Is gabapentin (Neurontin) safe to use during lactation?

Gabapentin Use During Lactation

Gabapentin can be used during breastfeeding with infant monitoring, as it is secreted into breast milk at levels that could expose a nursing infant to approximately 1 mg/kg/day, but the benefits of breastfeeding should be weighed against unknown risks to the infant. 1

FDA-Approved Labeling Guidance

• The FDA label explicitly states that gabapentin is secreted into human milk following oral administration, with potential infant exposure of approximately 1 mg/kg/day 1
• Because the effect on the nursing infant is unknown, gabapentin should be used in women who are nursing only if the benefits clearly outweigh the risks 1
• The FDA classifies gabapentin as potentially "developmentally toxic" based on preclinical data, raising concerns about widespread use particularly during pregnancy and lactation 2

Clinical Safety Profile

• Gabapentin is considered compatible with breastfeeding but with a less documented safety profile compared to older antiepileptic drugs like carbamazepine, valproic acid, and phenytoin 3
• Limited clinical data are available for gabapentin during lactation, and no clear-cut recommendations can be made until further data are present 4
• If breastfeeding continues during gabapentin treatment, the infant should be monitored for possible adverse effects 4

Practical Monitoring Recommendations

• Observe the breastfed infant for signs of sedation, poor feeding, and developmental concerns while the mother is taking gabapentin 5
• Infant monitoring for potential adverse effects is advisable when the mother is taking gabapentin 5
• Consider monitoring infant serum drug concentrations if there are concerns about infant exposure, though this is advisable but not compulsory 5

Emerging Safety Concerns

• Recent evidence reveals concerns regarding gabapentin safety, particularly for neonatal exposure via breastmilk 2
• Concerns have been raised about atypical or difficult-to-control withdrawal signs and symptoms in neonates exposed to gabapentin, including those dually exposed to opioids 2
• The current literature suggests that gabapentin use should be considered with caution during the postpartum period 2

Risk-Benefit Considerations

• Women should not be discouraged from breastfeeding while taking compatible medications, given the substantial benefits of breastfeeding for both infant and maternal health 6
• The potential risk of drug therapy should be weighed against the risk of untreated maternal symptoms 6
• Breast milk has considerable advantages over formula milk, and the benefits of continuing breastfeeding should always be taken into consideration in the risk-benefit analysis 4

Dosing Strategy to Minimize Infant Exposure

• The drug should be given in the lowest effective dose, guided by maternal serum or plasma drug concentration monitoring 4
• If breastfeeding is avoided at times of peak drug levels in milk, the exposure of the infant can be reduced to some extent 4