Alprazolam

Short-acting benzodiazepine with anxiolytic effect. Used in states of anxiety and depression. Oral administration 3 times a day.

It is excreted in breast milk in a small amount, but it could be clinically significant: RD 2.7 - 9.3% ^{(Nishimura 2021, Furugen 2019, Oo 1995)}

Several authors have found no problems in infants of mothers treated with alprazolam ^{(Saito 2022, Nishimura 2021)}, but some cases of mild sedation in infants whose mothers were taking alprazolam, alone ^{(Ito 1993)} or in combination with other sedatives ^{(Kelly 2012)}, have been reported, and withdrawal syndrome in newborns and infants when the mothers discontinued alprazolam ^{(Anderson 1989)}. Both facts indicate that the passage to breast milk, although scarce (<10% of maternal dose), may become clinically significant, therefore, especially in the neonatal period and in case of prematurity, it is preferable to use benzodiazepines with a faster action and less passage to breast milk.

Expert authors consider the use of this medication possible during lactation. ^{(Uguz 2021)}

While most benzodiazepines can lower prolactin levels, alprazolam increases them and can cause galactorrhea. ^{(Petric 2011, Madhusoodanan 2010, Zemishlany 1990)}

The occasional and low-dose use of benzodiazepines is compatible with breastfeeding. ^{(Kelly 2012, Rubin 2004, Iqbal 2002, Hägg 2000, McElhatton 1994, Lee 1993, Kanto 1982)}

Choose short-acting benzodiazepines and use the lowest effective dose ^{(Rowe 2013)}, especially during the neonatal period and in prematurity, as 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. Bed-sharing with the baby is not recommended if this medicine is being taken due to increased risk of suffocation or sudden infant death. ^{(UNICEF 2018, 2017, 2014 and 2013, Landa 2012, ABM 2008, UNICEF 2006)}