Is Digoxin safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Digoxin. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Because of the low levels of digoxin in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. If the mother is to receive digoxin intravenously, avoidance of breastfeeding for 2 hours after the dose will lessen the dose the infant receives.
Effects on the breastfed infant
At least 4 infants have been reported to have been breastfed in studies on digoxin in breastmilk. None had any detectable digoxin effect.[2,4,6]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. In 11 women taking digoxin 0.25 mg daily orally, milk digoxin levels obtained on days 3 to 7 postpartum were relatively constant at 0.644 mcg/L.[1] The amounts in milk represent an infant dosage of about 2.3% of the maternal weight-adjusted dosage or 0.097 mcg/kg daily, which is about 1% of the neonatal maintenance dosage.
Milk digoxin levels were 0.41 and 0.78 mcg/L in two mothers taking oral digoxin 0.25 mg daily.[2]
Milk digoxin levels ranged from undetectable (<0.5 mcg/L) to 1 mcg/L in 5 women treated with unspecified doses of digoxin. Milk and serum levels were similar.[3]
A milk digoxin level of 1.9 mcg/L was measured in a mother taking 0.75 mg daily of digoxin during pregnancy and postpartum.[4]
After an intravenous bolus dose of digoxin 0.5 mg in 11 women, digoxin serum and milk levels rapidly equilibrated, with high levels occurring rapidly, dropping to low levels by about 2 hours after the dose. A pharmacokinetic simulation using data from these mothers indicate that a fully breastfed infant would obtain a serum level of only about 3% of a therapeutic level with maternal intake of 0.5 mg daily of digoxin.[5]
Infant Levels. In two breastfed infants whose mothers were taking oral digoxin 0.25 mg daily, digoxin was undetectable (< 0.1 mcg/L) in their serum after 10 days of maternal therapy.[2]
A mother took 0.75 mg daily of digoxin during pregnancy and postpartum. Her infant had a serum level of 0.2 mcg/L after nursing for 7 days, having decreased from a level of 0.6 mcg/L at birth.[4]
Digoxin in pregnancy
LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Digoxin” (LM93). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.