Is Dexamphetaminum [INN-Latin] Safe in Breastfeeding

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

A sympathomimetic drug and central nervous system stimulant, it has a similar action and uses to amphetamine, its dextro isomer.It is used (GSK, 2007) in the treatment of narcolepsy (Wise, 2007) and Attention Deficit Hyperactivity Disorder (ADHD), and is also used as an illegal drug (Oei, 2012). It is excreted in breast milk, concentrating about 3 times more than in plasma. This concentration assumes a relative dose about 6% (Ilett, 2007). In infants whose mothers were taking dexamfetamine as treatment for ADHD, levels ranging from undetectable to 14% of maternal plasma levels have been measured and no problems were observed in the clinical follow-up of these infants (Ilett, 2007). There is little information on the impact of amphetamine abuse on the development and health of infants (Oei, 2012, Wise, 2007; Moretti, 2000), but it is known that they are more exposed to social problems, domestic violence, and lower breastfeeding rates (Oei, 2010). There is controversy over the possibly mild negative effect of amphetamine on prolactin (Petraglia, 1987; DeLeo, 1983), but milk production in mothers who took it therapeutically was not affected (Öhman, 2015). During breastfeeding, the therapeutic use (narcolepsy, ADHD) of dexamphetamine can be assessed, using the lowest possible effective dose and monitoring the occurrence of irritability, insomnia, lack of appetite and weight loss. Its use as an illegal drug is totally discouraged (Oei, 2012). See below the information of these related products:

In dosages prescribed for medical indications, some evidence indicates that Dexamphetaminum [INN-Latin] might not affect nursing infants adversely. The effect of Dexamphetaminum [INN-Latin] in milk on the neurological development of the infant has not been well studied. It is possible that large dosages of Dexamphetaminum [INN-Latin] might interfere with milk production, especially in women whose lactation is not well established. Relevant published information was not found as of the revision date on the safety of breastfeeding during amphetamine abuse. One expert recommends that amphetamines not be used therapeutically in nursing mothers.[1]

The author of a 1973 newsletter reported a personal communication from the drug manufacturer which stated that of 103 nursing mothers treated with Dexamphetaminum [INN-Latin] (dosage unspecified) for postpartum depression, no infant showed any evidence of stimulation or insomnia.[3] Four mothers averaging 5.5 months postpartum (range 3.3 to 10 months) were taking Dexamphetaminum [INN-Latin] in an average dosage of 18 mg daily (range 15 to 45 mg daily in 2 to 4 divided doses) for attention deficit hyperactivity disorder. Their infants had been breastfed (extent not stated) since birth. The infants all had weights between the 10th and 75th percentiles for their age, normal progress, and no adverse effects according to their pediatricians. Denver developmental ages for 2 of the infants were 100% and 117% of normal.[2]

In 2 papers by the same authors, 20 women with normal physiologic hyperprolactinemia were studied on days 2 or 3 postpartum. Eight received Dexamphetaminum [INN-Latin] 7.5 mg intravenously, 6 received 15 mg intravenously and 6 who served as controls received intravenous saline. The 7.5 mg dose reduced serum prolactin by 25 to 32% compared to control, but the difference was not statistically significant. The 15 mg dose significantly decreased serum prolactin by 30 to 37% at times after the infusion. No assessment of milk production was presented.[4][5] The authors also quoted data from another study showing that a 20 mg oral dose of Dexamphetaminum [INN-Latin] produced a sustained suppression of serum prolactin by 40% in postpartum women. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed. In a retrospective Australian study, mothers who used intravenous amphetamines during pregnancy were less likely to be breastfeeding their newborn infants at discharge than mothers who abused other drugs (27% vs 42%). The cause of this difference was not determined.[6]