May 27 2022




Recommendations

Risks to the infant

There are few observations published in the literature on possible effects of alprazolam on infants whose mothers received the drug.

A study on eight women volunteers who breastfed their children and received a single dose of 500 mcg of the drug, showed the peak concentration of 3.7 ng/ml of alprazolam between 0.47 and 3.8 hours after dosing, with half-life time of alprazolam in milk secretion of 14.5 hours. The authors believe that the child may receive about 3% of the maternal dose under usual dosage regimen [1]. Overall, the data indicate a low infant exposure to the drug [2].

A short communication describes the case of a mother who received alprazolam during pregnancy and lactation and stopped breastfeeding by observing the infant irritable and agitated the seventh day of life. At 48 hours showed a picture compatible with benzodiazepine withdrawal syndrome, which was treated with phenobarbital [3]. A succinct cohort study with five children followed by telephone, whose mothers received alprazolam, records a case of a baby drowsy. The case resolved spontaneously despite continuing mother anxiolytic treatment [4].

Influence on lactation

No data is available directly from alprazolam influence on lactation or lactating women.

Recommendations

Surely, alprazolam is not the best anxiolytic to administer to a nursing mother, it is preferable the use of short half-life benzodiazepines.

Should be noted that the use of psychotropic drugs has not been investigated in a systematic manner, so that the available documentation does not accurately reflect the implications of the use of these drugs during breastfeeding [5].

Some authors admit that the administration of a single dose of a benzodiazepine within the usual therapeutic range is not contraindicated, given the low level of exposure that occurs in infants [6]. However, prolonged high doses or chronic use of the drug is contraindicated and requires the interruption of breastfeeding [7].

References

1. Oo CY, Kuhn RJ, Desai N, Wright CE, McNamara PJ. Pharmacokinetics in lactating women: prediction of alprazolam transfer into milk. Br J Clin Pharmacol. 1995 Sep; 40(3):231-6.
2.Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv. 2002 Jan;53(1):39-49.
3. Anderson PO, McGuire GG.Neonatal alprazolam withdrawal--possible effects of breast feeding. DICP. 1989 Jul-Aug;23(7-8):614.
4. Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9.
5. Llewellyn A, Stowe ZN.Psychotropic medications in lactation. J Clin Psychiatry. 1998;59 Suppl 2:41-52.
6. Pons G, Rey E, Matheson I. Excretion of psychoactive drugs into breast milk. Pharmacokinetic principles and recommendations. Clin Pharmacokinet. 1994 Oct;27(4):270-89.
7. Mortola JF.The use of psychotropic agents in pregnancy and lactation. Psychiatr Clin North Am. 1989 Mar;12(1):69-87.

Warning of the manufacturer:

Because benzodiazepines are excreted in breast milk, its use is contraindicated in nursing mothers.

Updated:26.03.08