Ambien and Lorazapam and breastfeeding

[Betsy]

Client is taking 10 mg of Ambien and 2 mg of Lorazapam for chronic, debilitating insomnia. With her first child she weaned at 11 weeks because she started Ambien again. With the new baby, she weaned during the day and BF at night at 11 weeks when restarting Ambien; but then her physician put her on the new combination and said the risk was low and the amount transferred was low. She would prefer to continue breastfeeding. Her goal is to completely eliminate the Ambien and switch completely to the Ativan/Lorazapam. Baby nurses: every 1.5-2 hrs during the day. Feeds at 10 pm prior to medication dose of 1 mg of Ativan and 10 mg Ambien at 11 pm, then feeds 3:30 am, then if needed, 1 mg of Ativan, then then 5:30 am.

can you please confirm that this dosage/half life is safe for this dyad? thank you so much, I'm so grateful for all you do.
Betsy

[admin-james]

Hi, thanks for your post.

Dr. Hale and I have discussed this question. The half-life of Ambien is 3-5 hours and the half-life of Ativan/Lorazepam is about 12 hours in an adult. We find that only 0.02% of the mother's dose of Ambien is transferred to the baby. It's about 3% for lorazepam. Waiting one half-life before breastfeeding (and discarding the intervening milk) will further reduce those numbers by 50%. We have given both drugs an L3 rating (out of 5) ("Probably Compatible") with regards to their lactation safety.

By following the feeding pattern that you describe, the baby should be avoiding the peak concentrations of both of these drugs, although we'd suggest the mom breastfeed and immediately take the drugs. Thus the interval following the drugs is slightly longer. No serious side effects have been reported in babies exposed to lorazepam at these quantities. For Ambien, side effects are rare but the mother should keep alert for excessive sleepiness or poor feeding in her baby.

Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

-James Abbey, MD