Pregabalin and breastfeeding

Pregabalin and breastfeeding

• seek expert advice in this scenario
• pregabalin can be used while breastfeeding, but with caution and infant monitoring
  • in comparison with pregabalin, gabapentin is the preferred choice, as there is more published evidence of its use during breastfeeding (1)
    • treatment choice should primarily focus on managing the underlying condition with suitability in breastfeeding as a secondary consideration
• pharmacokinetic model predicted that a maternal dosage of 150 mg daily would not result in a therapeutic level in an exclusively breastfed infant of any age (2)
• there is very limited published evidence for the use of pregabalin in breastfeeding (1,2)
  • limited data indicate that amounts of pregabalin in breastmilk are low and one infant breastfed for 3 months with no discernable adverse effects (2)

Milk levels and infant absorption

• the drug properties of pregabalin enable it to pass into breast milk
• is a small molecule and does not bind to proteins, therefore there are lots of free drug molecules to pass into milk
• data from one study shows that levels in milk are low and estimated at around 7% of the weight-adjusted maternal dose (2)
• a further study has demonstrated that infant serum levels are also low, and estimated to be around 8% of the maternal serum level (2)

Effects in infants

• have been no adverse effects, reported in any of the infants exposed to date. Due to the low levels reported in breast milk and infant serum, side-effects would not be expected
• are no data looking at long term infant effects

Monitoring the infant

• although adverse effects are highly unlikely from gabapentin or pregabalin exposure via breast milk, as a precaution monitor the infant for:
  • feeding; the infant should be feeding well and continue to gain weight as expected
  • over sleepy; for example, not waking to feed or sleeping for longer and more often than expected
  • slowed breathing
  • gastro-intestinal disturbances, including diarrhoea and constipation
• monitoring the infant will quickly pick up any potential issues, but usually further investigation is required before the cause can be identified
• if any of these adverse effects occur, the mother should contact a healthcare professional for advice

Notes:

• both gabapentin and pregabalin are compatible with breastfeeding (1)
  • gabapentin is the preferred choice, as there is more published evidence of its use during breastfeeding
  • are no data on long term developmental effects for gabapentin or pregabalin from infant exposure via breast milk.

Reference:

• NHS Specialist Pharmacy Service (February 2026). Using gabapentin or pregabalin whilst breastfeeding
• Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Pregabalin. [Updated 2024 Nov 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501821/