I have a patient who is due to deliver in the next month. She is
Schizophrenic and followed by a Psychiatrist. Her mental illness has
only been adequately controlled by Clozaril which she has been on
throughout her pregnancy. We had a meeting with her psychiatrist and all
the social services that are working with this patient. There is a real
question as to weather this patient is capable of caring for an infant.
The decision was made to attempt to let her try to parent but with very
close following with public health and other social services. The topic
came up about breastfeeding. I felt that this would be the easiest way
for her to feed the baby along with all the other obvious benefits. Her
psychiatrist felt that clozaril was definitely contraindicated with
breastfeeding. I have checked in Hales which states 95% protein bound.
This is one drug where the PDR states unequivocally that women taking
this should not breastfeed. I guess the risk is fatal agranulocytosis
which is not dose dependent. They are quite strict about people taking
this drug to get regular CBC etc. Psych said that they have not been
able to control this patients schizophrenia with other medications so
little chance of switching medications. Can she breastfeed? Would one
have to check CBCs on the baby? Breastmilk levels?

David Abdun-Nur, MD  Family Practice in Grants Pass, Oregon