Is Clonazepam Safe in Breastfeeding

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

Intermediate-acting Benzodiazepine. Excreted in low levels into breast milk. No adverse effect on breastfed infant has been reported. However, some cases of high infant serum levels along with excessive somnolence and respiratory pauses when the mother started treatment at pregnancy were reported. Avoid use in preterm infants and early neonatal period. Whether anxiolytic rather than anticonvulsivant treatment is intended, benzodiazepines with a shorter half-life span like Lorazepam or Oxazepam should be considered. Eventual and low dose use of benzodiacepines are compatible with breastfeeding. Use the short-acting benzodiazepine and minimal effective dose as possible mostly in the neonatal period. WHO Model List of Essential Medicines (2002) rates it compatible with breastfeeding. Follow-up for sedation and feeding ability of the infant. Bed-sharing is not recommended for mothers who are taking this medication.

Maternal clonazepam occasionally causes sedation in their breastfed infants, especially when given with other central nervous system depressants. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant's serum concentration may be indicated if excessive sedation occurs. Because it has a long half-life, a safer, shorter-acting drug should be used as rather than clonazepam.[1][2] An expert consensus guideline indicates that low-dose clonazepam is an acceptable choice for refractory restless leg syndrome during lactation.[3]

Excessive periodic breathing and prolonged apnea and cyanosis occurred in a newborn at 6 hours after birth at 36 weeks gestation and reoccurred repeatedly up to 10 days of age. The neonate was breastfed starting at 72 hours after delivery and her mother took clonazepam (dose not stated) during pregnancy and lactation. The repeated periodic breathing episodes continued up to 10 weeks of age and were possibly related to clonazepam in breastmilk. A neurodevelopmental examination was normal at 5 months of age.[5] The infant of a mother taking clonazepam 1 mg daily during pregnancy and lactation was rated as highly apathetic and had decreased weight increase and slight neurologic signs at 4 weeks of age, but normal intelligence at 6 years of age.[9] None of 11 infants whose mothers were taking clonazepam in dosages ranging from 0.25 to 2 mg daily (including 4 who were taking other psychotropic drugs also) had any side effects reported by their mothers. The infants' average age was 7.9 weeks, but 6 were under 1 month of age.[8] One author reported a mother who was taking clonazepam 6 mg daily and carbamazepine 1400 mg daily. The infant had serum clonazepam levels of about 40% of the mother's serum level. Her infant was described as "somewhat lazy at the breast and tired."[7] In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. Twenty-two mothers took clonazepam while breastfeeding and 1 reported sedation in her infant. She was taking clonazepam 0.25 mg twice daily, flurazepam 15 mg daily, 1 mg of bupropion daily, and 0.75 mg of risperidone daily.[10] All adverse reactions in breastfed infants reported in France between January 1985 and June 2011 were compiled by a French pharmacovigilance center. Of 174 reports, clonazepam was reported to cause adverse reactions in 5 infants and to be one of the drugs most often suspected in serious adverse reactions, primarily sedation. One two-month old infant had well-documented hypotonia, somnolence and apnea caused by clonazepam in breastmilk.[11]