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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

If the baby of a mother receiving midazolam sedation is more than 2 months of age breastfeeding can continue as normal.  If the baby is less than 2 months waiting 4 hours may be justified but in view of the way the drug is handled in the body the risk of continuing to breastfeed as normal is low especially if the baby is exclusively breastfed.

Some people become very anxious about undertaking dental procedures and prefer to be sedated prior to the filling or extraction. The drug normally used is midazolam which is injected. This drug is also used in several other procedures such as colonoscopy, endoscopy or other explorative surgery.

Lactmed states “The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. Two expert panels advocate waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing (Shergill 2012 Vargo 2012).  However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age.

Hale reports that in a study of five lactating women who received a single 2 mg IV dose, milk levels of midazolam were exceedingly low after 7 hours. The median amount of midazolam recovered within 24 hours was only 26 µg which was only 0.004% of the maternal dose of 2 mg (Nitsun 2006).  Midazolam is so rapidly redistributed to other tissues from the plasma compartment, milk levels will invariably be exceedingly low

For healthcare professionals: Midazolam has a very rapid onset of action and excretion. It is highly protein bound (97%) and poorly bio available making it poorly absorbed from the gut (27-44%). It’s half life is 2-5 hours.

References

• Hale T W Medications and Mothers Milk 2016 (17th Ed)
• LACTMED http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACTMED
• Nitsun M, Szokol JW, Saleh HJ, Murphy GS, Vender JS, Luong L, Raikoff K, Avram MJ. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther 2006; 79(6):549-557
• Shergill AK, Ben-Menachem T, Chandrasekhara V et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76:18-24. PMID: 22579258
• Vargo JJ, Delegge MH, Feld AD et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012;143:e18-41. PMID: 22624720

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network August 2020