Is Rizatriptan safe while breastfeeding?

Summary of use during breastfeeding

Breastmilk levels of rizatriptan are low and the half-life in milk is relatively short. Amounts ingested by the infant are small and unlikely to affect the nursing infant. Painful, burning nipples and breast pain have been reported after doses of sumatriptan and other triptans. This has occasionally been accompanied by a decrease in milk production.

Effects on the breastfed infant

Relevant published information was not found as of the revision date.

Effects on milk supply

A review of four European adverse reaction databases found 26 reported cases of painful, burning nipples, painful breasts, breast engorgement and/or painful milk ejection in women who took a triptan while nursing. Pain was sometimes intense and occasionally led to decreased milk production. Pain generally subsided with time as the drug was eliminated. The authors proposed that triptans may cause vasoconstriction of the arteries in the breast, nipples, and the arteries surrounding the alveoli and milk ducts, causing a painful sensation and a painful milk ejection reflex.[2]

Levels in milk

Maternal Levels. Five women who were at least 1 month postpartum and used rizatriptan to treat migraine provided one milk sample before their dose, then additional milk samples at 1, 2, 4, 8, 12 and 24 hours after their 10 mg oral dose. The average peak milk level was 58.4 mcg/L (range 14.6 to 105.6 mcg/L) and occurred 2 hours after the dose in 4 women ad 4 hours after the dose in another. The average milk level was 9 mcg/L (range 2.6 to 14.8 mcg/L) and the average half-life in milk was 2.2 hours (range 1.6 to 3.1 hours). The average daily infant dosage of rizatriptan was 1.3 mcg/kg (range 0.4 to 2.2 mcg/kg) and the weight-adjusted infant dosage averaged 0.9% (range 0.5 to 1.4%) of the maternal dose.[1]

Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Eletriptan
• Sumatriptan
• Zolmitriptan