Summary of Use during Lactation

There is minimal published experience with almotriptan during breastfeeding, although the dose in milk appears to be low. If almotriptan is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Painful, burning nipples and breast pain have been reported after doses of sumatriptan and other triptans. This has occasionally been accompanied by a decrease in milk production.

Drug Levels

Maternal Levels. One woman who was over 1 month postpartum took a single oral dose of almotriptan to treat migraine. She provided one milk sample before the dose, then additional milk samples at 1, 2, 4, 8, 12 and 24 hours after the dose. The peak milk level of 106.2 mcg/L occurred 2 hours after the dose. The average milk level was 29.6 mcg/L and the half-life in milk was 4 hours. The infant’s daily dosage of almotriptan was estimated to be 4.4 mcg/kg and the weight-adjusted infant dosage was 1.8% of the maternal dose.[1]

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 review of four European adverse reaction databases found 26 reported cases of, painful, burning nipples, painful breasts, breast engorgement and/or painful milk ejection in women who took a triptan while nursing. Pain was sometimes intense and occasionally led to decreased milk production. Pain generally subsided with time as the drug was eliminated. The authors proposed that triptans may cause vasoconstriction of the arteries in the breast, nipples, and the arteries surrounding the alveoli and milk ducts, causing a painful sensation and a painful milk ejection reflex.[2]

Alternate Drugs to Consider

Eletriptan, Rizatriptan, Sumatriptan, Zolmitriptan

References

1.

Amundsen S, Nordeng H, Fuskevåg OM, et al. Transfer of triptans into human breast milk and estimation of infant drug exposure through breastfeeding. Basic Clin Pharmacol Toxicol 2021;128:795-804. [PubMed: 33730376]

2.

Conijn M, Maas V, van Tuyl M, et al. Breastfeeding-related adverse drug reactions of triptans: A descriptive analysis using four pharmacovigilance databases. Breastfeed Med 2024;19:645-51. [PubMed: 38563407]

Substance Name

Almotriptan

CAS Registry Number

154323-57-6

Drug Class

Breast Feeding

Lactation

Milk, Human

Serotonin Receptor Agonists

Serotonin 5-HT1 Receptor Agonists

Triptans

Vasoconstrictor Agents