Breastfeeding and migraine drugs

  title={Breastfeeding and migraine drugs},
  author={Riccardo Davanzo and Jenny Bua and Giulia Paloni and Giulia Facchina},
  journal={European Journal of Clinical Pharmacology},
PurposeBreastfeeding women may suffer from migraine. While we have many drugs for its treatment and prophylaxis, the majority are poorly studied in breastfeeding women. We conducted a review of the most common anti-migraine drugs (AMDs) and we determined their lactation risk.MethodsFor each AMD, we collected all retrievable data from Hale’s Medications and Mother Milk (2012), from the LactMed database (2014) of the National Library of Medicine, and from a MedLine Search of relevant studies… 
Women and Migraine: the Role of Hormones
An overview of a woman’s migraine throughout her lifetime, the impact of hormones and an approach to management is provided.
Drug safety and tolerability in prophylactic migraine treatment
The background of the recurrence and chronification of migraine attacks has not been fully clarified, and causative preventive therapy is therefore not currently available, and the tolerability and adverse effects of the currently used medications often limit their use.
Codeine Precipitating Serotonin Syndrome in a Patient in Therapy with Antidepressant and Triptan
The development of syntomatology, the clinical examination and the possible pharmacokinetics explanation were carefully discussed and analysed and the patient was diagnosed as a probable case of serotonin syndrome due to a pharmacological interaction between venlafaxine and rizatriptan trigged by opioid intake.
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Rodent research has the potential to forecast impairments in breastfed children long before information emerges from post-marketing reports and should be prioritized during preclinical drug evaluation by the FDA for new drugs and for drugs currently prescribed off-label for lactating women.
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Evaluated literature on valproic acid in women and girls of childbearing age finds adherence to guidelines in VPA use in reproductive-aged girls and women remains low.
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Pharmacogenomic testing might be a valuable tool for personalization of pain treatment, with a multidisciplinary team approach involved.
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Combined therapy with liposomal curcumin and naproxen showed an improved antioxidant effect and anti-nociceptive effect in a rat model of migraine.
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Understanding factors that affect transfer of medications into human milk can help providers give appropriate guidance to mothers with chronic illnesses who want to breastfeed.


Antiepileptic drugs and breastfeeding
Most AEDs can be considered safe during breastfeeding according to this review, and gabapentin, lamotrigine, oxcarbazepine, vigabatrin, tiagabine, pregabalin, leviracetam and topiramate are compatible with breastfeeding with a less documented safety profile.
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A systematic review of drugs commonly used in the treatment of postpartum depression found that knowledge of pharmacokinetic characteristics are scarcely useful to assess safety and the majority of antidepressants are not usually contraindicated.
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The issue of prescribing anticonvulsant drugs during lactation is clinically important, but also complex and no clearcut recommendations can be made until further data are present.
Pharmacological treatment of unipolar depression during pregnancy and breast-feeding—A clinical overview
This overview is aimed at clinicians working with patients in the fertile age who suffer from depressive disorders, and finds that citalopram and sertraline can be used during pregnancy, while some controversy remains over in utero exposure to paroxetines and fluoxetine, which might be associated with an increased risk of foetal cardiovascular malformation.
Antirheumatic medication during lactation.
The infant should be closely monitored if antimalarials are being used by lactating women, and the choice of NSAIDs would be between a short half-life propionic acid derivative, with little biotransformation, such as ibuprofen or flurbiprofen.
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Information regarding safety of triptans while breastfeeding is limited but also reassuring, as the minimal amounts excreted into the milk are insufficient to cause any adverse effects on the breastfeeding infant.
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Weighing the benefits of breast feeding against the potential risk to the nursing infant, breast feeding is considered to be safe when the mother is taking carbamazepine, valproic acid or phenytoin; however, observation for adverse effects is recommended.
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