Migraine Medications and Breastfeeding

August 1, 2011. Posted in: Medications & Vaccines

Info on selected migraine meds

The information summarized below is only a general overview. For detailed information on the specific drugs, please review the references listed below with your health care provider.

Info on selected meds used for migraine prevention and/or pain relief
Name of medication
AAP approved?*
Notes
Acetaminophen (Tylenol)
yes
L1 (safest)
Almotriptan malate (Axert)
not reviewed
not reviewed
Amitriptylline (Elavil, Endep)
no
L2 (safer)
Asprin
no
L3 (moderately safe)
Butalbital (Fioricet, Fiorinal, Bancap, Two-dyne)
not reviewed
L3 (moderately safe)
Caffeine
yes
L2 (safer)
Codeine
yes
L3 (moderately safe)
Ergot alkaloids (DHE 45, Cafergot, Wigraine, Ergostat, Ergomar)
no
L4 (possibly hazardous)
Frovatriptan (Frova, Migard)
not reviewed
not reviewed
Ibuprofen (Advil, Motrin)
yes
L1 (safest)
Isometheptene Mucate (Midrin)
not reviewed
L3 (moderately safe)
Ketorolac (Toradol, Acular)
yes
L2 (safer)
Metoprolol (Toprol-XL, Lopressor)
yes
L3 (moderately safe)
Naproxen (Anaprox, Naprosyn, Aleve)
yes
L3 (moderately safe);
L4 (possibly hazardous) for chronic use
Naratriptan (Amerge)
not reviewed
L3 (moderately safe)
Nifedipine (Adalat, Procardia)
yes
L2 (safer)
Propranolol (Inderal)
yes
L3 (moderately safe)
Rizatriptan (Maxalt) not reviewed L3 (moderately safe) 14
Sumatriptan (Imitrex)
yes
L3 (moderately safe)
Valproic Acid (Depakene, Depakote)
yes
L2 (safer)
Verapamil (Calan, Isoptin, Covera-HS)
yes
L2 (safer)
Zolmitriptan (Zomig, Zomig-ZMT)
not reviewed
L3 (moderately safe)
*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2002 edition).

1. Almotriptan malate (Axert) is a new drug in the same category as Sumatriptan (Imitrex). It has a relatively short half-life (3-4 hours) and reaches peak plasma level 2-4 hours after administration (see pharmacologic info). No data is currently available regarding its transfer into human milk.

2. Amitriptylline (Elavil, Endep) is listed by the AAP as a “drug whose effect on nursing infants is unknown but may be of concern.” However, several studies have shown that this drug is secreted into breastmilk in very small amounts and per Hale, “no untoward effects have been reported in several studies” of breastfed babies whose mothers took this med.

3. Aspirin use is discouraged in children and nursing mothers due to the risk of Reye’s syndrome and internal bleeding. The AAP lists it as a “drug associated with significant side effects and should be given with caution.”

4. Fioricet (Fiorinal, Bancap, Two-dyne) contains acetaminaphen or asprin, caffeine, and butalbital. Per Hale, baby should be observed for sedation.

5. Codeine (in Tylenol #3 and #4) is AAP approved for nursing mothers but, per Hale, is probably not a good choice for mothers of premature or weakened infants. Hale suggests weakened or premature infants be observed for sedation and apnea .

6. Per Hale, use of ergot alkaloids during lactation should be strongly discouraged. The AAP lists them as “drugs associated with significant side effects and should be given with caution.” Excessive dosing and prolonged use may inhibit lactation. Long term exposure is contraindicated.

7. Because better drugs exist for migraine therapy, Hale suggests that Isometheptene Mucate (Midrin) is probably not a good choice for breastfeeding mothers.

8. Per Hale, although the levels of this drug transferred to the infant are probably too low to be clinically relevant, close supervision should be used. No pediatric concerns have been reported in several studies, but observe infant for hypotension, weakness, bradycardia.

9.Aleve (Naproxen) is AAP-approved for nursing mothers, but (per Hale) should be used with caution due to its long half-life and its effect on baby’s cardiovascular system, kidneys and GI tract; short-term, infrequent or occasional use is not necessarily incompatible with breastfeeding.

10. Per Hale, no pediatric concerns reported via milk, but observe infant closely for changes in liver enzymes, clinical status and platelet levels.

11. Per Hale, no pediatric concerns reported via milk, but observe infant for hypotension, bradycardia, weakness.

12. Per Hale, zolmitriptan is structurally similar to sumatriptan. It is currently unknown how much of this drug is secreted into human milk.

13. More info on frovatriptan:

Thoughts from Dr. Hale

14. It is currently unknown how much of this drug is secreted into human milk. It is concentrated in rodent milk, so caution is recommended.

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References

Table 6: Maternal Medication Usually Compatible With Breast-Feeding, from the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.

Hale, Thomas. Medications and Mothers’ Milk, 10th Edition. Pharmasoft Medical Publishing, 2002. Dr. Hale’s website is located at http://neonatal.ttuhsc.edu/lact/index.html.

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Links for additional information

Selected List of Medications approved by the AAP for use in breastfeeding mothers (revised 9/01) @

Migraine: Natural Treatment @

Medications and Breastfeeding: References @

The National Migraine Association

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