Last update: May 11, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Short-acting benzodiazepine with anxiolytic effect. Used in states of anxiety, panic and depression.
Oral administration 3 times a day.
It is excreted in breast milk in small quantities (Oo 1995).
Cases of sedation have been reported in infants whose mothers were taking alprazolam (Kelly 2012, Ito 1993) and withdrawal syndrome in the newborn and infant when the mother discontinues alprazolam (Anderson 1989).
Both circumstances indicate that excretion into breast milk - despite small (<10% of maternal dose) - can achieve clinical significance. Hence, rapid acting and lower excretion into breast milk should be preferred.
Most benzodiacepine drugs may decrease prolactin levels but Alprazolam increases it and can cause galactorrhea (Petric 2011, Madhusoodanan 2010, Zemishlany 1990).
The occasional use and low doses of benzodiazepines are compatible with breastfeeding (Kelly 2012, Rubin 2004, Iqbal 2002, Hägg 2000, McElhatton 1994, Lee 1993, Kanto 1982).
It is advisable to choose a short-acting benzodiazepine and minimal effective dose as possible (Rowe 2013), especially in the neonatal period and in case of prematurity because they can accumulate in the infant during chronic use (Sachs 2013, Amir 2011).
It is advisable to monitor drowsiness and adequate feeding of the infant.
It is not recommended to share a bed (co-sleeping, bed-sharing) with the baby if this drug is being taken, due to increased risk of asphyxia or sudden infant death (UNICEF UK 2018, 2017, 2014 and 2013, Landa 2012, ABM 2008, UNICEF UK 2006).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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e-lactancia is a resource recommended by Academy of Breastfeeding Medicine from United States of America
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