Is Tolterodine Safe in Breastfeeding

Question

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

Tolterodine lactation summary

Tolterodine usage has low risk in breastfeeding

DrLact safety Score for Tolterodine is 3 out of 8 which is considered Low Risk as per our analyses.
A safety Score of 3 indicates that usage of Tolterodine may cause some minor side effects in breastfed baby.
Our study of different scientific research indicates that Tolterodine may cause moderate to no side effects in lactating mother.
Most of scientific studies and research papers declaring usage of Tolterodine low risk in breastfeeding are based on normal dosage and may not hold true for higher dosage.
While using Tolterodine We suggest monitoring child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

Answer by Dr. Ru: About Tolterodine usage in lactation

Antimuscarinic agent with atropine-like action. At latest update no published data on excretion into breast milk were found. A high plasma protein-binding capacity makes it unlikely its passage into breast milk.Its low oral bioavailability hinders the passage from ingested milk towards the infant’s plasma, except in preterm babies and immediate neonatal period, which may show an increased intestinal permeability. There are few poor metabolizers (CYP2D6 deficient) who may exhibit increasing oral bioavailability to 66% Take as smallest dose as possible and avoid long-term use since anticholinergics can reduce milk production. Monitoring anticholinergic symptoms in infants (dry mouth, constipation ..) is warranted.

Answer by DrLact: About Tolterodine usage in lactation

No information is available on the use of tolterodine during breastfeeding. Long-term use of tolterodine might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).

Tolterodine Possible Effects in Breastfeeding

Relevant published information in nursing mothers was not found as of the revision date. Anticholinergics can inhibit lactation in animals apparently by inhibiting growth hormone and oxytocin secretion.[1][2][3][4][5] Anticholinergic drugs can also reduce serum prolactin in nonnursing women.[6] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.