I am looking for some help when advising mothers who are taking Fluoxetine.
In my 2000 Medications and Mother's Milk, Dr. Hale strongly advises that
mothers not use Fluoxetine while breastfeeding.  He also states that the
infants blood level will be elevated at birth due to the mother's use during
pregnancy, which then exacerbates the levels when continuing postpartum.
Changing SSRI's needs to be done over a period of time to get an affective
level.  My question is why don't we recommend during the pregnancy that the
mother change to a drug that would be more suited to breastfeeding than to
wait until postpartum?  If the levels have a potential negative effect from
transplacental, why is this drug considered safe in pregnancy?
I am not an expert in this field but I want to help the mothers breastfeed
and feel comfortable with the medications they are taking.
Thanks for any help.
Ann Perry RN IBCLC
Boston, MA

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