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Amphetamines & buprenorphine - supression of prolactin through dopamine release

ellua

ellua

Bluelighter
Joined
Jun 21, 2006
Messages
1,191
I feel like a bad person even asking this due to obvious reasons - I have a 4 month old daughter that I have been exclusively pumping milk for since birth. Both my addictionologist and my OB agreed that even though I'm on Subutex 12-16mg/day and d-amp 80mg/day, breastmilk is still superior to formula and I haven't seen any symptoms that suggest they are affecting her at all. I know this board is probably mostly men, but I really need help figuring out how this works so I can do what's best for my daughter.

I have a low-ish milk supply, and I believe it could be because of the adderall. I don't know enough to try to put this into my own words so I'll keep it simple and hope you guys get the gist.

Prolactin and oxytocin are both extremely important for milk supply and eliciting a let-down (allowing the milk to flow). I know amphetamines cause increased dopamine which in turn supresses prolactin. a bit of reading into the effects of buprenorphine show that low doses actually cause prolactin to rise, but higher doses do not.

are the amounts of subutex & adderall i'm taking enough to be causing my issues with supply? My guess is yes, at least for the d-amp. If so, would a drug like domperidone (often used off label to increase supply by raising prolactin) work in a way that effectively counters the supression from them? Like, is it strong enough to overpower those effects or do they all work too differently?

Last, if domperidone would work to bring my prolactin back up, would that mean decreased effects from my adderall?

I hope this makes sense, thanks in advance for any insight.
 
Well firstly, assuming you can't reduce your drug intake try to make sure you have a adequate diet and a decent fluid intake to keep milk volume up. I'll do some more digging, but you should check with your doctor about domperidone entering the breast milk prior to thinking of taking it.

Be sure to check with your doctor prior to taking advice from this forum as you're not the only one being affected.
I'll try and figure out if anything is well known to help in these situations when I have time.

Also, is this your first child?
 
breast feeding while taking amphetamines is ridiculous. surely you can cut out the speed for a few months. an infant doesn't need to be super focused. the opiate would worry me less (although its not ideal) but speed can be neurotoxic so cut it out please.

i think if you cannot stop taking drugs at least stop inflicting them on your new baby. its just a bit unfair. well how about you see if taking her away from your breast milk causes drug withdrawl type distress if it does then you know there is an effect and 80mg of amphetamine a day is a quite a lot.

maybe i'm being harsh but my cousin (who is a nurse) who just had a child said she wont drink coffee as it will affect her baby via the breast milk.

speed for me messed my head up so thats where i'm coming from
 
i feel i'd lose my job without the meds, and i should add she's not getting just my milk anyway, she's always had at least a couple bottles of formula. i've also experimented for a week and gave her only formula to see if there was a difference in her behavior and there wasnt. since my docs said it was safe and still better than all formula, i went ahead. do you think i don't feel bad enough about this already without you giving me grief about women who won't even touch caffeine?? i don't need the guilt trip.

the research i've done shows that on average, the level of medication that reaches the infant thru milk is 3% of the weight-adjusted maternal dosage, so it's not worth risking my livelihood over. if i lose my job i won't be able to keep a roof over her head.
 
also, 80mg/day is greatly reduced from what i'd been taking for several years prior to getting pregnant. anyone who wants to slam me for that, go ahead, but i came to Bluelight & not a parenting forum for a reason.
 
I wasn't sure if the above posters were male or female, so I figured since I'm a woman i would give you my prospective. Even though I am not positive, for what you wrote I would have to agree the low milk supply is probably somewhat related to the adderall. To be on the safe side you could always call a pharmacist or Dr. and ask about medicine and the milk supply. I'm sure someone here will have a more detailed answer. However, I think if you took the baby off the breast milk and switched it to formula, you might see her be a little more crabby. I'm sure she is getting some of the drug through the breast milk. I'm certainly not going to slam you for it, and I think coming here and asking this was good. Since she is getting close to the 6 month mark have you considered switching to formula permantly? That way you can still take your medication and the baby gets her nutrition. It's just a suggestion but in the end it's up to you and your Dr. There is no need to feel like a bad person. This forum is here to help people. You have to do what is best for you and your baby.
 
