Have any of you worked with anyone taking Ritalin while breastfeeding?

I would appreciate any insights, information, and experiences that any of
you may have that might help the mother (this is posted with her
permission)in the following situation.

26 y.o. primipara, who did not plan on breastfeeding as she has narcolepsy,
(which was diagnosed 5 years ago) and so she takes Ritalin.  Also, she will
be returning to work, so figured that she would be back on the Ritalin
because of working.

She did not take Ritalin during pregnancy.
Her daily dose is 20 my up to 4X/day.
Per Tom Hale: Ritalin is categorized as an L4 med.  A 10 mg dose has a 1-3
hour half-life.

Infant was born at 34 weeks, was in the NICU for 4 days for prophylactic tx
with IV antibiotics as Mom’s GBS status was unknown.

Infant is now 6 weeks old and not tolerating formula: four different
formulas have been tried: basic formula with Fe, a soy-based, one without
lactose, and a pre-digested formula. She has signs of reflux, is miserable,
fights eating, and has poor weight gain. Docs are concerned and want Mom to
try to provide breastmilk.

Mom is willing to stop Ritalin, or decrease it-she feels that she really
needs to take it in the am in order to function and to even make it to the
shower in the morning. She wants to know if she could take it the am and
pump and discard that milk.  I wonder if there is anything that can be done,
such as heat treating, to alter the Ritalin in the milk, so it would be
possible to use the pumped milk. Maybe a crazy thought, but anything is
worth exploring-any biochemists out there?                          She has
a flexible schedule, so figures she can come home and nap if she needs to in
order to make it through the day. She is able to work a day or two out of
the week from her home.  She did manage to go without the Ritalin during
pregnancy.

She has been started on Reglan by her OB: 10 mg, 3X/day, and per her OB’s
advice, is starting on Fenugreek.

I told her:

We need more info about Ritalin if she is going to take any while
breastfeeding.

About banked milk to use until she has a supply built up-am sending her info
about Milk Bank in Raleigh.  I think she could possibly get her insurance to
pay for it given the circumstances-worth a try.

To start pumping round the clock 8X/day with a hospital grade pump, using
breast massage first, etc.

To do lots of skin-to-skin, co-bathing, and give baby opportunities to latch
on, without forcing the issue.  She said that the baby has tried to
latch-on, they have been doing lots of skin to skin, so that all sounds
hopeful.

I think that it would be best if she goes off the Ritalin completely,
especially as she is willing to do so, but still I am would like to find
information about the Ritalin. I have plenty of info for her on inducing
lactation.

TIA, Diana







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