Is d-threo-Methylphenidate Safe in Breastfeeding

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

d-threo-Methylphenidate is an isomer of methylphenidate. No information is available on the clinical use of d-threo-Methylphenidate during breastfeeding; however, the manufacturer estimates that a fully breastfed infant would receive a relative dose of 0.2 to 0.7% of the maternal weight adjusted dose. In dosages prescribed for medical indications, limited evidence indicates that methylphenidate levels in milk are very low and not detectable in infant serum. The effects of methylphenidate in milk on the neurological development of the infant have not been well studied. If methylphenidate is required by the mother, it is not a reason to discontinue breastfeeding.[1] It is possible that large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established.

Seven of 8 infants, whose mothers were taking either dextroamphetamine (average dosage 25 mg daily) or methylphenidate (average dosage 52 mg daily) were clinically evaluated. The infants had no drug-related adverse reactions and were developing normally for their ages which averaged 4.4 months.[2] One 6.4-month-old infant was mostly breastfed by a mother who had been taking methylphenidate 40 mg twice daily 5 days/week for 5.5 weeks. The mother reported that the infant was sleeping, eating and gaining weight normally.[3] This patient might have been one of those in the report above by the same authors. An infant was being breastfed (extent not stated) by a mother who began taking sertraline 50 mg daily and methylphenidate after 5 weeks postpartum. Dosage was started at 10 mg daily with an immediate-release product and gradually increased to 72 mg daily of an extended-release product. At 14 weeks of age, the infant was developing normally no feeding difficulties. Examinations at 6 months and 1 year of age found no developmental problems in the child.[5] A nursing mother was taking extended-release methylphenidate (Concerta) 36 mg daily and duloxetine 90 mg daily for ADHD, generalized anxiety disorder, borderline personality disorder, and depression. She partially (amount not stated) breastfed her infant for about 1 month. At 6 months of age, the infant's development was considered to be normal, except for recurrent pneumonia caused by congenital pulmonary airway malformation.[6]

Methylphenidate reduces serum prolactin,[7] but no studies have been located as of the revision date on the effect of methylphenidate or d-threo-Methylphenidate on milk production. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed. A 15-year-old girl had been receiving methylphenidate 54 mg daily in an osmotic release tablet (OROS) for 2 years. Sertraline was started for depression at 50 mg daily and increased to 100 mg daily along with haloperidol 0.5 mg daily. After 12 weeks of therapy, inattentativeness at school and headaches prompted a change from the OROS product to a modified-release methylphenidate product (brand not specified) at 30 mg daily, then increasing to 50 mg daily. Three days after the increase in dosage, the girl had spontaneous milk flow from both breasts and subsequently had an elevated serum prolactin of 67.7 mcg/L. Methylphenidate and haloperidol were discontinued, but sertraline was continued. One week later, galactorrhea resolved completely. Fifteen days after drug discontinuation, the girl's prolactin level was in the normal range at 19.4 mcg/L.[8]