Alendronate and Breastfeeding

Summary of use during lactation

Limited evidence indicates that breastfeeding after cessation of long-term bisphosphonate treatment appears to have no adverse effects on the infant. Because no information is available on the use of alendronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of alendronate by a breastfed infant is unlikely. If the mother receives a bisphosphonate during pregnancy or nursing, some experts recommend monitoring the infant's serum calcium during the first 2 months postpartum.[1]

Drug levels in milk and infant serum

Alendronate is poorly absorbed orally (average in adults 1% on an empty stomach, negligible with food and calcium), so absorption of alendronate by a breastfed infant is unlikely. Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Because alendronate can persist in the body for years after long-term administration, the following cases may be relevant. A woman received alendronate for 6 months, then pamidronate every 4 months for 1 year prior to conception. Her infant was breastfed (extent not stated) for 3 months. The infant had mild hypocalcemia at 2 months of age, but a normal calcium level and normal long bone development at 5 months of age.[2]

Effects on lactation and breastmilk

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

Alternative drugs to consider

Pamidronate

References

1. StathopoulosIP LiakouCG KatsaliraA The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones 2011 10 280 91 22281884 PubMed
2. Hassen-ZrourS KorbaaW BejiaI Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int 2010 21 709 10 19533208 PubMed