Is it necessary to avoid breast-feeding 24 hours after use of rizatriptan (Maxalt)? Are there other alternatives?
A 30 year-old woman with frequent migrainous attacks delivered a baby two weeks ago and tries to collect enough breast milk to supply her daughter for 24 hours in case of a migraine attack.
The recommendation not to breast-feed for 24 hours after intake of rizatriptan seems to be a precaution taken by the manufacturer due to lack of knowledge. A thorough literature search revealed no data on the passage of rizatriptan to breast milk.
The plasma concentration peak of rizatriptan is reached 1.5-2.5 hours after intake. The half-life is 2-3 hours. Oral bioavailability is 40-45% (1). Therefore plasma concentrations should be negligible 18 hours after intake. Avoiding breast-feeding for 24 hours therefore seems adequate.
Sumatriptan is the first drug of this class and is therefore the most studied triptan. It passes to breast milk to some extent, but the relative infant dose has been estimated to only 3.5% after a subcutaneous dose to the mother (2,3). Due to poor bioavailability (14%) (3), the risk of negative effects on the nursing child is considered to be low.
Due to lack of data, breast-feeding should be avoided for 24 hours after the use of rizatriptan. Sumatriptan, however, is a better-documented alternative judged to be compatible with breast-feeding.
Senast ändrad 2018-09-20