Last update: May 4, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Intermediate-acting Benzodiazepine. indicated in certain forms of epilepsy and in panic disorder with or without agoraphobia.
Oral or intravenous administration 3 times a day.
It is excreted in milk in very small quantities (Schaefer 2007 p701, Misri 2006, Söderman 1988, Fisher 1985).
The plasma levels of infants whose mothers took a dose of 0.25 to 4 mg per day were undetectable or very low, less than 15 micrograms/L (Birnbaum 1999, Söderman 1988, Fisher 1985).
Higher levels (20-22 micrograms/L) were found in two cases; in one of them the mother took a 6 mg daily dose of clonazepam (Schaefer 2007 p701, Birnbaum 1999).
No side effects were found in infants whose mothers were taking clonazepam (Birnbaum 1999), unless they were taking more than one medication with neurological effects (Kelly 2012, Schaefer 2007 p701) or if the mother was already taking clonazepam during pregnancy and associated with prematurity (Fisher 1985).
The frequency of reported side effects is very low: a single case demonstrated in 26 and a half years of follow-up in the French Pharmacovigilance Database (Soussan 2014).
Whether anxiolytic rather than anticonvulsivant treatment is intended, benzodiazepines with a shorter half-life span like Lorazepam or Oxazepam should be considered.
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).
Several medical societies, experts and expert consensus, consider the use of clonazepam safe during breastfeeding (Briggs 2017, Picchietti 2015, WHO2002), especially at doses no greater than 1 mg per day (Picchietti 2015).
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 (LactMed rev.2018, Crettenand 2018).
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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