Hi Laura,

Risperdal is one of the newer antipsychotic agents that have come on the
market.  It is considered a first line agent when treating a psychotic
break, especially if this is the first break.  One of the reasons that it
is a first line agent is that it appears to lack some of the side effects
that are noted with older antipsychotic agents.  Your mom is receiving a
fairly low dose (1mg two times a day) since the manufacturer recommends
that 6mg per day is the maximum dose.  As with many medications the
information on use of this med and breastfeeding is lacking.  However, it
is 90% protein bound thus leaving little of the drug available to travel
into the breastmilk.  Of course the risks (drug exposure to the infant)
and benefits (having a nonpsychotic mom available to the child) need to
be weighed.  I support your response that the mom should continue to
breastfeed.  Mom should monitor baby for sleepiness.  Interestingly,
hyperprolactinemia is a side effect of this medication so mom might see
an increase in milk supply.  Also if she responded so well and so quickly
to this minimal dose the mom might discuss with her clinician a desire
to decrease the dose of Risperdal so that she can continue to function
and avoid the psychotic state.  Also would suggest that mom, dad and
clinician identify stressful factors that can be addressed.  Since mom
responded so quickly maybe she needs more support or structure in her
environment.

For your information, I provide clinical pharmacy services at a state
psychiatric hospital and I have been trying to promote breastfeeding in
our patient population.  I don't usually see the moms with 8 month old
babies but I do see a fair number of pregnant moms that need psychotropic
medications (such as risperidone, trifluoperazine, lithium) during the
pregnancy.  I try to educate the health care professionals about the need
to promote breastfeeding to these moms.

Good luck with your mom and tell her that the breastfeeding will probably
help her relax.  As you well know fixing bottles can be an added
stress!!!!!!!

Julie Cold Kissack

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Julie Cold, Pharm.D., BCPP                      office # 770 986-3208
Assistant Professor of Pharmacy Practice        fax #    770 986-3384
Mercer University Southern School of Pharmacy   digital beeper 404 225-2404
Atlanta, GA. 30341
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