bi-polar meds and bfing

[mamabain]

Does anyone know which bipolar meds are safe for bfing? i have a client who is needing to go back on her meds that she felt were unsafe during pregancy and who wants to wean 1 mo baby to go on meds again.

Any ideas?
I don't have the name of the meds... sorry. Mother has researched and found they are L3s, but doesn't want to take the risk.

Thanks in advance.

[MaryJaneLouise]

Olanzapine (Zyprexa, Symbyax) is an L2. Others are L3s such as ARIPIPRAZOLE (Abilify) and are probably safe, but haven't been studied as thoroughly:

http://www.mothering.com/discussions...php?p=11501976

[MaryJaneLouise]

Here's another reference:
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

CONCLUSIONS: Breast-fed infants were exposed to a calculated olanzapine dose of approximately 1%-well below the 10% notional level of concern. In infant plasma, olanzapine was below the detection limit; there were no adverse effects on the infants. These data support the use of olanzapine during breast-feeding. However, the authors recommend that breast-fed infants be monitored closely and the decision to breast-feed be made after individual risk-benefit analysis.

[mamabain]

thanks so much

After looking around in the mental health forum and doing some other research, I am confident this mom has done her research and will be making the best decision for her family.

Thanks for insights and quick answers,

paz
rachael

[Heavenly]

I have bipolar and with my second child I chose to stay off meds to breastfeed. It almost ruined my life. Bipolar is nothing to mess around with - tell her to stop breastfeeding and take her meds.

[DirtyHippyMama]

I disagree with the above post (sorry Mama). I too have bipolar disorder, and I take my meds, and I breastfeed full time. This is one of those situations where you have to weigh the pros and cons of everything before making a decision. For me, pregnancy hormones stabilized me until about 8 weeks postpartum. I then researched whether my meds were safe to take. I take Lamictal, which, according to Medication and Mother's Milk is "considered moderately safe when taken in doses up to 500mg/day" (I currently take 150mg/day). Considering the seriousness of my illness, I chose to move forward with the meds while also continuing to breastfeed (which is extremely important to me). The truth is that there are very few meds that are entirely incompatible with breastfeeding. I have permission from my baby's pediatrician to take a Xanax for anxiety or a painkiller for my back problems as needed (it is very sporadic). The amount that passes into the milk is very small, and I must take care of myself so I can be the best mama I can be.

[MaryJaneLouise]

Bipolar disease is, of course, "nothing to mess with". It IS possible to treat bipolar in the mother, without exposing the baby to the risks of formula feeding.

Like many parenting decisions, it is a cost / risk / benefits calculations. It's just too bad that so many health professionals just say "wean permanently" without really researching the safest method of treating mom's disease

Here's more info on bipolar disease in general from Dr. Thomas Hale's forum:

http://66.230.33.248/discus/messages/47/223.html

http://66.230.33.248/discus/messages/57/928.html

[mamameg]

Not all meds work the same way for everyone. If the right meds for mom are not the right meds for baby, I agree that baby should be weaned so mama can keep herself healthy.

[ccohenou]

In my understanding, managing the meds for bipolar can be very complex...not so simple as just picking out the one that looks best from Hale's and taking that...and really a job for a psychiatrist to manage. Hale himself notes this in the second link above - his expertise is in pharmacology, not psychiatry.

If it were someone asking for help with continuing to nurse, I would focus on communicating with the doctor about her desire to keep nursing, giving copies of references regarding the drugs that were recommended that she could share with the doctor, etc. But if she doesn't want to keep breastfeeding and is uncomfortable with the risks of the medications, that's pretty much the end of the issue in my perspective.

[GooeyRN]

Everyone has different responses to medications, and different levels of severity of bi-polar disorder. Mama has to do what she has to do to be healthy, first and foremost.

[transformed]

as far as I know xanax is VERY dangerous to nursing babys.

I have to go to a regular doctor - and this will be my first appt with them, for meds. I do not have access to a psych at this time but I consider it an emergency that I get meds RIGHT NOW. So I am doing some research - even though doctors dont usualy take kindly to being told what meds a patient want. LOL

[MaryJaneLouise]

Xanax (alprazolam) is an L3 in Dr. Hale's book. He has a complete description in there of its pros and cons.
In discussing one study of 8 women, he states: "The neonatal dose of alprazolam is low. While the infants in this study did not breastfeed, these doses would probably be too low to induce a clinical effect.

In a brief letter, Anderson reports that the manufacturer is aware of withdrawal symptoms following exposure in utero and via breastmilk. In a mother who received 0.5 mg 2-3 times a dailoy (PO) during pregnancy, a neonatal withdrawal was evident in a breastfed infant the first week postpartum. This data suggests that the amount of alprazolam in breastmilk is insufficient to prevent a withdrawal syndrome following exposure."

There's more in the book. Doctors and moms need to realize that while there are risks to bfing on certain meds, there are also risks to the child for formula feeding instead, and guide their discussions with that in mind.

[doublyblessed]

what is lamictal rated, does anyone know? thank you.

Originally Posted by mammaofthree

I disagree with the above post (sorry Mama). I too have bipolar disorder, and I take my meds, and I breastfeed full time. This is one of those situations where you have to weigh the pros and cons of everything before making a decision. For me, pregnancy hormones stabilized me until about 8 weeks postpartum. I then researched whether my meds were safe to take. I take Lamictal, which, according to Medication and Mother's Milk is "considered moderately safe when taken in doses up to 500mg/day" (I currently take 150mg/day). Considering the seriousness of my illness, I chose to move forward with the meds while also continuing to breastfeed (which is extremely important to me). The truth is that there are very few meds that are entirely incompatible with breastfeeding. I have permission from my baby's pediatrician to take a Xanax for anxiety or a painkiller for my back problems as needed (it is very sporadic). The amount that passes into the milk is very small, and I must take care of myself so I can be the best mama I can be.