Can you take sumatriptan while breastfeeding?

What LactMed would consider instead

LactMed ends this record by naming the drugs it would consider in place of sumatriptan. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.

• Eletriptan
• Rizatriptan
• Zolmitriptan

How much sumatriptan gets into breastmilk

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.

Seven women who were at least 1 month postpartum and used sumatriptan to treat migraine provided one milk sample before the dose, then additional milk samples at 1, 2, 4, 8, 12 and 24 hours after the dose. One mother took a 6 mg dose subcutaneously, two took 20 mg by nasal spray, four took a 50 mg oral dose (including one who used the nasal spray separately), and one mother took 100 mg orally. Peak milk levels did not correlate well with dosage, averaging 59.3 mcg/L (range 24.6 to 112.8 mcg/L) and occurred 2 to 4 hours after the dose. The average milk level was 23.2 mcg/L (range 7.7 to 50.6 mcg/L) and the half-life in milk averaged 4.9 hours (range 3.6 to 5.9 hours). The average infant’s daily dosage of sumatriptan was 3.5 mcg/kg (range 1.2 to 7.6 mcg/kg) and the weight-adjusted infant dosage averaged 0.7% (range 0.2 to 1.8%) of the maternal dose.

Infant Levels. Relevant published information was not found as of the revision date.

What has been seen 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.

Effects on milk supply

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.

A review of four European adverse reaction databases found 26 reported cases of painful, burning nipples, painful breasts, breast engorgement and/or painful milk ejection in women who took a triptan while nursing. Pain was sometimes intense and occasionally led to decreased milk production. Pain generally subsided with time as the drug was eliminated. The authors proposed that triptans may cause vasoconstriction of the arteries in the breast, nipples, and the arteries surrounding the alveoli and milk ducts, causing a painful sensation and a painful milk ejection reflex.