Summary of Use during Lactation

Limited evidence indicates that breastfeeding after cessation of long-term bisphosphonate treatment appears to have no adverse effects on the infant. Because no information is available on the use of alendronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of alendronate by a breastfed infant is unlikely. If the mother receives a bisphosphonate during pregnancy or nursing, some experts recommend monitoring the infant's serum calcium during the first 2 months postpartum.[1]

Drug Levels

Alendronate is poorly absorbed orally (average in adults 1% on an empty stomach, negligible with food and calcium), so absorption of alendronate by a breastfed infant is unlikely.

Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Because alendronate can persist in the body for years after long-term administration, the following cases may be relevant. A woman received alendronate for 6 months, then pamidronate every 4 months for 1 year prior to conception. Her infant was breastfed (extent not stated) for 3 months. The infant had mild hypocalcemia at 2 months of age, but a normal calcium level and normal long bone development at 5 months of age.[2]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

Alternate Drugs to Consider

Pamidronate

References

1.

Stathopoulos IP, Liakou CG, Katsalira A, et al. The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones. 2011;10:280–91. [PubMed: 22281884]

2.

Hassen-Zrour S, Korbaa W, Bejia I, et al. Maternal and fetal outcome after long-term bisphosphonate exposure before conception. Osteoporos Int. 2010;21:709–10. [PubMed: 19533208]

Substance Name

Alendronate

CAS Registry Number

66376-36-1

Drug Class

Breast Feeding

Lactation

Bisphosphonates

Bone Density Conservation Agents

Diphosphonates