Ergotamine and Breastfeeding

Summary of use during lactation

There is limited published experience with ergotamine during breastfeeding and it might cause adverse effects in the infant and decrease milk supply. Most authorities consider ergotamine to be contraindicated during nursing.[1-5]

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

A study in which ergotamine was administered to mothers of newborns immediately postpartum in a dose of 1 mg 3 times daily for 6 days found no effect on weight gain in the breastfed infants.[6] Milk intake, and therefore infant dosage, might have been minimal during the first few days before the mothers' milk came in fully.

Effects on lactation and breastmilk

Thirty women who delivered fullterm infants received a single intramuscular dose of methylergonovine 0.2 mg after delivery, followed by oral ergotamine 1 mg 3 times daily for 6 days. Compared to 28 women who delivered fullterm infants and received no ergot derivatives, there was no difference in the milk production, as measured by weight differences before and after nursing, between the 2 groups during the first 6 days postpartum.[6] A woman who was given ergotamine postpartum for lochia retention experienced severe nipple pain consistent with vasospasm of the nipple or Raynaud syndrome. She was unable to nurse her infant directly, but pumped and fed expressed milk by bottle. The drug had no apparent adverse effect on the milk supply or the infant.[7]

Alternative drugs to consider

Eletriptan, Rizatriptan, Sumatriptan, Zolmitriptan

References

1. MorettiME LeeA ItoS Which drugs are contraindicated during breastfeeding? Can Fam Physician 2000 46 1753 7 11013791 PubMed
2. WHO Department of Child and Adolescent Health and Development. Breastfeeding and maternal medication. Recommendations for drugs in the eleventh WHO model list of essential drugs. 2002.
3. DavanzoR BuaJ PaloniG Breastfeeding and migraine drugs. Eur J Clin Pharmacol 2014 70 1313 24 25217187 PubMed
4. MacGregorEA Migraine in pregnancy and lactation. Neurol Sci 2014 35 Suppl 1 61 4
5. AndersonPO Migraine drug therapy during breastfeeding. Breastfeed Med 2019 14 445 7 31347910 PubMed
6. JolivetA RobynC Huraux-RenduC [Effect of ergot alkaloid derivatives on milk secretion in the immediate postpartum period] J Gynecol Obstet Biol Reprod (Paris) 1978 7 129 34 641312
7. MorzeK. Finding a path in a maze. identification of an adverse reaction during lactation based on a case study of ergotamine. Breastfeed Med 2023 18 A3 10.1089/bfm.2023.29239.abstracts