Is Alprazolam Safe in Breastfeeding

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

Short-acting benzodiazepine. A case of Abstinence Syndrome in a child after mother withhold of Alprazolam at 9 months and sedation among infants has been reported. Both circumstances indicate that excretion into breast milk - despite small (< 10% of maternal dose) - can achieve clinical significance. Hence, rapid acting and less excretion into breast milk should be preferred. Most benzodiacepine drugs may decrease prolactin levels but Alprazolam increases it. Short-term and low dose treatment is compatible with breastfeeding. Choise of a low dose and short-acting benzodiacepine is advisable especially in the post-partum period. Be aware of somnolence and poor feeding in the child. Bed-sharing is not recommended for mothers who are taking this medication.

Because of reports of effects in infants, including sedation, alprazolam is probably not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred. After a single dose of alprazolam, there is usually no need to wait to resume breastfeeding.

Increased infant irritability following discontinuation of breastfeeding occurred in a 1-week-old infant whose mother had taken alprazolam during pregnancy and continued to take it after delivery. This reaction probably indicates that there was sufficient alprazolam in breastmilk to prevent withdrawal. The authors reported correspondence with the manufacturer who stated that they had received reports of infant withdrawal symptoms (crying, irritability and sleep disturbances) for 2 weeks in a 9-month-old exclusively breastfed infant after slow (over 3 weeks) maternal discontinuation of alprazolam (dosage unspecified).[2] In one telephone follow-up study of 5 infants (ages not stated) exposed to alprazolam during breastfeeding, 1 mother reported drowsiness in her infant. The reaction did not require medical attention.[3] In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. About 5% of mothers were taking alprazolam. One mother who was taking sertraline 50 mg daily, zopiclone 2.5 mg about every 3 days as needed, and also took alprazolam 0.25 mg on 2 occasions, reported sedation in her breastfed infant.[4]

Unlike other benzodiazepines, alprazolam can increase serum prolactin.[5][6] One woman developed galactorrhea, amenorrhea and elevated serum prolactin after taking 3 mg of sustained-release alprazolam and 5 to 6 mg of immediate-release alprazolam daily for several months for self-treatment of fear, poor sleep, palpitations and gastrointestinal discomfort. After slow discontinuation of alprazolam and institution of quetiapine and fluvoxamine, galactorrhea ceased after about one month, menses normalized after about 2 months, and serum prolactin decreased to a normal level.[7] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.