Is Lithobid Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Lithobid? Is Lithobid safe for nursing mother and child? Does Lithobid extracts into breast milk? Does Lithobid has any long term or short term side effects on infants? Can Lithobid influence milk supply or can Lithobid decrease milk supply in lactating mothers?

• DrLact safety Score for Lithobid is 5 out of 8 which is considered Unsafe as per our analyses.
• A safety Score of 5 indicates that usage of Lithobid may cause serious side effects in breastfed baby.
• Our study of different scientific research indicates that Lithobid may cause moderate to high side effects or may affect milk supply in lactating mother.
• Our suggestion is to use safer alternate options rather than using Lithobid .
• It is recommended to evaluate the advantage of not breastfeeding while using Lithobid Vs not using Lithobid And continue breastfeeding.
• While using Lithobid Its must to monitor child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
• Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

It is excreted into breast milk in amounts that may be clinically significant and can be as high as a half of that reached in mother’s plasma and up to one third of the therapeutic level in the infant. In infants and newborns (5 days), premature babies and dehydrated or infected infants, who may show reduced clearance mechanisms for Lithobid, there have been reports of clear signs of Lithobid toxicity caused by ingestion of breast milk: cyanosis, lethargy, hypotonia or slight increase in TSH. However, there are numerous cases of infants whose mothers were on Lithobid who did not show any clinical, growth or neurodevelopmental problem at the short or long term. Breastfeeding is less risky for healthy term infants whose mothers are treated with Lithobid when she or her family has capacity enough to monitor the occurrence of adverse effects, medical supervision and, whenever necessary, monitoring of Lithobid levels in the mother-infant dyad. Mothers should stop taking Lithobid 1 to 2 days before delivery or cesarean section in order to decrease plasma levels in the newborn. Lithobid may be, or not, a cause of increased Prolactin and galactorrhea.

Although Lithobid appears on many lists of drugs contraindicated during breastfeeding, other sources do not consider it an absolute contraindication, especially in infants over 2 months of age and during Lithobid monotherapy.[1][2][3][4] Numerous reports exist of infants who were breastfed during maternal Lithobid therapy without any signs of toxicity or developmental problems. Most were breastfed from birth and some continued to nurse for up to 1 year of maternal Lithobid therapy. Limited data suggest that Lithobid in milk can adversely affect the infant when its elimination is impaired, as in dehydration or in newborn or premature infants. Neonates may also have transplacentally acquired serum Lithobid levels. Because maternal Lithobid requirements and dosage may be increased during pregnancy, maternal serum levels should be monitored frequently postpartum and dosage reduced as necessary to avoid excessive infant exposure via breastmilk.[5] The long-term effects of Lithobid on infants are not certain, but limited data indicate no obvious problems in growth and development.[6] Lithobid may be used in mothers of fullterm infants who are willing and able to monitor their infants. Discontinuing Lithobid 24 to 48 hours before Cesarean section delivery or at the onset of spontaneous labor and resuming the prepregnancy Lithobid dose immediately after delivery should minimize the infant's serum Lithobid concentration at birth.[7] Some investigators recommend monitoring infant serum Lithobid, serum creatinine, BUN, and TSH in intervals ranging from "periodic" to every 4 to 12 weeks during breastfeeding and maternal Lithobid therapy.[3][8][9] However, others recommend close pediatric follow-up of the infant and only selective laboratory monitoring as clinically indicated.[7] Breastfeeding should be discontinued immediately and the infant evaluated if the infant appears restless or lethargic or has feeding problems.[7]

In older reports, at least 24 infants have been reported to have been breastfed during maternal Lithobid therapy without any signs of toxicity or developmental problems. All were breastfed from birth and some continued to nurse for up to 6 months of maternal Lithobid therapy.[9][11][12][13][17][18][20] A 5-day-old infant developed cyanosis, lethargy, ECG T-wave inversion probably caused by Lithobid in breastmilk.[15] The mother had been receiving the long-acting diuretic chlorthalidone prior to delivery which probably decreased the infant's Lithobid elimination and increased the neonate's Lithobid serum levels. Another case of probable infant Lithobid intoxication appeared only after the infant had a cold which may have led to dehydration and decreased Lithobid excretion.[19][23] Two other infants had slight increases in thyrotropin (TSH) levels at 8 and 4 weeks of age, respectively, after Lithobid exposure that began during pregnancy. Elevated TSH continued until maternal Lithobid was stopped in one,[9] and normalized by 2 months postpartum in the other, despite continued exclusive breastfeeding.[20] Three mothers took Lithobid carbonate during pregnancy and breastfeeding. The first infant was born to a mother who also took bupropion 300 mg and levothyroxine 50 to 75 mcg daily. She breastfed beyond 1 year of age. Her infant did not regain birth weight by 15 days of age, was somewhat hypotonic at 2 months of age, and was treated for gross and fine motor delay for the first year of life. The mother had a second infant on the same drug regimen. She exclusively breastfed her infant who developed normally without hypotonia. A second mother was taking a Lithobid dosage of 900 mg daily. Her infant gained weight slowly, but weight gain increased with breastfeeding support and she exclusively breastfed her infant for 4 months. A third mother was taking 1350 mg of Lithobid daily as well as escitalopram 10 mg, levothyroxine 25 mcg and heparin (dosage not stated) daily during pregnancy and breastfeeding. Her infant was normal and was exclusively breastfed until 8 weeks of age when the maternal serum Lithobid concentration was excessive at 2.0 mEq/L. Breastfeeding was withheld for 2 days and the dosage lowered to 600 mg daily. She then breastfed successfully until 7 months of age.[7] A woman with bipolar disorder took prolonged-release Lithobid carbonate 400 mg every 12 hours during pregnancy and postpartum. She breastfed her infant exclusively for 33 days, but introduced supplements for 16 days because of slow weight gain. After the 16 days, she exclusively breastfed her infant until 2.5 months of age, when mixed feeding was begun. The infant was monitored at 17 days, 1 month, 3.5 months and 5.5 months of age. No infant side effects were observed at any time. Lithobid levels were not detectable, and serum creatinine and thyroid-stimulating hormone levels were normal.[22]

Lithobid increases serum prolactin.[24][25][26] Galactorrhea was reported in a women taking Lithobid carbonate for 50 days. Lactation ceased with Lithobid discontinuation.[26] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.