Gabapentin and breastfeeding

Gabapentin and breastfeeding

Seek expert advice:

• gabapentin is considered compatible with breastfeeding, but should be used with caution and infant monitoring (1)
• published evidence for the use of gabapentin during breastfeeding is very limited. Data is from 10 mothers using gabapentin doses up to 2.1g daily
• both gabapentin and pregabalin are compatible with breastfeeding (2)
  • in comparison with pregabalin, gabapentin is the preferred choice, as there is more published evidence of its use during breastfeeding
    • there are no data on long term developmental effects for gabapentin or pregabalin from infant exposure via breast milk
• limited information indicates that maternal doses of gabapentin up to 2.1 grams daily produce relatively low levels in infant serum (2)
  • monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs
  • a single oral dose of either 300 mg or 600 mg given to the mother before cesarean section appeared to have no effect on breastfeeding initiation
  • expert consensus indicates that gabapentin is an acceptable choice for refractory restless leg syndrome during lactation

Breast milk levels, infant absorption and effects in infants

• gabapentin is a small molecule with low protein binding, which enables it to pass into breast milk
• limited evidence shows gabapentin only transfers in small amounts (1)
  • infant levels of gabapentin after breastfeeding have either been undetectable or very low
  • are no published reports of side effects in breastfed infants exposed to gabapentin
  • all exposed infants have developed normally
  • are no data looking at longer term infant effects
  • a case report details where an infant whose mother was taking gabapentin 36.7 mg/kg daily breastfed her infant 6 to 7 times daily with some additional artificial feeding at night (2)
    • at 1.6 months of age, the infant's plasma gabapentin concentration was 0.4 mg/L which was about 6% of the average maternal plasma concentration

Infant monitoring (1)

• as a precaution, monitor the infant for potential side-effects including drowsiness, changes in feeding (including not waking to feed) and adequate weight gain, gastro-intestinal disturbances (such as vomiting, diarrhoea, and constipation), irritability, and tremor
• monitoring the infant will quickly pick up any potential issues but usually further investigation is required before the cause can be attributed to the medicine

Neonatal withdrawal (1)

• withdrawal symptoms and poor neonatal adaptation syndrome have been associated in infants exposed to gabapentin or pregabalin in pregnancy
  • is more likely to occur for exposure near delivery or when more than one centrally acting medicine is used
• continuing breastfeeding may theoretically help relieve withdrawal effects but does not reduce the risk completely

Reference:

1. NHS Specialist Pharmacy Service (February 2026). Using gabapentin or pregabalin whilst breastfeeding
2. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Gabapentin. [Updated 2025 Apr 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501224/