7The mechanism of action of stimulants (methylphenidate and amphetamines) in the reduction of ADHD symptoms is not fully known 8, but most likely involves the improvement of daily functioning via increased neurotransmission of dopamine and norepinephrine. 1ĪDHD in adulthood is associated with significant impairment in occupational, academic, and social functioning. 1 Keep in mind that differences exist among patients, so monitor the breastfed infant for any clinically significant changes (see table below).
3 Calculations are based on the mother’s weight-adjusted dose, using an infant’s average daily milk intake of 150 mL/kg/day. If the RID is less than 10%, the medication is generally considered safe for breastfeeding. When assessing the compatibility of a drug with breastfeeding, the relative infant dose (RID) provides an estimate of a baby’s exposure to that drug from breast milk. 6 Several factors -solubility, size, blood level, protein binding, oral bioavailability, and half-life-can influence the transfer of drugs into breast milk. If a medication was of concern during pregnancy, patients should discuss those medications with their healthcare provider, since medications that are unsafe during pregnancy may be safe during breastfeeding and vice versa. 1,5 In all cases, the risk of exacerbation of symptoms in the mother if medication were to be stopped must be balanced against any risks to the infant if medications are to be continued. 4 Few patients with ADHD require management that may be a contraindication to breastfeeding. 3 While the long-term neurodevelopmental effects of ADHD medications have not been adequately studied, 3 the most up-to-date recommendations and evidence 1 can help guide the decision-making process.įor most lactating mothers with ADHD, benefits of breastfeeding 2 outweigh the risks of concurrent treatment with stimulants, the most commonly prescribed medications 3 available in immediate-release and extended-release formulations. 1,2 Multiple studies have demonstrated that the risk for adverse outcomes in breastfed infants is minimal if a mother takes her ADHD medication as prescribed. It is rare that a breastfeeding mother needs to discontinue breastfeeding to take a medication. Women who plan to breastfeed while taking medications for attention deficit hyperactivity disorder (ADHD) should discuss treatment options with their healthcare provider. Breastfeeding is the gold standard of infant nutrition and provides unmatched health benefits for both mother and infant.
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