I received a call about an hour ago from a mother of a 3 month old asking
what to do about engorgement following abrupt weaning yesterday morning
(approx 36 hours ago).  It appears that mom tried to commit suicide over the
weekend by taking a drugs overdose (I don't know what kind) and has been
prescribed a cocktail of drugs:  Carbamazepine, Haloperidol, Largactil
(chlorpromazine) and Artane (trihexyphenidyl).  The prescribing psychiatrist
has told her that these drugs are compatible with breastfeeding, however she
phoned her previous paediatrician, outside the country, who said she must
not breastfeed with these meds.  The mother doesn't sound depressed - she
sounds hyped up, talking very fast, impatient, uninhibited etc.

I have the 98/99 Hale, and the 4th ed of Briggs Freeman and Yaffe. The
carbamazepine is not a problem.  It looks as if both the haloperidol and the
largactil will increase mom's prolactin levels (exacerbating engorgement)
and cause possible sedation in the baby.  There is no data for Artane, but
it is suggested that this is a similar drug to Atropine, which is compatible
with breastfeeding.  I just called the baby's local paediatrician, who
thinks there is not much of a problem with any one of these meds
individually, but is unsure about the combination (mutters about
"poly-pharmacy") and suggests that the *mother* should make the decision
about whether to continue breastfeeding or not.

Mom is coming to see me tomorrow morning (in about 11 hours from now) to get
more information and to do something about the engorgement. Would anyone
care to venture an opinion about whether it would be safe for her to
continue breastfeeding a three month old while on this cocktail?  Thanks if
you can help.

Pamela Morrison IBCLC, Zimbabwe
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