This is an example of "if we don't know, we should discourage
breastfeeding". But the conservative approach is "if we don't know, we
should encourage breastfeeding". There are positives and negatives (long
half life, very good oral absorption) about olazepine, but ultimately, what
we do know is that blood levels are very low (23 ng/ml after repeated
dosing, which is really low), and protein binding is high.

On that basis I would not discourage the mother from breastfeeding. In fact,
what I would do is encourage her, watch the baby, and get levels of the drug
done on her and her milk (maybe even the baby). Why on earth do physicians
not do this? It would help all of us so much and they might even get a paper
out of it.

Jack Newman, MD, FRCPC