Can you take zolmitriptan while breastfeeding?

What LactMed would consider instead

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

• Eletriptan
• Rizatriptan
• Sumatriptan

How much zolmitriptan gets into breastmilk

Zolmitriptan is metabolized to the active metabolite, N-desmethylzolmitriptan by CYP1A2 and CYP3A4.

Maternal Levels. Four women who were at least 1 month postpartum used zolmitriptan 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 used a 5 mg dose by nasal spray. The other 3 mothers took 2.5 mg orally. N-desmethylzolmitriptan was undetectable (<1 nM) in milk. The average peak milk level of 8.2 mcg/L (range 2.5 to 18.1 mcg/L) occurred from 4 to 12 hours after the dose. The average milk level was 4.6 mcg/L (range 1.5 to 10.1 mcg/L) and the half-life in milk averaged 6.5 hours. Their infants’ average daily dosage of zolmitriptan was 0.7 mcg/kg (range 0.2 to 1.5 mcg/kg) and their average weight-adjusted infant dosage was 2.1% (range 0.7 to 5.3%) of the maternal dose. The woman who had the highest average and peak milk levels and the highest relative and absolute infant dosages was taking propranolol concurrently, which is known to increase serum zolmitriptan levels. Excluding this woman, the other three infants’ average daily dosage of zolmitriptan was 0.4 mcg/kg (range 0.2 to 0.6 mcg/kg) and their average weight-adjusted infant dosage was 1% (range 0.7 to 1.4%) of the maternal dose.

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

What has been seen in breastfed infants

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

Effects on milk supply

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.