We all know some of the overt ways that the medical establishment undermines breastfeeding but I’ve been faced just recently with a more subtle one. I have been having soul-shattering migraines almost daily since April 14. I have never had a migraine prior to this and I have no family history. These are definitely NOT bad headaches and nothing I have tried has helped (If you have any ideas I’d be happy to hear them!).
So I went to the doctor who told me that, since I was breastfeeding, I could only take Motrin for my headaches – despite the fact that Motrin did nothing for my pain. No one told me “you should stop breastfeeding” (and thank goodness because I was ready for that fight) but the implication is that I have to put up with the pain in order to keep breastfeeding. I think a less committed or less informed person would have given up already. (Like I said this is not a “headache” but completely debilitating pain in the back left of my head).
Here’s why this makes me mad. Of course Imitrex (sumatriptan) is category C – which means avoid if at all possible while pregnant and nursing. Almost all drugs fall into this category. Who wants to risk it? I’m on Zoloft as well which comes with a big sticker that says “don’t use if pregnant or nursing” and yet it was the recommended antidepressant during pregnancy according to my prescribing doctor. The fact is, the categorization of pharmaceuticals, while important is really about butt-covering and lawsuits than about helping patients. A completely drug-free body is the ideal but there are circumstances where the illness (like my depression) would be worse than the side effects. This is where I expect my doctor to do their research and find me a solution to me that doesn’t include moaning in the fetal position for hours on end with pain so bad I can’t even find the bliss of sleep.
The truth about Imitrex? It is the recommended drug for nursing mothers. Are you familiar with LactMed? LactMed is part of the National Library of Medicine’s Toxicology Data Network. LactMed is;
Drugs and Lactation Database (LactMed) – A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.
It is the go-to source for information about pharmacology while nursing. It has actual scientific studies about the real risks vs. benefits of drugs during breastfeeding. Here is their entry on Imitrex
For other data, click on the Table of Contents
Drug Levels and Effects:
Summary of Use during Lactation:
Because of the low levels of sumatriptan in breastmilk, amounts ingested by the infant are small. It also has poor oral bioavailability, further decreasing infant exposure to the drug. Some authors have suggested that withholding breastfeeding for 8 hours after a single subcutaneous injection would virtually eliminate infant exposure to the drug. This maneuver might be helpful in extreme cases, such as in the mother of a preterm infant, but sumatriptan would not be expected to cause any adverse effects in most breastfed infants. One anecdotal report of lactation ceasing after a single injection of sumatriptan has not been verified.
Maternal Levels. Five women who had been breastfeeding for 11 to 28 weeks received a single dose of sumatriptan 6 mg by subcutaneous injection. The peak milk level averaged 87.2 mcg/L (range 62 to 113 mcg/L) and it occurred 2.5 hours (range 1.7 to 3.5 hours) after the dose. The mean half-life in milk was 2.2 hours (range 1.2 to 3.1 hours). The authors calculated that an exclusively breastfed infant would receive 14.4 mcg in breastmilk with this dose, which is 3.5% of the weight-adjusted dosage.
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants:
One author reported correspondence with the drug’s manufacturer stating that of 3 women known to the manufacturer who used sumatriptan (dose and route unspecified) during breastfeeding none reported adverse effects on the infants.
Possible Effects on Lactation:
One author reported correspondence with the drug’s manufacturer stating that 1 woman who used a single injection of sumatriptan (dose unspecified) during breastfeeding had a cessation of lactation.
Usually compatible with breastfeeding.
Alternate Drugs to Consider:
1. Wojnar-Horton RE, Hackett LP, Yapp P et al. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol. 1996;41:217-21. PMID: 8866921
2. Kristensen J. Sumatriptan and breastfeeding. Aust J Hosp Pharm. 1996;26:460. Letter.
3. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352
Not an overwhelming number of cases, of course, and it is understandable that the manufacturer would want to keep it in Category C but I would expect my care provider to respect both my nursing relationship and my pain enough to provide me the option.
I find her unwillingness to do so a silent undermining of breastfeeding.
I pushed. I sent her the LactMed research (and Dr. Hale’s) and she reluctantly prescribed me Imitrex with the caveat to pump and dump my breastmilk for 8 hours – which I have not done because I am comfortable with the minimal risk (a decision each person needs to make based on all the information available). If I were less informed (or less awesome of a Librarian – yeah baby!) I would be locked in a battle between immense pain and breastfeeding or weaning and being pain free. This is a horrible, disrespectful, and needless battle to put a mother in.
Mothers! Be your own advocate because no one else will!
Doctors! Come on! Breastfeeding is in everyone’s best interest. Bone up on the facts. Give your patients their options and all the information and work with them to make an informed decision.
Imitrex has been a miracle for me. It takes me from agony to normalcy with no side-effects (not everyone is as lucky – read up on Imitrex before you try it). I am going to a specialist to see why I’m having migraines and having them so often but of course, they can’t see me until June 7th. In the interim I am able to breastfeed without fear and function without pain. Thanks to me. Despite of my doctor.
Does that sound like it is the way it is supposed to work?
Have you been undermined in your breastfeeding?