Breastfeeding While Taking Vyvanse and Wellbutrin
Yes, you can breastfeed while taking both Vyvanse (lisdexamfetamine) and Wellbutrin (bupropion), though both medications require careful infant monitoring for specific adverse effects.
Vyvanse (Lisdexamfetamine) and Breastfeeding
Lisdexamfetamine is compatible with breastfeeding based on amphetamine class data, with a Hale lactation risk category of L3. 1
Key Evidence for Amphetamines During Lactation
- Lisdexamfetamine is a prodrug that converts to dextroamphetamine, so amphetamine breastfeeding data directly applies 1
- Therapeutic amphetamine use during lactation does not appear to adversely affect infants 1
- Amphetamines are present in breast milk at relative infant doses of 2% to 13.8% of the maternal weight-adjusted dosage, with milk/plasma ratios ranging from 1.9 to 7.5 2
- The FDA label notes that while amphetamines are present in human milk, there are no reports of adverse effects on breastfed infants from published case reports 2
Required Infant Monitoring for Vyvanse
Monitor your infant carefully for: 1
- Irritability
- Insomnia or sleep disturbances
- Feeding difficulties
- Poor weight gain
Wellbutrin (Bupropion) and Breastfeeding
Bupropion can be used during breastfeeding with caution, though data are very limited (only 21 published cases). 1
Key Evidence for Bupropion During Lactation
- Bupropion is present in human milk and has been detected in infant serum at very low levels (sometimes undetectable) 1
- Generally no adverse events have been reported in most cases 1
- Critical safety concern: There have been 2 case reports of seizures in breastfed infants exposed to bupropion 1
Required Infant Monitoring for Wellbutrin
Monitor your infant carefully for: 1
- Vomiting
- Diarrhea
- Jitteriness
- Sedation
- Seizures (most serious concern)
Combined Use Considerations
When taking both medications simultaneously while breastfeeding:
- Both medications transfer into breast milk, creating cumulative infant exposure to stimulant effects 1, 2
- The combination increases the importance of vigilant infant monitoring for CNS stimulation (irritability, jitteriness, insomnia) 1
- Weight gain and feeding patterns require close attention, as both medications can potentially affect these parameters 1, 2
Clinical Decision Framework
The decision to breastfeed on these medications should prioritize:
- Maternal mental health and quality of life: Untreated ADHD and depression significantly impair maternal functioning and bonding 1
- Infant safety monitoring: Establish a clear monitoring plan with your pediatrician before continuing breastfeeding 1
- Benefits of breastfeeding: The immunologic, developmental, and bonding benefits of breastfeeding are substantial 3, 4, 5
Practical Monitoring Plan
- Schedule frequent pediatric follow-ups in the first weeks of combined medication use 1
- Document infant sleep patterns, feeding duration/frequency, and weight gain weekly 1, 2
- Immediately contact your pediatrician if seizure activity, severe irritability, or feeding refusal occurs 1
- Consider timing breastfeeding sessions to occur when maternal drug levels are lowest (just before next dose) to minimize infant exposure 6, 5
Important Caveats
- The FDA label for lisdexamfetamine states that "breastfeeding is not recommended during treatment," citing potential for serious cardiovascular reactions, blood pressure increases, growth suppression, and peripheral vasculopathy 2
- However, the 2024 American Journal of Obstetrics and Gynecology guidelines provide more nuanced guidance supporting breastfeeding with monitoring for therapeutic amphetamine use 1
- This represents a divergence between FDA labeling (which takes a maximally cautious approach) and clinical practice guidelines (which weigh maternal benefits against infant risks) 1, 2
- Large doses of dextroamphetamine might interfere with milk production, especially in women whose lactation is not well established 2