Gabapentin and Pregnancy

To provide information regarding the effects of in utero exposure to gabapentin, physicians are advised to recommend that pregnant patients taking gabapentin enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry.

How Gabapentin Can Be Addictive

Mechanism: Gabapentin affects the brain’s neurotransmitters, particularly by increasing the availability of GABA (gamma-aminobutyric acid), which has a calming effect. This can lead to feelings of relaxation, euphoria, or mild sedation in some individuals, contributing to its potential for abuse.
Tolerance: Over time, some individuals may develop a tolerance to gabapentin, meaning they need higher doses to achieve the same effects.
Dependence: Regular use of gabapentin can lead to physical dependence. If someone suddenly stops taking it, they may experience withdrawal symptoms, which can drive continued use.

This can be done by calling the toll free number 1-888-233-2334, and must be done by patients themselves. Information on the registry can also be found at the website http://www.aedpregnancyregistry.org/. Limited observations have suggested an active transplacental transport of gabapentin, with accumulation in the fetus as a consequence.

Gabapentin has been assigned to pregnancy category C. Animal studies have revealed evidence of fetotoxicity involving delayed ossification in several bones of the skull, vertebrae, forelimbs and hindlimbs. Hydroureter and hydronephrosis have also been reported in animal studies. There are no controlled data in human pregnancy. Gabapentin should only be given in pregnancy when benefit outweighs risk.

Gabapentin Breastfeeding Warnings

Gabapentin is secreted into human milk following oral administration. A nursing infant may be exposed to a maximum dose of approximately 1 mg/kg/day of gabapentin. Because the effect on the nursing infant is unknown, gabapentin should be used in women who are nursing only if the benefits clearly outweigh the risks.

Gabapentin can be used during breastfeeding, but there are important considerations and potential risks to be aware of. Here’s a breakdown of the guidelines and warnings for breastfeeding mothers taking gabapentin:

1. Gabapentin Transfer to Breast Milk

Gabapentin does pass into breast milk, but typically in low concentrations.
Studies suggest that the levels of gabapentin in breast milk are relatively low, ranging from about 1% to 5% of the maternal dose. This means that an exclusively breastfed infant would receive a small fraction of the dose.
The actual impact on the baby depends on the dosage, the mother’s metabolism, and the duration of use.

2. Potential Risks to Breastfed Infants

Drowsiness: There have been reports of infants experiencing drowsiness or sedation when breastfeeding mothers take gabapentin.
Feeding Difficulties: In some cases, drowsiness in the infant may affect feeding patterns or lead to reduced feeding.
Weight Gain Monitoring: Some infants may require monitoring of weight gain and developmental milestones to ensure they are feeding properly and growing at a normal rate.
Other Side Effects: While uncommon, irritability, sleep disturbances, or other mild behavioral changes may be observed.

3. Guidelines for Breastfeeding Mothers on Gabapentin

Discuss with Your Healthcare Provider: Always consult with a healthcare professional before starting or continuing gabapentin while breastfeeding. They will weigh the potential benefits to the mother against the risks to the infant.
Monitor the Infant: If you continue gabapentin while breastfeeding, closely monitor the baby for any signs of drowsiness, feeding difficulties, irritability, or unusual behavior.
Regular Check-Ups: Schedule regular pediatric check-ups to monitor the baby’s development, weight gain, and overall health.
Timing of Doses: Some mothers may be advised to take gabapentin immediately after breastfeeding or during a longer period between feedings to reduce the infant’s exposure. This timing strategy can help limit the amount of the drug in breast milk during nursing.
Dosage Considerations: Using the lowest effective dose for the shortest duration can help minimize the potential risks. Never adjust your dosage without consulting your healthcare provider.

4. When Gabapentin is Necessary for the Mother

In cases where gabapentin is medically necessary (e.g., to manage chronic pain, seizures, or nerve pain), the decision to continue breastfeeding should involve a thorough risk-benefit analysis.
If gabapentin provides significant relief or is crucial for managing a health condition, the benefits to the mother’s well-being may outweigh the risks to the infant.
Abruptly stopping gabapentin without medical advice is not recommended, as it can lead to withdrawal symptoms or worsening of the underlying condition.

5. Alternative Medications

Depending on the medical condition, there may be alternative medications that are considered safer for use during breastfeeding. Discuss with your healthcare provider if switching medications is an option.
If no suitable alternatives are available and gabapentin is necessary, careful monitoring and dosage adjustments may help mitigate risks.

6. Professional Recommendations

American Academy of Pediatrics (AAP): Does not specifically mention gabapentin, but generally supports medications with minimal transfer into breast milk if necessary for maternal health.
World Health Organization (WHO): Recommends evaluating the necessity of the medication and its potential effects on the infant.
LactMed Database: Indicates that gabapentin is compatible with breastfeeding in small doses, as long as the infant is closely monitored for any adverse effects.

Key Takeaway

While gabapentin can pass into breast milk in small amounts, it is often considered relatively safe for use during breastfeeding if the potential benefits to the mother outweigh the risks to the infant. The decision to use gabapentin while breastfeeding should be made in consultation with a healthcare provider, with close monitoring of the infant for any signs of adverse effects. Always prioritize the well-being of both mother and child when making medication decisions during breastfeeding.