Last update: June 1, 2020
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Trimethylxanthine stimulant of the central nervous system which is present in many compounds like decongestant or pain relief drugs (50 to 100 mg per unit) ( (Mitchell 1999).
It is also present in many infusion beverages (coffee, tea, mate, guarana), in cocoa/chocolate and other drinks with cola or allegedly energizing properties (Barone 1996, Fulton 1990). See also Coffee, Caffeine (beverages).
It is excreted in human milk in variable amount (Calvaresi 2016, Stavchansky 1988, Ryu 1985, Bucher 1985, Berlin 1984, Findlay 1981, Tyrala 1979).
Moderate caffeine consumption does not produce significant plasma or urine levels in infants, and may be undetectable or below therapeutic levels in the neonatal period (Blanchard 1992, Fulton 1990, Berlin 1984, Hildebrandt 1983, Bailey 1982, Rivera 1977).
Doses greater than 300 - 500 mg per day can cause nervousness, irritability and insomnia in the infant (Santos 2012, Martin 2007, Clement 1989, Rustin 1989), as well as decreased iron levels in breast milk and anemia in the infant (Muñoz 1988 ). Also has been related to the Raynaud's phenomenon in the nipple of nursing women (McGuinness 2013).
One study found no problems in infants whose mothers consumed 500 mg of caffeine daily for 5 days (Ryu 1985).
There is insufficient evidence on the recommended amount of caffeine during lactation (McCreedy 2018).
Intravenous high doses used to treat post-epidural anesthesia headache within 2-3 days after delivery, before mature breast milk comes, are compatible with breastfeeding.
The elimination half-life, of a few hours in adults, can be 10 times longer in preterm infants and during the neonatal period, reaching adult values by 3-5 months of age. (McNamara 2004, Oo 1995).
The moderate use of caffeine during lactation is considered compatible or probably compatible by various experts (Hale 2019, Briggs 2017, Bordini 2016, Davanzo 2014, Rowe 2103).
American Academy of Pediatrics: Maternal Medication Usually Compatible With Breastfeeding (AAP 2001).
We do not have alternatives for Guaranine.
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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