Sumatriptan is the most widely used triptan in breastfeeding because we have more evidence on its compatibility.
See also Migraine treatment and Breastfeeding – Breastfeeding and Medication
and training powerpoint on migraine prevention and treatment Migraine and breastfeeding powerpoint –
Migraine and breastfeeding powerpoint – Breastfeeding and Medication
In 1996 Wojnar et al concluded that It is excreted in breastmilk in clinically insignificant amounts (Wojnar-Horton, R.E., Hackett, L.P., Yapp, P., Dusci , L.J., Paech, M. and Ilett, K.F. (1996), Distribution and excretion of sumatriptan in human milk. British Journal of Clinical Pharmacology, 41: 217-221.).https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2125.1996.tb00185.x. They determined that If oral bioavailability in the infant is similar to that in adults (14%), the weight-adjusted infant dose is reduced to 0.49%.
LactMed reports that “Some authors have suggested that withholding breastfeeding for 8 hours after a single subcutaneous injection would virtually eliminate infant exposure to the drug.[citing Wojnar] The manufacturer recommends withholding breastfeeding for 12 hours after a dose. Withholding breastfeeding might be helpful in extreme cases, such as in the mother of a preterm infant, but sumatriptan would not be expected to cause any adverse effects in most breastfed infants.”
Hale and Krutsch cite a half life of 2-3 hours, plasma protein binding 14-21%, milk-plasma ratio 4.9 and an oral bioavailability of 14%. From this they determine a relative infant dose of 0.53% – 3.51%.
Anecdotally many mothers use triptans whist breastfeeding without causing any adverse effects in their babies .
Whilst the manufacturer recommends not breastfeeding for 12 hours this seems unnecessarily cautious considering the limit amount in breastmilk and absorption by the baby. https://www.nhs.uk/medicines/sumatriptan/pregnancy-breastfeeding-and-fertility-while-taking-sumatriptan/
