Lithium use while breastfeeding

For a patient in whom the harm–benefit analysis indicates that treatment with lithium is required in the postnatal period, advise against breastfeeding. The passage of lithium into the breastmilk is highly variable and there is a risk of lithium toxicity in the infant, with associated thyroid dysfunction, nephrotoxicity and neurotoxicity. Infants can easily become dehydrated, placing them at risk of lithium toxicity. Obtaining infant blood lithium concentrations via venepuncture may be traumatic for the infant and interpretation of the results can be difficult.

Although these guidelines and international consensus do not recommend breastfeeding during lithium therapy, some centres have advocated this practice on the basis. that breastfeeding offers many benefits, and there are limited data of serious harm. If lithium is taken while breastfeeding, the infant must be closely monitored by their paediatrician (if possible, or their general practitioner). Consider regularly monitoring the infant’s kidney and thyroid function and blood lithium concentration.

For advice on lithium use in females of childbearing potential, see here.