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With all due respect to the above posters, try to avoid completely stopping feeding breastmilk till at least 18 months. The protective effects of breastmilk are too complex to be completely replaced by formula especially before 6 months, granted perhaps supplementing formula is the best bet you can have.
http://en.wikipedia.org/wiki/Breastfeeding

Perhaps giving this group a shout may be helpful?
http://www.llli.org/webindex.html

Also, in the interest of promoting harm reduction and positive discussion I will edit/delete offensive posts. She's explained her situation in a satisfactory manner.
 
thanks a lot SB, you made me feel a lot better.

i should have added that i am strategic about what milk she gets and the possible amount of adderall in it, to minimize the effects- most of the milk pumped between 2PM & midnight is frozen because i figure the highest concentration of meds will be present then, and i haven't decided if i'm going to feed it to her little by little once she's at least 6 months old, or if i'm going to throw it out (very difficult to do as i've spent over 400 HOURS pumping, but if the docs tell me the risks outweigh the benefits, i will). the milk i pump in the middle of the night thru early afternoon should have very little to no amps in it.

because of this system, the milk i will feed her is just over half of what she needs for the day. so by increasing supply overall, i will be able to pump that much more milk in the early hours of the day which have minimal amounts in it, and the milk with higher concentrations i'm not worried about yet. so, increasing my supply will ultimately result in her getting more of the milk with little to no adderall, and decrease my need to use the milk with higher concentrations at all.

i am considering stopping at 6 months & going to formula but that's expensive too, so i hope to keep pumping for a few more months though it's super exhausting. it has to be done every 2-4 hours around the clock, 25-30mins each time. so even with her sleeping through the night, i am NOT!! this is an awful lot of work to do for the yield i get, let alone just half of that which i actually feed her.

Epsilon, yes, this is my first baby. Thanks to all for the non-judgemental responses.
 
Your welcome glad to help when I can. I wasn't aware about the breast milk until 18 months, I always heard it was 6 so my apologies if that was incorrect. Best of luck to you and your new baby! :)
 
Have you considered finding a milk donor or even a wet nurse? This would be the safest option. Even if she couldn't supply all of the necessary milk, it would reduce the amount of amphetamine that your child is exposed to or the amount of formula that you use.

You could try posting a wanted ad on Craigslist for someone with extra breastmilk. Just explain your situation as someone who has to take medicine that might affect your baby through your milk and I'm sure you could find a sympathetic young mother willing to help out for free or minimal payment. I don't know how much you spend on formula, but you could offer to pay a similar amount.

Other than that, your strategy of milk timing is good. It's important to take all the steps you can to reduce your baby's exposure. I, too, wish you and your child the best of luck.
 
I'm a guy, but were I in this situation I would probably get a wet-nurse. Amphetamine is fat soluble enough that I'd be concerned about it affecting the infant's developing brain. It's very fat soluble and has a half-life of 12 hours, so if you dose daily there will be quite a reservoir of drug left in your body. Opioids are somewhat less soluble and are much less of a concern w.r.t. neurotoxicity.

However, I wouldn't add an antipsychotic, namely because they're terrible drugs for anyone who doesn't truly need them. They can cause terrible side effects and generally impair cognitive function in many cases.
 
domperidone is an antipsychotic? i thought its main use was for acid reflux...?

milk doner is a great idea, i guess i'd just feel a bit guilty about it, but at the same time i kinda know it's better overall. i will definitely look into it and see what i can find in my area.
 
Domperidone is an antidopaminergic drug that is structurally related to antipsychotics like risperidone. It just so happens that blocking dopamine receptors reduces vomiting too.

I would e wary of using it, esp. in pregnancy - the US FDA recommends against it.
In June 2004, the FDA issued a letter warning women not to take domperidone, citing unknown risks to parents and infants, and warned pharmacies that domestic sale was illegal, and that import shipments from other countries would be searched and seized. Domperidone is excreted in breast milk, and no studies on its effects on breastfeeding infants have been reported in the literature.
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Antidopaminergic drugs would also reduce the efficacy of your amphetamine.
 
ellua said:
milk doner is a great idea, i guess i'd just feel a bit guilty about it, but at the same time i kinda know it's better overall. i will definitely look into it and see what i can find in my area.
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There's nothing to feel guilty about. Milk sharing has been around for most of human history. You're just helping your child develop as best as you can, and I'm sure the donor will get some good karma for helping you.

If Craigslist is too sketchy, you could try asking around your local women's clinic or see if you could post a flyer there. You'll probably reach more moms that way.

edit: You could also ask a religious congregation leader (priest/pastor/imam/rabbi/whoever) for leads. Even if you're not particularly religious, most churches will be more than happy to help a mother in need. And despite what some people in modern society say, there's absolutely nothing wrong with seeking other people's assistance when you really need it. That's why we have communities, to support each other.
 
