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Date: | Wed, 15 Apr 2009 13:50:33 -0400 |
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To answer your question:
There would be no detrimental effect on mother if she divided the dose
in two. The only disadvantage is that she
is more likely to forget a dose. When I prescribe zoloft to mothers I
start at 25 or 50 mg and gradually increase in 25-50 mg increments
until she is stable. Maybe starting low and monitoring her infant
would have two benefits. Mom is less lkely to have side effects
and she can watch her infant and when she sees her infant not having
any response it will build her confidence that it won't hurt her baby.
A couple of other thoughts you are welcome to use to help counsel this
mom:
Did you mention to her the study that showed there was no response in
blood seritonin receptors of infants whose mothers took
100mg? IF there is no reaction in the blood there is no way there is
any reaction in the brain which is harder for meds to penetrate.
Haivng said that, the half life of Zoloft is extremely long and the
peak is 7-8. If the infant sleeps over 8 hours at night she could dose
at bedtime and
thus avoid the peak. Twice daily dosing would lower the peak but there
would be two peaks a day instead of one.
The theoretical dose is 21.45 ug/kg/day--does she realize there is
probably more cyanide, lead, and medications like prozac in the water
she drinks and will likely use to make the formula
than in her milk?
She could have her dr. measure infant blood levels of zoloft.
Depending on how severe her depression, she could try increasing her
exercise and psychotherapy instead of meds.
I work at Children's hospital and in our NICU even the littlest and
sickest infants would be given maternal milk from mothers who take not
only zoloft but many more
problematic meds. In fact, our informal policy is if its an L3 or less
then we give it without consulting the MD if its an L4 we discuss it.
L5 aren't given.
Bottom-line health-wise infants of depressed mothers are not as healthy
as infants of non-depressed mothers , formula fed infants are not as
healthy as breastfed infants and there is no
evidence to my knowledge of any direct side effects in breastfed
infants of mothers taking zoloft. So which caries a higher risk
formula feeding with maternal anti-depressant or breastfeeding and
using an antidepressant?
Well, given that there is no evidence of any direct harm from zoloft
and that there is a multitude of risks for using formula it is logical
to conclude that breastfeeding and using zoloft is a safer choice.
Hope that helps, Chris
Christine M. Betzold NP CLC MSN
Date: Wed, 15 Apr 2009 08:43:15 EDT
From: [log in to unmask]
Subject: benefit to dosing sertraline
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Tom Hale is currently not available on his forum, so asking here:
would=
divided dose of sertraline (Zoloft) be beneficial in reducing
immediate=
effects on infant? I realize a once daily dose of say 100 mg might be
us=
ual way
to dose, but mom I'm working with has asked if it would help to take
her=
Zoloft twice a day as far as possible side effects in her 6.5 mos
infant.=
(I
also realize side effects are rare and have shared all this info but
mom=
is anxious about using medication in the first place and considering
weaning. Also, would dividing dose have any effect on the efficacy for
=
mom?
Barbara Latterner, BSN, RN, IBCLC
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