[megababymomma]

Is this the right place to post a question like this? I hope so!

I am experiencing some VERY severe anxiety. Neither my baby's nor my life is at risk, but it is quite frightening and I am trying to stay on top of it to avoid a deep depression.

I called my psychiatrist yesterday who told me there was no medication I could take and still safely breastfeed (yeah, thanks doc), but he did prescribe me Lorazepam (Ativan) and said if I take it that I could not bf for 48 hours afterward.

I have looked it up online and on babycenter.com (which I consider to be a pretty reputable resource), the drug is on the "probably safe" list (L2?) http://www.babycenter.com/general/8790.html

Also from another board I found this from "Medication & Mother's Milk-Hale":
Ativan (Lorazepam) is a typical bezodiazepine from the Valium family fo drugs. It is frequently used prenatally and presurgically as a sedative agent. In one prenatal study it has been found to produce a high rate of depressed respiration, hypothermia, and feeding problems in newborns. (skipping pregnancy info)

In one patient receiving 2.5 mg twice daily for 5 days post partum the breastmilk levels were 12µg/L. In another patient four after an oral dose of 3.5 mg, milk levels averaged 8.5 µg/L. Summerfield reports an average concentration in milk of 9 µg/L an an average milk/plasma ratio of 0.22.

It would appear from these studies that the amount of lorazepam secreted into milk would be clinically insignificant under most conditions.

The benzodiazepine family as a rule are not ideal for breastfeeding mothers due to relatively long half-lives and the development of dependence. However, it is apparent that the shorter-acting benzodiazepines are safest during lactation provided their use is short-term or intermittent, low dose, and after the first week of life.

Lactation Risk Category: L3 (moderately safe)

Pediatric concerns: None reported via milk but observe for sedation.

1/2 life is 12 hrs, peak is 2 hrs.
************************************************** ****************************************

Does this mean that the medication is at its highest levels in my breastmilk two hours after taking it, and then completely gone 12 hours later?

Would you consider this a drug that it is safe to take (I would be taking .5-1 mg a day, MAX) without any disruption in breastfeeding?

Are there any special considerations because my son is a week old today (hooray!)?

Thanks for your help!

 

[quirkylayne]

My first advice is find another doctor!

I've only got a minute here but I found some info from what I consider good sources, first Lactmed has some of the same info you posted.

http://toxnet.nlm.nih.gov/cgi-bin/si...temp/~d0hJpY:1

Lorazepam
CASRN: 846-49-1
For other data, click on the Table of Contents

Drug Levels and Effects:

Summary of Use during Lactation:
Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is administered directly to infants. Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.

Drug Levels:
Maternal Levels. Four women were given 3.5 mg of lorazepam orally 2 hours before undergoing cesarean section. Colostrum levels of lorazepam averaged 8.5 mcg/L at 4 hours after the dose; conjugated lorazepam metabolites were not measured.[1]

Another woman taking 2.5 mg orally twice a day for the first 5 days postpartum had milk levels of free and conjugated lorazepam of 12 and 35 mcg/L, respectively, at an unspecified time on day 5.[2] Since infants can deconjugate and absorb glucuronides, the total drug level is probably more important than the free drug alone. Using the total amount excreted, an exclusively breastfed infant would receive about 7 mcg/kg daily with this maternal dosage or about 8.5% of the maternal weight-adjusted dosage.

A woman who was 4 weeks postpartum was taking lorazepam 2.5 mg 1 to 3 times daily and lormetazepam, which is partially metabolized to lorazepam, 2 mg once daily. On day 5 of therapy after taking 2 doses of lorazepam in the previous 8 hours, her lorazepam milk level was 123 mcg/L. On day 6 after having taken 3 doses in the previous 24 hours, her milk lorazepam level was 89 mcg/L. On day 7, milk levels were 55 and 40 mcg/L at 14 and 18.5 hours after her last dose, respectively.[3]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:
In one case, the newborn infant of a mother taking 2.5 mg of lorazepam orally twice daily for 5 days after delivery showed no signs of sedation.[2]

Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

AAP Category:
Effect on nursing infant is unknown but may be of concern.[4]

I would also check out Kellymom, you may find some alternatives and you can also use that as a starting point for anxiety meds/antidepressants.
http://www.kellymom.com/health/meds/...oved-meds.html

 

[courtenay_e]

Quote:

Originally Posted by megababymomma 1/2 life is 12 hrs, peak is 2 hrs. ************************************************** **************************************** Does this mean that the medication is at its highest levels in my breastmilk two hours after taking it, and then completely gone 12 hours later? Would you consider this a drug that it is safe to take (I would be taking .5-1 mg a day, MAX) without any disruption in breastfeeding? Are there any special considerations because my son is a week old today (hooray!)? Thanks for your help!

I second the vote for another doctor! Also, I would seriously consider investing in a hard copy of Hales to donate to your doctor's office!!!

Now, about the half life. Yes, it is at it's highest levels two hours after taking it. No, it is NOT completely gone after 12 hours...it is only HALF gone. And then half of what is left is gone after 12 more hours, and half of what is left after that is gone after 12 MORE hours, etc.

I looked up Xanax for you, as that's what my doc put me on when I was having anxiety issues before I was married and it worked really well to just use on an "as needed" basis. It's acutally in the same class of drugs, and is also one of the shorter termed of the group, though it's peak time is 1.1 hours and the half life is 12-15 hours.

NOW. I would highly suggest looking into nutritional "treatments" as well. We know that many women with issues post partum have low copper levels. Also, Cod Liver Oil has been shown to help anxiety and depression issues (and I started using it after I read that and stopped needing the occaisional 1/4 tablet of Xanax. I just never needed it again!), as well...and it REALLY can't hurt to supplement with it--unless you're allergic to deep sea fish! Even if your "Prenatal" vitamin has some omega fats in it, I'd get yourself something like the Nordic Naturals Complete Omega 3-6-9 or Carlson's Cod Liver Oil and start taking it today!

 

[RootSnort]

All the above is right, there's really no great drug for directly addressing anxiety in a nursing Mom. They all have risks. It would be better to address underlying depression, first choice for that in a nursing Mom is Zoloft. And I would see a counselor to talk about the anxiety, since the medication options, quite frankly, suck.

 

[Mamato3wild ponnie]

Rescue Remedy works wonderfully for anxiety.....4 drops under the tongue...in a matter of mintues the anxiety is gone...all natural...i really suggest trying that and the supplements....L3 is pretty high level..how old is your baby? If the American Academy of Pediatrics suggest observing for sedation...i would be cautious in an younger baby...an older baby may be less issues...Hope you start feeling better.