Is Zolpidem safe while breastfeeding?

Summary of use during breastfeeding

The levels of zolpidem in breastmilk are low and is rapidly eliminated from milk, so it would not be expected to cause any adverse effects in older breastfed infants who does not breastfeed during the night after the mother’s dose. The manufacturer states that excess sedation in infants exposed to zolpidem through breastmilk has been reported, although details are lacking. Some expert opinion recommends against zolpidem use during breastfeeding, primarily because of the lack of robust documentation.[1] Monitor the infant for sedation, poor feeding and poor weight gain.

Effects on the breastfed infant

The mother of a newborn was taking 5 to 10 mg of zolpidem nightly. At the one-month checkup, no adverse effects were noted by the patient’s pediatrician.[3]

Three infants were breastfed by mothers taking zolpidem 5 mg daily (n = 2) or as needed (n = 1). No abnormalities were found at the one-month checkup.[4]

An infant was partially breastfed by a mother taking zolpidem 5 mg daily and bromazepam 6 mg daily. No abnormalities were found at the infant’s 1-month and the 3-month checkups.[5]

Effects on milk supply

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

Levels in milk

Maternal Levels. Five nursing mothers who were 3 to 4 days postpartum were given a single oral dose of zolpidem 20 mg. Milk collected 3 hours after the dose contained between 0.76 and 3.88 mcg of zolpidem. This corresponded to 0.004 to 0.019% of the maternal dosage. The drug was undetectable (<0.5 mcg/L) in milk 13 and 16 hours after the dose. The authors estimated the half-life in milk to average 2.6 hours.[2]

A woman was taking zolpidem 5 mg nightly for sleep. Breastmilk concentrations were measured at 3 times postpartum: day 1 at 8.2 hours after a dose the concentration was 12.8 mcg/L; day 2 at 9 hours after the dose the concentration was 6.4 mcg/L; day 3 at 2.2 hours after the dose the concentration was 26.5 mcg/L. The authors estimated the maximum infant dose to be 4 mcg/kg daily based on the day 3 value.[3]

Two pregnant women took zolpidem 5 mg doses daily during pregnancy and postpartum. One woman had a breastmilk zolpidem concentration of 10.1 mcg/L at 6.5 hours after a dose on day 6 postpartum. The other woman had milk zolpidem concentrations ranging from 0.6 mcg/L mcg/L at 18.1 hours after a dose on day 2 postpartum to 4.8 mcg/L at 10.1 hours after a dose on day 3 postpartum. A third woman who took a 5 mg dose as needed had a milk level of 3.4 mcg/L at 17.2 hours after a dose on day 1 postpartum. On day 7, 105 hours after a dose, zolpidem was undetectable in milk.[4]

A woman taking zolpidem 5 mg daily provided 3 milk samples on day 6 postpartum at 35.7 to 69.8 hours after the last dose. Milk zolpidem concentrations were all <0.1 mcg/L.[5]

Infant Levels. Three infants were breastfed by mothers taking zolpidem 5 mg daily (n = 2) or as needed (n = 1). The infants were breastfed 4 to 6 times daily. All of the infants had undetectable (< 0.05 mcg/L) serum levels of zolpidem.[4]

An infant was partially breastfed by a mother taking zolpidem 5 mg daily. A serum concentration of 20 mcg/L at 5.8 hours after the dose on day 1 postpartum probably reflects transplacental passage. A serum concentration of 2.1 mcg/L at 17.4 hours after the mother’s dose on day 2 day postpartum likely reflects breastmilk passage.[5]

Alternatives LactMed lists

• Zaleplon

Zolpidem in pregnancy

LactMed covers breastfeeding only. For what the NHS and the US prescribing label say about pregnancy, see:

• Is zolpidem safe in pregnancy and breastfeeding?