Breastfeeding and ADD meds. Any ideas?

April 19, 2009 2:40 PM

Breastfeeding and ADD meds. Any ideas?

I'm exclusively breastfeeding. I also have things that I need to get done a few days a week. I want to go back on my ADD meds (Adderall) to help me get through getting things done a few days a week. Any advice and/or recommendations on ADD meds, pumping and dumping, and half-life would be appreciated.

Specific questions:
- How do I determine when the drug is safely out of my system so that I can feed the baby? Online calculator?
- Are there drugs out there besides Adderall that get out of the system faster?

I don't want to stop breastfeeding, as I only need to get stuff done a few days a week and only for 2 months before I am exclusively a Mommy again. (So if I stopped completely and we went to formula, I would likely stop producing and I don't want that.) I have tried getting stuff done without the drugs and it is not working for me.

YANMD, but I'm currently without very good medical care and would like some ideas to discuss with my crappy medical provider.
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posted by anonymous to Health & Fitness (12 answers total)

Not a good idea. Adderall does get into breast milk and can be passed to your baby. Not a good drug for a developing brain. A google search will give you all the relevant info. Don't worry so much about what all needs to get done. You only have a short period of time to nurse your baby so enjoy it and try not to be stressed about what isn't getting accomplished.
posted by pearlybob at 2:46 PM on April 19, 2009

Hit return too soon... You are doing a great job by exclusively breastfeeding. Keep up the good work and enjoy this time.
posted by pearlybob at 2:49 PM on April 19, 2009

Mrs Jaybo here and a fellow breastfeeding mom. You could try looking at this website. I don't know if it will answer your question but they also have a phone number you could try calling and asking them directly. They have a lot of info about drugs and breastfeeding. And good for you for breastfeeding and wanting to do the best for your child - such a great gift.
posted by Jaybo at 3:17 PM on April 19, 2009

I think the first step is finding good medical care. Breastfeeding on any medication can be dangerous. Your kid MIGHT be better off with the bottle.
posted by roomthreeseventeen at 3:26 PM on April 19, 2009

Another good resource is La Leche League. You may be able to find a group in your area and the leaders are used to questions like this and would be able to point you in the right direction. A bonus is that they don't charge for their consultations (people can choose to buy memberships but they are not mandatory.)
posted by Jaybo at 3:47 PM on April 19, 2009

Don't worry so much about what all needs to get done. You only have a short period of time to nurse your baby so enjoy it and try not to be stressed about what isn't getting accomplished.

...wanting to do the best for your child...

While I agree that breastfeeding is great and fine way to bond with your baby, don't feel guilty if you can't breastfeed all the time because you need to take meds that help you do, you know, non-maternal things. There's very little hard scientific evidence that proves breastfeeding provides significant advantages that formula does not. And La Leche League isn't exactly a non-biased source of information either. I have no idea if Adderall will clear out of your system in 2 hours or 2 days, but please read that article before determining if you need to give up medicine that helps you function better at work just to nurse exclusively. I'm not trying to turn this into a polemical anti-nursing thread, but formula isn't poison, and it's doubtful that going half-breast milk/half-formula will impair your baby's development. It's just something to consider if you indeed discover that Adderall will filter into your breast milk over extended periods of time.
posted by zoomorphic at 4:10 PM on April 19, 2009 [4 favorites]

Gah. Taking amphetamines and breast feeding is very much not a good idea. Adderall is a mixture of a couple different amphetamine salts with different half-lives but I think it comes out to about 12 hours. So unless your baby only likes to eat once every 3 days the adderall isn't going to be safely out of your system.

Here's what the FDA says about adderall and breastfeeding:

Breast feeding: Do not breast feed while taking Adderall because it can pass into your breast milk.

That's a blanket "do not" statement and I think it's for good reason. Babies and speed don't mix. Ritalin has a much shorter half-life but the effects on breast milk aren't well understood and I really, really wouldn't advise taking such a big risk with a helpless baby.

This is one of those "just say no" times.
posted by Justinian at 4:18 PM on April 19, 2009

Do you have a pump? Could you pump and dump and use formula while you're on the drugs and then switch back to full time breastfeeding when you're ready? Seems like your pediatrician is the go to person here.....
posted by dpx.mfx at 4:28 PM on April 19, 2009

Most mothers are surprised to learn how few drugs are actually counterindicated for breastfeeding moms. Maternal/child care is an incredibly conservative field, however, and so many providers will default to a "no drugs" stance without looking up how the patient's particular drug actually enters the milk, in what form, in what concentration, and, finally, how safely the infant metabolizes whatever concentration, amount, form of the drug. This default stance leads to a casual observation by lay folks and non-pediatric/maternal healthcare providers that moms can't do anything to take care of their own health but maintain a healthy diet and worry about micro-doses of Advil. That said, though I am a lactation consultant and in grad school for pediatrics, it is very important that you consult with your child's pediatrician, a lactation consultant, or a maternal health provider well-versed in breastfeeding and maternal prescriptions. Since you said that you're without healthcare you trust this minute, let me offer a few suggestions for getting this kind of expert consultation.

