeding if:

1. The medication is required for your daily functioning 1
2. You can implement infant monitoring 1
3. You can apply strategies to minimize exposure 1

Consider switching to methylphenidate if:

1. ADHD control allows for medication change 1
2. You prefer the lowest possible infant exposure 1

Discontinue breastfeeding only if:

1. Infant shows signs of adverse effects despite dose adjustments 2
2. Adequate infant monitoring is not possible 1