Is Adderall safe while breastfeeding?

What does the evidence say about Adderall while breastfeeding?

1. Adderall's manufacturer labeling states that women who are breastfeeding should not use this medication, though the benefit of continuing it might outweigh possible risks for some, which is why the decision should be made with a healthcare provider rather than from the label alone. 1
2. In one small study, four mothers taking an average of 18 mg of dextroamphetamine daily had breast milk levels that worked out to about 5.7% of the mother's weight-adjusted dose reaching the infant, below the level generally used as a signal for closer attention. 2
3. One mother taking 35 mg of amphetamine daily successfully breastfed exclusively for 6 months with no reported problems with milk production, illustrating that therapeutic-dose exposure is not automatically incompatible with nursing. 3
4. Reviews of ADHD medication use during lactation note that the published safety data comes mainly from small case reports and case series, and conclude that prescribing a stimulant to a breastfeeding parent should follow an individual risk-benefit conversation with a provider rather than a blanket rule. 4
5. Experts recommend watching a breastfed baby whose parent takes a stimulant medication for trouble eating, trouble sleeping, extra sleepiness, or irritability, and contacting the child's healthcare provider if any of these appear. 1

How Adderall changes by nursing stage

• Early weeks. In the early weeks of breastfeeding, milk supply is still being established, and this is when any theoretical effect of stimulant medications on supply would matter most. If you notice a drop in supply, mention it to your provider and a lactation consultant early rather than waiting.
• Established nursing. Once breastfeeding is well established, small studies have not shown clear problems in infants whose parent takes a therapeutic dose of Adderall, though ongoing monitoring for irritability or poor sleep is still reasonable.
• Weaning. In more established, later breastfeeding, some parents time their dose right after a nursing session to put more time between the dose and the next feed, though this specific timing strategy has not been formally studied for Adderall.