To learn, in general, more about breastfeeding, infant feeding, and drugs this page is by the healthcare field's primary authority in this area, Dr. Hale. Most healthcare providers consult his annual desk reference to advise mothers on breastfeeding and drugs, as his research is incredibly exhaustive. This page gives a nice intro into exactly how we metabolize different kinds of drugs, how breastmilk is made, and how drugs enter milk and whether or not those drug metabolites impact the baby. This is just an introduction, not an answer for you--but I think that it's important that moms who take prescriptions get some background education in order to make the decision that's right for them and to give them a foundation for talking with a provider. From there, I would first contact your baby's pediatrician--this is a unique situation where something you're doing involves another patient's health, and so even though your baby's doctor is not your doctor, they can advise about your drug intake. Make sure your pediatrician has done this kind of thing before and is supportive of breastfeeding moms. Pediatricians often do this kind of consult with a lactation consultant, who, if board certified, can research the information and provide consultation. Even if you don't have healthcare, your baby should.

Finally, like those said above, call an LC or a LLL leader who will likely look up your prescription's info in the Hale reference. In the case of a LLL leader, this isn't medical advice, and so should be approached as such, but, again, can give you a foundation of info so that you can proceed with something like a one-time clinic visit with your provider.

There isn't a safe way to calculate this yourself online and proceed without working with a ped or other medical advice--it's true that many, many commonly prescribed drugs (even so-called 'strong drugs' or drugs for serious conditions) can be safe for breastfeeding moms, but coordinating with healthcare providers is essential to make sure levels and drugs are correct over time (your body changes so much right now). I do encourage you, though, to learn as much as you can from places like the site or others I linked and from LLL or an LC so that you are armed with info before you see a ped or your provider.

Don't feel guilty for taking care of yourself while you take care of your babe. Breastfeeding is this great thing weathers a lot of different situations well, and a healthy baby is likewise good at thriving (which is why it's important to get a solid consult form a ped and LC or some other medical combo, just to check to make sure baby is healthy, too). In most cases, breastmilk from a well-monitored mom for a healthy baby is the best practice for infant feeding, and that includes those moms taking medication.
posted by rumposinc at 4:41 PM on April 19, 2009 [8 favorites]

The Physician's Desk Reference says not to do it.

The only time I ever had an argument with a health care professional during my high-risk pregnancy was with a Hale-wielding nurse, regarding antidepressants and breastfeeding. She tried her best to make me feel like a horrible mother for choosing my mental health over passing my meds to my baby, when the book itself admitted that the research at the time was inconclusive. I'm just enough of an asshole that the guilt trip didn't work.

Get as much information as you can, and do what you think will be best overall.

And now, I'm leaving this question before my head explodes.
posted by gnomeloaf at 5:11 PM on April 19, 2009

Ritalin has a fairly short half life - about 3 hrs, according to this article One half life is the time it takes for half the drug to leave your system, so 3 hrs after taking it, you expect to have 50% of the dose left. 6 hrs after taking it (2 half-lives), you have 25%, and so on. After 6 half lives (6 x 3 = 18 hrs), you'd expect less than 2% of the drug to remain. I would be conservative and call it 24 hours. Ask your doctor if it would make sense for you to feed the baby right before taking Ritalin, then pump and dump for 24 hours thereafter before resuming feeding.

This is not something I'd do without talking to a real doctor -- pretty much any drug that can pass into the brain will pass into breast milk. Obviously you are concerned for the safety of your baby. Consider your own sanity too - ADD drugs are essentially amphetamines, and anyone who's held a screaming baby at 2 am will tell you the last thing you want is a tot on speed.

Make sure any prescription you get is for an immediate release drug. If it's extended-release (XR, SR, SA) then - duh - it will take longer to get out of your system. Sorry if that's obvious, but most docs are in the habit of prescribing extended release drugs for the convenience of their patients. The half life of extended release Ritalin is more in the ballpark of 8 hours, which means it wouldn't be out of your system for at least 48 hours.

Finally: I know you already know this, but DO talk to the doctor before doing anything. The askmefi med squad doesn't know your particular situation well enough to give you a good answer.
posted by selfmedicating at 7:04 PM on April 19, 2009 [1 favorite]

Like others have said, this is definitely not something you want to try to do without consulting a physician. You want your baby to be eating as much as it needs and gaining weight, not the opposite.

There's very little hard scientific evidence that proves breastfeeding provides significant advantages that formula does not.

I would hardly call an article published in The Atlantic, which was written by a mother that 'sat up and read dozens of studies' one night, hard scientific evidence. Certainly she understands the difference between different types of studies, statistical analysis, types of bias, etc. Sorry, but there is more to reading scientific articles than skimming abstracts.
posted by sero_venientibus_ossa at 2:51 AM on April 20, 2009