Is it safe for breastfeeding mothers to use Adderall (amphetamine and dextroamphetamine)?

Adderall Use in Breastfeeding Mothers

Adderall (amphetamine mixed salts) can be used during breastfeeding with careful infant monitoring, as breastfeeding does not appear to adversely affect infants when mothers use therapeutic doses of amphetamines. 1

Evidence-Based Recommendation

The 2024 American Journal of Obstetrics and Gynecology guidelines provide the most comprehensive and recent guidance on this topic, indicating that amphetamines are assigned a Hale Lactation Risk Category of L3 (moderately safe), and therapeutic use during breastfeeding appears compatible with nursing. 1

Key Safety Data

• Amphetamines are excreted in human milk, but the information provided relates specifically to therapeutic use for ADHD treatment, not recreational or illicit amphetamine use. 1, 2

• Breastfeeding does not seem to adversely affect infants when mothers use amphetamines at prescribed therapeutic doses for ADHD. 1

• A 2024 pilot study (the most recent research available) followed 13 children exposed to amphetamine stimulants during breastfeeding and found normal neurodevelopment with no significant adverse effects, suggesting amphetamines are likely compatible with breastfeeding. 3

• The consensus from 2024 guidelines 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

Clinical Management Algorithm

Monitoring Requirements

Infants must be monitored carefully for the following symptoms: 1

• Irritability
• Insomnia
• Feeding difficulty

Dosing Strategy to Minimize Infant Exposure

• Consider intermittent, as-needed dosing rather than continuous daily use, with the goal of maximizing maternal functioning while reducing overall infant exposure, since stimulants have rapid onset of action. 1

• Time breastfeeding to avoid peak maternal serum concentrations when possible to further limit infant exposure. 4

Alternative Medication Considerations

• Methylphenidate may be preferred over amphetamines for breastfeeding mothers, as it is secreted in only small amounts in human milk with relative infant doses (RIDs) of <1%, is generally not detected in infant blood, and no adverse effects have been reported in infants. 1

• Bupropion could be considered as an alternative, particularly for mothers with co-occurring depression, though it has very limited breastfeeding data (only 21 cases) and two case reports of seizures in breastfed infants exist, though causality remains uncertain. 1

Important Caveats

Critical Distinction

• This guidance applies ONLY to therapeutic, prescribed amphetamine use for ADHD treatment, not to illicit amphetamine use or stimulant use disorder, which carries different and significantly higher risks. 1

Risk-Benefit Context

• Untreated maternal ADHD poses its own risks to the mother-infant dyad and maternal functioning, which must be weighed against the low documented risks of medication exposure through breast milk. 1

• The FDA drug label states that mothers taking amphetamines should be advised to refrain from nursing, but this represents older, more conservative guidance that has been superseded by more recent evidence-based guidelines showing compatibility with careful monitoring. 2

Research Limitations

• Data on ADHD medication transfer into breast milk remains limited, with most evidence coming from case reports rather than large controlled studies, highlighting the need for shared decision-making with patients. 1, 5