The Basics
What is Alprazolam?
Used to treat anxiety disorders and panic disorder.
Brand names for Alprazolam
Xanax
How Alprazolam is classified
Desloratadine, Fexofenadine, Loratadine.
Alprazolam During Pregnancy
Alprazolam pregnancy category
Category D
Note that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Alprazolam while pregnant
Not recommended for use in pregnancy. Therefore, inform your physician if you are pregnant, if you are planning to have a child, or if you become pregnant while you are taking this medication.
Taking Alprazolam While Breastfeeding
What are recommendations for lactation if you're taking Alprazolam?
Because of reports of effects in infants, including sedation, alprazolam is probably not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred. After a single dose of alprazolam, there is usually no need to wait to resume breastfeeding.
Maternal / infant drug levels
Because of reports of effects in infants, including sedation, alprazolam is probably not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred. After a single dose of alprazolam, there is usually no need to wait to resume breastfeeding.
Possible effects of Alprazolam on milk supply
Unlike other benzodiazepines, alprazolam can increase serum prolactin.[6][7] One woman developed galactorrhea, amenorrhea and elevated serum prolactin after taking 3 mg of sustained-release alprazolam and 5 to 6 mg of immediate-release alprazolam daily for several months for self-treatment of fear, poor sleep, palpitations and gastrointestinal discomfort. After slow discontinuation of alprazolam and institution of quetiapine and fluvoxamine, galactorrhea ceased after about one month, menses normalized after about 2 months, and serum prolactin decreased to a normal level.[8] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Possible alternatives to Alprazolam
Lorazepam, Oxazepam.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 1. Oo CY, Kuhn RJ, Desai N et al. Pharmacokinetics in lactating women: prediction of alprazolam transfer into milk. Br J Clin Pharmacol. 1995;40:231-6. PMID: 8527284
2. Furugen A, Nishimura A, Kobayashi M et al. Quantification of eight benzodiazepines in human breastmilk and plasma by liquid-liquid extraction and liquid-chromatography tandem mass spectrometry: Application to evaluation of alprazolam transfer into breastmilk. J Pharm Biomed Anal. 2019;168:83-93. PMID: 30798209
3. Anderson PO, McGuire GG. Neonatal alprazolam withdrawal — possible effects of breast feeding. DICP. 1989;23:614. Letter. PMID: 2763587
4. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID: 8498418
5. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr. 2012;161:448-51. PMID: 22504099
6. Zemishlany Z, McQueeney R, Gabriel SM, Davidson M. Neuroendocrine and monoaminergic responses to acute administration of alprazolam in normal subjects. Neuropsychobiology. 1990-1991;23:124-8. PMID: 2098668
7. Madhusoodanan S, Parida S, Jimenez C. Hyperprolactinemia associated with psychotropics–a review. Hum Psychopharmacol. 2010;25:281-97. PMID: 20521318
8. Petric D, Peitl MV, Peitl V. High doses alprazolam induced amenorrhoea and galactorrhoea. Psychiatr Danub. 2011;23:123-4. PMID: 21448116
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
