Epinephrine and Breastfeeding

Summary of use during lactation

No information is available on the use of epinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any epinephrine in milk is unlikely to affect the infant. High intravenous doses of epinephrine might reduce milk production or milk letdown. Low-dose intramuscular (such as Epi-Pen), epidural, topical, inhaled or ophthalmic epinephrine are unlikely to interfere with breastfeeding. To substantially diminish the effect of the drug after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue. Epinephrine is the first line-medication of choice for treatment of anaphylaxis; it should be used in the same manner in breastfeeding and non-breastfeeding patients.

Drug levels in milk and infant serum

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

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

Effects on lactation and breastmilk

Relevant published information in nursing mothers was not found as of the revision date. Intravenous epinephrine infusion in nonnursing subjects and in women with hyperprolactinemia decreases serum prolactin concentrations.[1] Animal data indicate that intraarterial epinephrine can decrease serum oxytocin and inhibit milk ejection.[2,3] However, low-dose infusion of epinephrine as part of epidural analgesia does not impair breastfeeding in nursing mothers.[4,5] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. An Egyptian study compared lidocaine 2% (n = 75) to lidocaine 2% plus epinephrine 1:200,000 (n = 70) as a wound infiltration following cesarean section. Patients who received epinephrine in combination with lidocaine began breastfeeding at 89 minutes following surgery compared to 132 minutes for those receiving lidocaine alone. The difference was statistically significant.[6]

References

1. NicolettiI FilipponiP SfrappiniM Catecholamines and pituitary function. I. Effects of catecholamine synthesis inhibition and subsequent catecholamine infusion on gonadotropin and prolactin serum levels in normal cycling women and in women with hyperprolactinemic amenorrhea. Horm Res 1984 19 158 70 6425187 PubMed
2. GorewitRC AromandoMC Mechanisms involved in the adrenalin-induced blockade of milk ejection in dairy cattle. Proc Soc Exp Biol Med 1985 180 340 7 4048172 PubMed
3. SongSL CrowleyWR GrosvenorCE Evidence for involvement of an adrenal catecholamine in the beta-adrenergic inhibition of oxytocin release in lactating rats. Brain Res 1988 457 303 9 2851365 PubMed
4. ChangZM HeamanMI Epidural analgesia during labor and delivery: Effects on the initiation and continuation of effective breastfeeding. J Hum Lact 2005 21 305 14 16113019 PubMed
5. RadzyminskiS. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs 2003 32 322 31 12774874 PubMed
6. TharwatAA YehiaAH WahbaKA Efficacy and safety of post-cesarean section incisional infiltration with lidocaine and epinephrine versus lidocaine alone in reducing postoperative pain: A randomized controlled double-blinded clinical trial. J Turk Ger Gynecol Assoc 2016 17 1 5 27026771 PubMed