Can you use Aimovig while breastfeeding?

In this article:

• Can you use Aimovig while breastfeeding?
• What are the risks of using Aimovig while breastfeeding?
• What can I take instead of Aimovig while breastfeeding?

In this article

• Can you use Aimovig while breastfeeding?
• What are the risks of using Aimovig while breastfeeding?
• What can I take instead of Aimovig while breastfeeding?

Aimovig (erenumab) is a brand-name medication that’s approved by the Food and Drug Administration (FDA) to help prevent migraine. It’s given once a month by subcutaneous (under the skin) self-injection. Aimovig belongs to a class of medications called calcitonin gene-related peptide receptor (CGRP) inhibitors. It works by blocking the action of substances in the body that cause migraine headaches.

Migraine headaches and chronic migraine can be debilitating conditions. People who live with migraine rely on medication to prevent migraine attacks from interfering with their quality of life. But what happens when you become a parent? Many parents specifically want to know if you can use Aimovig while breastfeeding.

Here, we’ll take a close look at Aimovig and breastfeeding, including what the experts say, what possible risks may be, and alternative migraine treatments. 

Can you use Aimovig while breastfeeding?

Unfortunately, there simply isn’t robust data on the safety of Aimovig and breastfeeding, including how it might affect babies or milk production. For this reason, many providers don’t readily recommend Aimovig while breastfeeding, though exceptions are possible.

“There isn’t a lot of solid data on the safety of taking this drug during lactation,” says Andrew Youssouf, MD, who is double board-certified in addiction medicine and emergency medicine and is the medical director of Ikon Recovery. Because of this, Dr. Youssouf says he recommends exploring other options before using Aimovig while breastfeeding. “Due to the lack of extensive research, I generally recommend caution, especially during the early postpartum period or when nursing a newborn or preterm infant,” he explains. “If you’re considering Aimovig, it’s best to have a detailed conversation with your healthcare provider to weigh the benefits against any potential risks.”

Noah Rosen, MD, a neurologist with Northwell Health, has a similar recommendation. “It is still not known whether Aimovig is safe in breastfeeding,” Dr. Rosen says. However, there may be some indications that it may be safe. “There are preclinical animal studies of other similar large molecules that suggest the amount of antibody likely to pass would be very low and that is likely to be degraded in the gastrointestinal system of the baby.”

Still, Dr. Rosen says there simply aren’t enough clinical trials on Aimovig and breastfeeding for healthcare professionals to recommend it. In two published cases, blood levels of Aimovig in the breastfed infant were negligible, “but that is not enough to make the case for all women using this medicine,” he says. “I currently hold off on the use of CGRP antibodies for now in these cases, provided other options for prevention can be used.” 

What are the risks of using Aimovig while breastfeeding?

Like any medication, Aimovig can have adverse effects at times. Some possible side effects of Aimovig include:

• Injection site soreness, pain, redness, and itchiness
• Constipation
• Muscle spasms
• Increased blood pressure
• Cramping
• Allergic reactions

There are certain people who shouldn’t use Aimovig, including people with a hypersensitivity to erenumab or a history of allergic reactions to it. Similar to breastfeeding, when it comes to pregnancy, there isn’t enough data to know whether using Aimovig during pregnancy presents issues to babies. But the little data we have is promising. When pregnant monkeys were given Aimovig, no adverse effects were seen in their offspring. However, we do not yet know for sure that these findings translate to humans.

As for breastfeeding, the bottom line is that we lack any meaningful data on the risk of using Aimovig while breastfeeding. “Some case reports suggest minimal risk, with no observed adverse effects in infants whose mothers used Aimovig during breastfeeding,” says Dr. Youssouf. As such, he says the safest approach is to only use it when absolutely necessary and when the benefits outweigh the potential risks.

That being said, there is no evidence as of yet that using Aimovig while breastfeeding poses any risk to the baby, or that it reduces milk supply. “However, the long-term implications of infant exposure are still not known,” Dr. Rosen says. “Risks may be negligible and no significant short-term dangers have been described, but enough is still not known.”

What can I take instead of Aimovig while breastfeeding?

Ultimately, the decision whether to use Aimovig or not while breastfeeding will be between you and your healthcare provider. According to the Centers for Disease Control and Prevention, most prescription medications are safe for breastfeeding parents to use. The American Academy of Pediatrics (AAP) gives the same advice, emphasizing that whether or not to take a medication is something you and your healthcare provider will discuss, weighing factors like:

• How necessary the drug is for the mother
• Any potential adverse effects
• How much of it is excreted into breast milk
• How well it’s absorbed by the baby
• How old the baby is
• How frequently the baby breastfeeds

If your healthcare provider decides that the risks of using Aimovig outweigh any benefits, you have other options for migraine relief. There are several Aimovig alternatives you may be able to try that may be more breastfeeding-friendly.  

Pain relievers and preventive medications

According to Dr. Youssouf, certain pain relievers can be used to treat the pain and discomfort associated with migraine. “If you are wanting migraine relief during breastfeeding, safer options include acetaminophen and ibuprofen,” he says. “Other options like propranolol, a beta blocker, can also be considered under medical advisement.” While drugs like acetaminophen or ibuprofen can help with migraine pain as it occurs, beta blockers are used to prevent migraine.

Both acetaminophen and ibuprofen are breastfeeding-friendly, according to LactMed, a drugs and lactation database from the National Library of Medicine. Propranolol is excreted in low levels in breast milk and studies haven’t found adverse reactions among breastfed babies whose mothers have taken it.

Serotonin receptor agonists (triptans)

Selective serotonin receptor agonists, also known as triptans, can be useful in treating the symptoms of migraine and chronic migraine. “The use of subcutaneous Imitrex (sumatriptan) had been studied in breastfeeding and showed some expression in breast milk,” Dr. Rosen says. But the levels of sumatriptan excreted into breast milk are small, and it’s poorly absorbed by babies. Previously, mothers were instructed to pump their breast milk and then dispose of it after using sumatriptan, but Dr. Rosen said that is no longer the recommendation. “Now it is more common to simply limit dosing,” he explains. 

Anti-nausea medications

Migraine attacks aren’t just painful. They can include a whole host of unpleasant bodily symptoms. One prominent symptom is nausea. As such, taking anti-nausea medication can be helpful during migraine attacks. According to Dr. Rosen, some of these medications are safe during breastfeeding. One such medication is Zofran (ondansetron). No adverse effects in babies have been seen with the use of Zofran while breastfeeding.

As with all of these medications, you should only take them after consulting your healthcare provider. You also can’t overestimate the power of lifestyle modifications on migraine. Working on eliminating migraine triggers can be a powerful way to prevent migraine attacks. Here are recommendations from Dr. Rosen and Dr. Youssouf:

• Prioritize getting enough quality sleep and sticking to a regular sleep schedule, even on the weekends
• Stay well-hydrated
• Practice stress management
• Try acupuncture
• Track your dietary triggers and try to adjust your diet based on that
• Consider massage
• Try meditation
• Use progressive muscle relaxation

If you have any further questions about Aimovig and breastfeeding, don’t hesitate to reach out to your healthcare provider. Each person’s situation unit is unique, and only your healthcare provider will be able to determine whether this medication is safe for you and your baby.