I am currently back on LACTNET between jobs at the NIH and the FDA. Until I am at the FDA, I can be contacted at: [log in to unmask] My updated three-part series on medication use in breastfeeding will be published in the January, March, and May issues of the "journal of Pharmacy Technology." I have completed my first draft of my textbook which will be a practical guide for mothers and their healthcare professionals on the use of all types of medications and herbals during breastfeeding. SSRIs are similar to the tricyclic antidepressants, but usually have less side effects for the mother. Tricyclics are still a possible choice for breastfeeding mothers.There are no repots of adverse effects in infants with mothers' use of desipramine, amitriptyline, nortriptyline, or imipramine. These would appear to be the drugs of choice for tricyclic antiderpressants. Of the SSRIs, the drugs of choice appear to be sertraline (as it does not appear to significantly change infant plasma serum serotonin levels, it has high protein binding, and infant doses are 2 to 3% of mothers' doses), paroxetine (it is minimally excreted into breast milk at 1% of mothers' doses with no detectable levels in infants' plasma with no adverse effects noted, which may make it the best choice of all SSRIs), fluvoxamine (drug minimally gets into breast milk at 0.5% with no adverse effects reported in infants; it also has a short half-life, no active metabolite, and infant plasma levels too low to detect), and bupropion (very little appears in infants' plasma, and no adverse effects have been noted). Most mothers are on antidepressants during pregnancy. If the drug has been effective during pregnancy, it should be continued during breastfeeding (this includes fluoxetine). Since the infant drug load may be highest right after birth, mother and infant plasma levels may be advisable at this time to establish a baseline. If adverse reactions occur in the infant, it is then that the drug use should be reevaluated and another antidepressant chosen if necessary. The mother should be weaned off the the initial antidepressant while being titrated with the new antidepressant. If the mother wishes to begin an antidepressant while breastfeeding, the drug choices listed above should be utilized. Useful guidelines are: review risks and benefits of treatment versus nontreatment (taking into account also the benefits of breastfeeding), choose drugs based upon (if not already on drug during pregnancy, or if adverse effects occur on drug during breastfeeding) clinical status of the mother and prior treatment response, use the lowest effective dose, do not use multiple drugs, watch the mother and infant for adverse symptoms and take plasma levels if necessary, and inform mothers of potential side effects to look for in their children. Each case must be evaluated individually and carefully. Finally, a live mother taking an antidepressant who is breastfeeding in better than a dead mother who has committed suicide and cannot breastfeed. Frank J. Nice, DPA, CPHP _________________________________________________________________ Frustrated with dial-up? Get high-speed for as low as $26.95. https://broadband.msn.com (Prices may vary by service area.) *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html