From MedScape:



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.

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So...what I take from this is that it takes the newborn a long time to
clear the Prozac from their bloodstream that they were exposed to in
utero.  So it is not the Prozac obtained thru the milk that is the real
issue.  Because of the earlier study on weight gain, it is hard for me
to suddenly say it's absolutely OK to stay on it after delivery, but I
now feel fine about someone STARTING it immediately post-partum or later
in the breastfeeding relationship if needed.

Kathy Leeper, MD, IBCLC

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