Is Esomeprazole Safe in Breastfeeding

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

S-Enantiomer of Omeprazole with which shares similar characteristics. Due to a high serum-protein-binding capacity, Omeprazole is excreted into breast milk in non-significant amount without side-effects among breastfed infants from treated mothers. Since it's neutralized by the acid pH of stomach, capsules with enteric coated granules are used. Because of this, it is thought that the small quantity of Omeprazole that may reach the breast milk would be neutralized by infant's stomach. In addition, absorption is greatly decreased by the presence of food. Esomeprazole has been used for treatment of newborn and premature infants. Hyperprolactinemia and galactorrhea have been reported by the use of Omeprazole.

Esomeprazole is the -enantiomer of the proton-pump inhibitor, omeprazole. Limited information indicates that maternal doses of 20 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.

One mother taking omeprazole 20 mg daily orally pumped and discarded her milk once each day 4 hours after her morning dose. She breastfed her infant the remainder of the day for 3 months before weaning. The infant remained well at 12 months of age.[1]

Omeprazole has been reported to cause gynecomastia in men.[2] One woman developed elevated serum prolactin and estradiol with bilateral galactorrhea one week after starting esomeprazole 40 mg once daily for reflux esophagitis. The galactorrhea disappeared 3 days after discontinuing esomeprazole and prolactin and estradiol returned to normal 7 days after discontinuation. One month later, the patient restarted esomeprazole and again developed bilateral galactorrhea. She was switched to lansoprazole with no galactorrhea developing.[3] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.