From medscape today:

http://www.medscape.com/viewarticle/452548?mpid=12569&WebLogicSession=PqcPgm
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Fluoxetine Use During Pregnancy and Lactation Appears Safe for Infants



NEW YORK (Reuters Health) Apr 17 - The use of fluoxetine (Prozac) during
pregnancy and lactation appears to be safe for mothers and their offspring,
according to a report in the April issue of Clinical Pharmacology and
Therapeutics.

Although fluoxetine is widely used for the treatment of depression during
pregnancy and lactation, the authors explain, little is known of its
pharmacokinetics and metabolism in pregnant women and newborns.

Dr. Tuija Heikkinen and associates from the University of Turku, Finland
studied the pharmacokinetics of fluoxetine and norfluoxetine, its active
metabolite, in 11 mothers taking fluoxetine and their infants.

The trough fluoxetine levels in blood were significantly lower among the
pregnant women in the last weeks of gestation and in the first days after
delivery than in depressive patients who were not pregnant, the authors
report.

Levels of fluoxetine rose steadily from delivery to 2 months postpartum to
levels 55% higher than during late pregnancy, the report indicates. Maternal
norfluoxetine levels remained stable during pregnancy and thereafter,
resulting in fluoxetine+norfluoxetine levels 32% higher 2 months after
delivery than during late pregnancy.

Infant plasma levels of fluoxetine and norfluoxetine were consistently lower
(65% and 72%, respectively) than maternal levels, the researchers note, and
by 2 months after delivery the levels of both were undetectable or barely
detectable.

Concentrations of fluoxetine and norfluoxetine in maternal milk were only
2.4% (2 weeks postpartum) and 3.8% (2 months postpartum) of the maternal
daily dose, the results indicate, and there was no correlation between milk
fat concentrations and antidepressant levels in the milk.

"Our results support the current understanding that the exposure of the
nursed child to fluoxetine plus norfluoxetine is low," the researchers
write, "making breast-feeding possible."

Pregnancy outcomes were similar among patients and healthy controls, the
investigators report, with no malformations detected and no differences
between infant birth weights, weight gains, and neurological development at
1 year.

"Fluoxetine doses from 20 to 40 mg resulted in low fluoxetine and
norfluoxetine concentrations during pregnancy," the authors conclude. "This
might indicate that these low blood levels during pregnancy could lead to
therapeutic failure, and clinicians should be alert to this possibility so
that depression in pregnancy is not undertreated."

"However," the researchers add, "the infant fluoxetine and norfluoxetine
concentrations were high at delivery and during the early postnatal period,
indicating relatively high transplacental transfer and slow elimination of
these compounds by the infant."

Clin Pharmacol Ther 2003;73:330-337.



regards Karen Clements IBCLC
Melb Aust

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