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milk doner for the win- if you cannot cut your drugs because of the job and i understand that it may be a job you do well out of but are not naturally suited to unless under the influence, then use a milk donor.

the amphetamine is my concern as for me opiates have been relatively benign but speed sent me insane and made me (enhanced drastically an already significant problem) very bipolar and hugely anxious and depressed. i think its a harsh and unpleasant drug that does people noticable long term damage. 80mg is a lot even if you have gone down from a higher dose especially for your baby.

my friend who used cocaine a little and a lot of alcohol while pregnant now has a beautiful boy who is very gung ho at 1.5 years old but when you open a can of beer he starts shouting "beer beer beer" and tries to get it partly out of copying his mum and partly because he has been primed for this rewarding substance from an early age (womb). its not my place to judge but i hope your baby does really well and amphetamines really messed me up for years so if you can avert a near miss like i had then please do it for your child.
 
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ellua said:
i feel i'd lose my job without the meds, and i should add she's not getting just my milk anyway, she's always had at least a couple bottles of formula. i've also experimented for a week and gave her only formula to see if there was a difference in her behavior and there wasnt. since my docs said it was safe and still better than all formula, i went ahead. do you think i don't feel bad enough about this already without you giving me grief about women who won't even touch caffeine?? i don't need the guilt trip.

the research i've done shows that on average, the level of medication that reaches the infant thru milk is 3% of the weight-adjusted maternal dosage, so it's not worth risking my livelihood over. if i lose my job i won't be able to keep a roof over her head.
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i wasn't trying to guilt trip you, i was trying to get you to see that speed is certainly dangerous stuff (and sends a LOT of people temporarily crazy myself included). it doesn't matter what drug it is babies dont really need to be taking any psychoactives because they will shape the direction of neural plasticity for the future but opiates to me sound tolerable (but not ideal) in breast milk (bearing in mind the relationship between milk and casomorphin found in cows) where as amphetamine is a no-no

dont feel guilty because no situation or person in life is ever perfect (myself included for sure) but the amphetamine needs to not get into your baby's system. its not about guilt but about improving your positive future for your child and making a change for the better
 
Ok, so I'm going to look into donors. i realized domperidone was a dompamine antagonist so that would be pointless.

In the meantime, it will take me several weeks at least to wean from the pump, so I will still have some. My schedule for taking the addy is 30-40mg @ 8am, 20mg @ noon, and 20mg around 4pm.

If I don't use milk pumped between 8am & midnight (which kinda sucks but I've decided to broaden the window because of the total amount I take in a day) the milk I pump in the middle of the night should be pretty safe for now, right? And on weekends I will try to stick with just one a day so I can get more "safe" milk.
 
The negative effects of formula are well documented, but the negative effect of a bunch of psychotropic chemicals also are. The Academy of Pediatrics recommends avoiding breast feeding while on amphetamine, let alone also on Subutex. Steiner et al. (1984) state that amphetamine is found in the breast milk in concentrations 3-7 times of those of plasma. The bottom line is that you're exposing your child's brain to a lot of strongly active exogenous chemicals when things like their blood brain barrier and a whole lot of other neuronal systems are still developing -- really bad stuff.


Steiner E, Villén T, Hallberg M, Rane A. 1984. Amphetamine secretion in breast milk. Eur J Clin Pharmacol. 27(1):123-4.
 
::sigh:: jeez i wish i would've know this 4 months ago, and the docs hadn't been so passive about it. so i'm searching donors & have formula for the meantime, but am a bit worried about long-term effects now. she's perfectly on track for development so far but i'm aware the effects could be waaay more far reaching than anything we'd see for years. but i'm wondering, if there is some long term damage, in what ways would it manifest? or is it too broad to even guess at? just general cognitive impairment, or being slow, or something else?

then again, maybe i don't want to know if there's nothing i can do about it. just sign me up for the Worst Mother Evar award.
 
There haven't been a lot of studies on the effects of amphetamines on developing human neonates/toddlers for what I would assume to be self-evident reasons.

When all is said and done, however, relatively small amounts of amphetamine in breast milk is going to be much less of a contributing factor to development than an enriched, caring, & active family/childhood environment (or lack thereof), or even individual genetics. Given that you're not taking amphetamine "recreationally" and are doing all that you can to limit your child's exposure, I would say that you shouldn't worry yourself to death over it. Doubly so if your child appears to be developing normally.
 
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