Summary of use during lactation
Because no information is available on the use of rabeprazole during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
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
A retrospective claims database study in the United States found that users of proton pump inhibitors had an increased risk of gynecomastia.[1] The Spanish pharmacovigilance system found one case of a 90-year-old man who developed gynecomastia associated with rabeprazole reported during the time period of 1982 to 2006. The reaction occurred after 32 days of therapy and resolved after discontinuation of the drug.[2] A review article reported that a search of database from the European Pharmacovigilance Centre found 11 cases of gynecomastia, 3 cases of galactorrhea, 2 cases of breast pain and 1 case of breast enlargement associated with rabeprazole. A search of the WHO global pharmacovigilance database found 38 cases of gynecomastia, 29 cases of galactorrhea, 28 cases of breast pain and 5 cases of breast enlargement associated with rabeprazole.[3] A woman was prescribed metronidazole 400 mg three times a day, and a combination product containing rabeprazole 20 mg and domperidone 30 mg daily for diarrhea and dyspepsia. After 3 days of treatment, she developed bilateral galactorrhea. The combination of rabeprazole and domperidone was thought to be the cause.[4] A 27-year-old woman with gastroesophageal reflux disease was prescribed rabeprazole 20 mg once daily. After 10 days of treatment, she complained of sudden-onset bilateral galactorrhea. A bilateral breast ultrasound demonstrated dilated retroareolar ducts containing anechoic fluid. Her serum prolactin level was 245 ng/mL (normal range 4.79 to 23.3 ng/mL). Ten days after discontinuing rabeprazole, her serum prolactin had returned to a normal value of 15.0 ng/mL and her symptoms resolved.[5]
Alternative drugs to consider
Antacids, Cimetidine, Famotidine, Omeprazole, Pantoprazole, Sucralfate
Source: Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, NCBI Bookshelf. Check LactMed for the most recent revision.
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