On my mission again today to write information on the frequently asked questions by mothers and professionals. Neuropathic pain affects many mothers with chronic conditions and the data is not easy to find. I hope this information, much taken from my book, is useful.
If these fact sheets are proving helpful in your practice maybe you need a copy of Breastfeeding and Medication – available from Amazon and Routledge
pdf Neuropathic pain and breastfeeding
In Feb 2026 SPS posted “Both gabapentin and pregabalin are compatible with breastfeeding. Gabapentin is the preferred choice, as there is more published evidence of its use during breastfeeding. There are no data on long term developmental effects for gabapentin or pregabalin from infant exposure via breast milk.” https://www.sps.nhs.uk/articles/using-gabapentin-or-pregabalin-during-breastfeeding
Unlike most other types of pain, neuropathic pain doesn’t usually get better with common
painkillers, such as paracetamol and ibuprofen. The three drugs normally used to treat this type of pain are amitriptyline, gabapentin and pregabalin.
Amitriptyline
Amitriptyline has been used for many years even in breastfeeding women as an antidepressant as well as to treat neuropathic pain. Mothers taking amitriptyline should be counselled to take care with co-sleeping as their natural responses will be altered.
Amitriptyline undergoes extensive first-pass metabolism. It is extensively bound to plasma proteins. The levels measured in breastmilk are low because of this.
Bader and Newman (1980) studied a mother who took amitriptyline 100 mg daily for six weeks postpartum. She had breastmilk levels of amitriptyline and its metabolite nortriptyline of 151 and 59 µg per litre, respectively. This was calculated to represent 1.8% of the maternal weight-adjusted dosage. There were no reports of adverse effects on the baby. Misri and Sivertz (1991) followed-up a group of 20 breastfed infants whose mothers were taking a TCA for up to three years and found no adverse effects on growth and development even at a dose of 150 mg daily. Brixen-Rasmussen et al. (1982) studied a 3-week-old breastfed baby who had undetectable serum amitriptyline (<5 µg per litre) and nortriptyline (<15 µg per litre) during maternal amitriptyline use of 75 mg daily. Relative infant dose is quoted as 1.5% (Hale 2017 online access). The BNF states that the amount in breastmilk is too small to be harmful.
Compatible during breastfeeding due to extensive plasma protein binding and first-pass
metabolism.
References
Bader TF, Newman K, Amitriptyline in human breastmilk and the nursing infant’s serum, Am
J Psychiatry, 1980;137(7):855–6.
Gabapentin
Gabapentin is used to treat neuropathic pain as well as for its anti-epileptic activity. There is
moderate-quality evidence that oral gabapentin at doses of 1200 mg daily or more has an important effect on pain in some people with moderate or severe neuropathic pain after shingles or due to diabetes (Wiffen et al. 2017).
Limited information indicates that maternal doses of gabapentin up to 2.1 g daily produce relatively low levels in infant serum (Goa and Sorkin 1993). No adverse effects on the children have been noted in several studies and infant plasma levels have been low to undetectable (Ramsay 1994; Dichter and Brodie 1996). Minimal plasma protein binding is apparent with gabapentin. Öhman et al. (2005) studied six women taking 0.9–3.2 g gabapentin and their babies. The infant dose of gabapentin was estimated to be 0.2–1.3 mg per kilogramme per day. No adverse effects were observed. The plasma concentrations in the breastfed infants were approximately 12% of the mother’s plasma levels. Kristensen et al. (2006) studied one mother and baby pair and determined a m/p ratio of 0.86 and a relative infant dose of 2.34%. No adverse effects were noted in the baby. The baby should be monitored for drowsiness and adequate weight gain, particularly if the mother is receiving a multiple drug therapy regime. Relative infant dose quoted as 6.6% (Hale 2017 online access). The BNF relative safety in breastfeeding as above. Present in milk so the manufacturer advises use only if potential benefit outweighs risk (BNFC). Probably compatible with use during breastfeeding. Observe for sedation, poor feeding.
References
Dichter MA, Brodie MJ, New antiepileptic drugs, N Engl J Med, 1996;334(24):1583–90.
Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, Moore RA, Gabapentin for chronic
neuropathic pain in adults, Cochrane Database Syst Rev, 2017Jun 9;6:CD007938.
Goa KL, Sorkin EM, Gabapentin. A review of its pharmacological properties and clinical
potential in epilepsy, Drugs, 1993;46(3):409–27.
Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, Moore RA, Gabapentin for chronic
neuropathic pain in adults, Cochrane Database Syst Rev, 2017Jun 9;6:CD007938.
Kristensen JH, Ilett KF, Hackett LP, Kohan R, Gabapentin and breastfeeding: a case report, J
Hum Lact, 2006;22:426–8.
Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, Moore RA, Gabapentin for chronic
neuropathic pain in adults, Cochrane Database Syst Rev, 2017Jun 9;6:CD007938.
Öhman I, Vitols S, Tomson T, Pharmacokinetics of gabapentin during delivery, in the
neonatal period, and lactation: does a fetal accumulation occur during pregnancy? Epilepsia,
2005;46:1621–4.
Ramsay RE, Clinical efficacy and safety of gabapentin, Neurology, 1994;44(6 Suppl. 5): S23–
S30.
Kristensen JH, Ilett KF, Hackett LP, Kohan R, Gabapentin and breastfeeding: a case report, J
Hum Lact, 2006;22:426–8.
Öhman I, Vitols S, Tomson T, Pharmacokinetics of gabapentin during delivery, in the
neonatal period, and lactation: does a fetal accumulation occur during pregnancy? Epilepsia,
2005;46:1621–4.
Pregabalin
There are no published research studies on the effect of pregabalin on the breastfed baby. It is
prescribed in epilepsy, for neuropathic pain and for generalised anxiety disorder. Anecdotally I am
aware that it is being used. One mother told me it made her baby drowsy and she discontinued the
drug. This cannot be taken as clinical evidence.
In a study of 10 healthy women (median 35 weeks postpartum) given pregabalin 150 mg twice daily
for 4 doses Lockwood determined that the relative infant dose was 7.18% and the absolute infant
dose 0.31 mg/kg/day. The infants in this study were not breastfed.
The breastfed infant of a woman who was taking pregabalin as an anticonvulsant during pregnancy
had a pregabalin serum concentration of 429 mcg/L at 48 hours postpartum, (8% RID). Some of the
infant’s serum concentration could have been derived from transplacental passage.
There is a more recent case study (Gallego 2020) of one mother who experienced pain due to
Raynaud’s Phenomenon. Pregabalin was added to nifedipine at a dose of 75mg twice a day. Her
baby was breastfed for 3 months and showed no adverse effects.
The half life of pregabalin is 6 hours and it is not bound to plasma proteins. It is orally highly
bioavailable (90% Hale online access). Hale quotes the relative infant dose as 7.18% (below the 10%
normally defined as compatible with breastfeeding Lactmed comments that “Very limited data
indicate that amounts of pregabalin in breastmilk are low. If pregabalin is required by the mother of
an older infant, it is not a reason to discontinue breastfeeding”. The BNF makes no recommendation
on its use in lactation.
If a mother is taking it during breastfeeding she should observe the baby for drowsiness, and
effective feeding as well as signs of constipation. She should take care with co-sleeping as it may
cause her symptoms of drowsiness meaning she is less aware of the baby.
References
- Lockwood PA, Pauer L, Scavone JM et al. The Pharmacokinetics of pregabalin in breast milk,
plasma, and urine of healthy postpartum women. J Hum Lact 2016.
Lactmed on line access https://toxnet.nlm.nih.gov - Hale TW Medications and Mother’s Milk online access
- Ohman I, De Flon P, Tomson T. Pregabalin kinetics in the neonatal period, and during
lactation. Epilepsia. 2011;52 (Suppl 6):249-50. Abstract p824. - Gallego H, Aleshaki JS. Raynaud phenomenon of the nipple successfully treated with
nifedipine and gabapentin. Cutis. 2020;105:e22–e3