Can you take theophylline while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Expert opinion considers use of theophylline to be acceptable during breastfeeding. Maternal theophylline use may occasionally cause stimulation and irritability and fretful sleep in infants. Newborn and especially preterm infants are most likely to be affected because of their slow elimination and low serum protein binding of theophylline. There is no need to avoid theophylline products; however, keep maternal serum concentrations in the lower part of the therapeutic range and monitor the infant for signs of theophylline side effects. Infant serum theophylline concentrations can help to determine if signs of agitation are due to theophylline. Avoiding breastfeeding for 2 hours after intravenous or 4 hours after an immediate-release oral theophylline product can decrease the dose received by the breastfed infant. When theophylline is given as an oral sustained-release product, timing of nursing with respect to the dose is of little or no benefit.
Quoted from Theophylline — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised May 15, 2024.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of theophylline. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
How much theophylline gets into breastmilk
Maternal Levels. Theophylline rapidly equilibrates between plasma and milk. Peak milk levels occur 1 to 3 hours after oral ingestion of immediate-release products and almost immediately after intravenous administration. Milk levels parallel serum levels closely and average about 70% of simultaneous maternal serum levels. Assuming that each 1 mg/kg of maternal theophylline increases her serum level by 2 mg/L, an exclusively breastfed infant would receive about 21% of the maternal weight-adjusted dosage of theophylline or 17% of the maternal dosage of aminophylline.
A physiologically based pharmacokinetic model was created for theophylline that predicted an average relative infant dose of 13% and a maximum of 17%.
Infant Levels. Theophylline is found in the serum of breastfed infants. In newborn infants with typical theophylline clearance rates, infant serum levels are expected to be between 1 and 4 mg/L with a maternal serum level in the therapeutic range of 10 to 20 mg/L. Infant serum levels might occasionally accumulate to therapeutic levels in infants with slow clearance rates of the drug.
A physiologically based pharmacokinetic model was created for theophylline that predicted an average serum concentration in a preterm neonate was 6.8 mg/L.
What has been seen in breastfed infants
Irritability and fretful sleeping occurred in a 3-day-old breastfed infant on days of maternal aminophylline intake of 200 mg every 6 hours. These effects ceased with discontinuation and recurred on rechallenge over the next 9 months. These effects were probably caused by theophylline in breastmilk. Another five infants reported in this paper showed no adverse reactions after maternal theophylline ingestion. Accumulation of theophylline in infant serum appears most likely in neonates and premature infants because they eliminate theophylline slowly.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take theophylline while breastfeeding?
Expert opinion considers use of theophylline to be acceptable during breastfeeding. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
What can I take instead of theophylline while breastfeeding?
LactMed lists Terbutaline as alternate drugs to consider. That is the database's own list for this drug — whether any of them suits you depends on what you are treating.
Does theophylline pass into breastmilk?
LactMed's measured drug levels for theophylline are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking theophylline?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on theophylline
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.