Botox and Breastfeeding: Is it safe? What do studies say?

One of the biggest concerns a nursing mother has is the effects of any medications she is taking on her infant. Medications, like other ingested materials, can be potentially secreted into breast milk from maternal tissues and plasma through various methods including passive diffusion or binding to milk proteins. Indeed, research has provided sufficient evidence to suggest that nearly any drug that the mother had ingested will be present in her breast milk. A typical nursing mother will expect to breastfeed for a significant amount of time; the World Health Organization (WHO) recommends that a child be breastfed exclusively in their first six months and continued with complementary foods thereafter up to the age of two or beyond. During this period, the infant could potentially be exposed to all manners of maternally-ingested drugs through their mother’s milk.

Botox treatments

Botox (onabotulinumtoxinA) is a neurotoxin that inhibits the release of acetylcholine and stops neuromuscular activity. It is indicated for a variety of neuromuscular disorders, including cervical dystonia and blepharospasm, as well as a number of urologic and pain-associated conditions, like an overactive bladder and chronic migraines. Botox has a localized effect, meaning that its activity is usually limited to the site of injection. That being said, there is some evidence to suggest that Botox has an effect distal to the site of injection and that the effects are spread through networks of neurons. Given its widespread medical use, there is a real need to establish the safety of Botox use in lactating women. The greatest concern with the therapeutic use of botulinum toxins during breastfeeding is causing botulism in the baby. Botulism is a serious and life-threatening disease that is particularly dangerous for immunocompromised patients, such as infants, children, pregnant women, and the elderly. In fact, it is routinely advised that pregnant women and children avoid potential sources of botulism, such as foods like honey, cheeses, fermented fish and meats, and canned fruits and vegetables.

Is Botox safe while breastfeeding?

The record for Botulin A in the LactMed database has no data available on the medical use of Botox during breastfeeding. This view is also espoused by the manufacturer of Botox, Allergan, who also states that there is no data in respect to the presence of Botox in human or animal milk, the effects on a breastfed human, or the effects on milk production. As such, when considering Botox administration to a breastfeeding mother, the issues of importance that must be taken into consideration include the risk of adverse events to the breastfed infant from Botox injections and weighing the benefits of breastfeeding for the infant against the mother’s clinical need for treatment.  It goes on to mention that because the doses used medically are substantially lower than that needed to cause botulism, any amount that is expected to pass on to the infant would be small and will likely not cause any adverse effects in the breastfed infant.

LactMed cites one case of an infant being safely breastfed by a mother with botulism. The 24-year-old woman was breastfeeding her 8-month-old daughter when she contracted type A botulism from fermented salmon eggs, and the presence of type A botulinum toxin was detected in the mother’s serum and stool. However, no botulinum toxin or botulinum organisms were found in the mother’s breast milk. The infant was also observed for signs of botulism, but she never developed any symptoms. Furthermore, no botulinum toxin was found in her serum and stool. The infant continued to nurse throughout the mother’s illness without any untoward effects.

In general, there is a scarcity of data pertaining to the long and short-term effects of drug exposure on a breastfed child during lactation. This is mainly due to the ethical challenges associated with the inclusion of lactating women in clinical trials for drug testing. So, while a drug may be theoretically safe, there is usually little to no evidence available to validate this claim.

Should I get Botox while breastfeeding?

In the case of Botox, whatever limited data is available does suggest overall that breastfeeding while receiving Botox treatment will likely not cause any harm to the breastfed baby. That being said, given the lack of evidence and the potential harm to the breastfed infant, it is usually recommended that the mother not receive Botox injections during the time that she is breastfeeding her child. If it is necessary for health reasons that the mother is treated with Botox, it should be recommended that she discontinue nursing. Alternatively, to minimize exposure to the breastfed infant, the maternal dose may be administered right after a nursing period. In any case, the physician must always weigh the risks and benefits before deciding on administrating Botox to a breastfeeding mother. To establish the safety profile of Botox use in lactating mothers, further studies on the effects and safety of Botox in breast milk must be conducted.