Is Wellbutrin safe while breastfeeding?

What does the evidence say about Wellbutrin while breastfeeding?

1. Two published case reports describe a seizure-like event in a breastfed 6-month-old after maternal bupropion use, and in both cases the symptoms stopped once bupropion was no longer being used, which is why caregivers are told to watch for unusual movements, seizures, or increased sleepiness in a nursing baby. 1
2. Bupropion passes into breast milk in small amounts, with one study measuring peak levels of roughly 180 to 190 micrograms per liter one to two hours after a dose, and published estimates put an exclusively breastfed infant's dose at well under 10% of the mother's weight-adjusted amount. 2
3. Needing bupropion isn't considered a reason to stop breastfeeding altogether, though a different antidepressant may be favored while nursing a newborn or a baby born preterm, since younger infants clear medication more slowly and there is less reported experience with this specific drug in that age group. 2
4. Sertraline and paroxetine are the antidepressants most often preferred first during breastfeeding because of their lower infant plasma ratios and a longer track record without reported adverse effects, which is part of why bupropion is more often reserved as an alternative for people who haven't responded well to an SSRI. 3
5. Bupropion is the same medication whether it's prescribed as Wellbutrin for depression or as Zyban for smoking cessation, and the breastfeeding safety data available comes mainly from its antidepressant use, since the pregnancy study of bupropion for smoking cessation measured birth outcomes like weight and Apgar score rather than breastfeeding exposure. 4

How Wellbutrin changes by nursing stage

• Early weeks. In the early weeks after birth, whether you're continuing Wellbutrin from pregnancy or starting it fresh for postpartum depression that hasn't responded to an SSRI, a different antidepressant may be favored for a newborn or a baby born preterm, since younger babies clear medication more slowly and have been less studied on this drug specifically.
• Established nursing. Once breastfeeding is established, bupropion still only reaches milk in small amounts, but this is the stage where both published seizure case reports occurred, in breastfed 6-month-olds. Watch for unusual movements, seizures, or increased sleepiness, and call your baby's provider if you notice them.
• Weaning. If breastfeeding continues long-term or you're using bupropion under its Zyban brand for smoking cessation postpartum, the same monitoring guidance applies. There isn't dedicated breastfeeding-specific research on the smoking-cessation use, so the safety data here comes from its antidepressant use.