Weight Loss Medications
Generally, there is little research available on medications indicated for weight loss. Knowledge of medications in this category is most often based on known biochemical principles or limited data. Many classes of these medications are not an absolute indication to pump and dump, however in some cases alternatives may be preferred.
GLP1 Receptor Agonists
GLP1 Receptor Agonists include liraglutide/Victoza/Saxenda, semaglutide/Ozempic. Data is limited so these medications should be used with caution or an alternative may be preferred in the breastfeeding dyad (especially in high risk situations such as with premature infants). These drug molecules are very large peptides and the amount of these medications in breast milk is suspected to be low. Due to the nature of being a peptide molecule, the small amount that may enter the breast milk would likely be destroyed by the infant GI tract and not be absorbed by the infant. While data is limited, there is no absolute indication to pump and dump. For more information, see the section on Diabetes Medications.
Medications Altering Fat Digestion: Pancreatic Lipase Inhibitors
Orlisat/xenical alters fat digestion and is poorly absorbed from the GI tract. A small amount of medication was found in the breastmilk of one mother, but this level was thought to be low enough to not pose significant risk to the infant (1). This medication is known to inhibit the absorption of fat-soluble vitamins so lactating individuals should be counseled to take a multivitamin while nursing and to eat a well-balanced diet high in fat-soluble vitamins. There is no absolute indication to pump and dump.
CNS Stimulants include phentermine/Adipex/Lomaira, benzphentamine/Regimex. Data on the use of this medication in lactating individuals is limited. Per, it will theoretically readily enter human milk in significant quantities and is likely to be hazardous or cause side effects in the infant due to the CNS stimulation effects of this medication. Phentermine should be avoided in lactating individuals and alternative medications should be used due to the lack of data on this class of medication in lactating individuals and their infants and the significant theoretical risk of harm to the infant.
The anticonvulsant topiramate/Topamax is used for weight loss at times. Infant blood levels for this medication remain low with maternal doses up to 200 mg daily. No long-term infant risks have been found. However, there are reports of infant side effects including diarrhea and drowsiness so infants should be monitored for side effects if this medication is used. While infants should be monitored closely for side effects (diarrhea, sedation), there is no absolute indication to pump and dump. For more information, see the section on Antiseizure Medications.
Qysmia is a weight loss combination medication composed of Topamax and phentermine. Due to the concern for significant risks to the infant with the use of phentermine during lactation as noted above, an alternative is preferred and the use of Qsymia should be avoided in lactating individuals.
Contrave is a weight loss combination medication composed of naltrexone and bupropion. Small amounts of both components of Contrave – naltrexone and bupropion – are found in breastmilk. With maternal doses of up to 300 mg of bupropion, milk transfer has been shown to be low. Breastfed infants of lactating parents taking bupropion and an SSRI should be closely monitored for vomiting, diarrhea, jitteriness, or sedation. There has been one case report of a possible seizure in a 6-month-old partially breastfed infant whose mother was taking bupropion with escitalopram (2). Alternatives are preferred for high-risk dyads and parents on multiple psychoactive medications and infants should be monitored closely for side effects due to concerns with the use of bupropion based on the case report above. The use of this medication is not an absolute indication to pump and dump and patients and physicians should engage in shared decision making, especially if the patient is on higher doses or other psychoactive medications. For more information on bupropion, see the section on Perinatal Mood & Anxiety Disorder Medications. For more information on naltrexone, see the section on Pain Medications.
- Musatadi M, Gonzalez-Gaya B., Irazola M., et al. Multi-target analysis and suspect screening of xenobiotics in milk by UHPLC-HRMS/MS. Separations. 2021; 8. DOI: https://doi.org/10.3390/separations8020014
- Neuman G, Colantonio D, Delaney S, et al. Bupropion and escitalopram during lactation. Ann Pharmacother. 2014; 48:928-931. DOI: https://doi.org/10.1177/1060028014529548Med