Last update: Aug. 7, 2019
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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Ergot alkaloid and alpha adrenergic receptor antagonist with vasoconstrictor effect which is less effective than ergotamine.
Indicated in the treatment of acute migraine attack, usually together with caffeine. It is also used in orthostatic hypotension and prophylaxis of venous thromboembolism.
Subcutaneous, intramuscular, intranasal or oral administration every half hour if necessary, up to a maximum of 2-3 mg per day.
Since the last update we have not found published data on its excretion in breastmilk.
Its moderately high molecular weight and high plasma protein binding and large volume of distribution (AEMPS 2014, FDA 2008) make it unlikely it will transfer into breastmilk in significant amounts.
Its very low oral bioavailability (AEMPS 2014, FDA 2008) impedes its transfer from breastmilk to infant plasma, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.
Like other ergot alkaloids, it can inhibit prolactin secretion (Danjou 1989).
Occasional use and at a sufficient minimum dose would not create problems during breastfeeding.
Until there is more published data on this drug in relation to breastfeeding, safer known alternatives are preferable (Bordini 2016, Davanzo 2014, Duong 2010, Jürgens 2009, Loder 2007, MacGregor 2007, Moretti 2000), especially during the neonatal period and in cases of prematurity.
Sumatriptan, which is known to have minimal transfer to milk (Wojnar 1996), is a good alternative as a treatment for migraine during breastfeeding, and it is also more effective than the ergotamine/caffeine combination (Worthington 2013).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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