Andrea, I'll send you what Hale says. Also here is how to order your Hale
book, Medications and Mother's Milk 1997.
Call: 800-378-1317
Single copies 19.95
Shipping 3.00
Total 22.95
Wellbutrin (Buprpoion)
Antidepressant with a structure unrelated to tricyclics. May be teratogenic
in pregnant women. One report in the literature indicates that bupropion
probably accumulates in human milk. Following one 100 mg dose in a mother
the milk:plasma ratio ranged from 2.52 to 8.58, clearly suggesting a
concentrating mechanism for this drug in human milk. However, plasma levels
of bupropion in the infant were undetectable (however this infant was only
breastfed twice daily.). The peak milk bupropion level (0.189 mg/L)
occruued two hours after a 100 mg dose. This milk level would be 0.-19% of
the maternal dose. HALE
___________________________________________
There are many other antidepressants that have been shown to be safe. I
suggest that you tell the mother that and that she tell her HCP strongly
that she does want to continue feeding her baby and ask him if there is
another antidepressant that he could recommend. In Hale's book he tells
which ones are the tricyclics, which seem to be the safer ones for the
breastfeeding mother.
Pat Gima
Here are a couple of posts on this topic:
From: Julie Cold Kissack <[log in to unmask]>
Subject: Paxil and Prozac
Comments: cc: [log in to unmask]
To: [log in to unmask]
X-UIDL: 869682179.021
Both Paxil (paroxetine) and Prozac (fluoxetine) are relatively 'new
antidepressants'. There are selective serotonin reuptake inhibitors and
are considered first line treatments for depression by many clinicians.
Therefore, I suspect you will continue to see moms who are treated with
these meds. The side effects from these meds are GENERALLY less
bothersome than with the older antidepressants. From the limited data
available about the use of these drugs in breastfeeding moms it appears
that the child is exposed to the drug but at a much reduced quantity. I
doubt that you will find any reference that says unequivocally that it is
OK to use these drugs in the bf moms since we don't know what the long
term effects of the small or minimal exposure might be to the child. I
believe you need to weigh the risks and the benefits of drug treatment
and if use of the medication means that the mom's depression is resolved
and she is better able to parent then the benefit outweighs the risk (IMO).
Good luck with your clients,
Julie Cold Kissack
***************************************************************************
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
***************************************************************************
From: "A. Montgomery" <[log in to unmask]>
Subject: Paxil
To: Multiple recipients of list LACTNET <[log in to unmask]>
X-UIDL: 845946897.006
Paxil is one of the SSRI drugs that are not really contraindicated in
breastfeeding but about which the AAP recommends caution. The long-term
effect of these drugs on the developing infant's brain are not known.
However, we *do* know that maternal depression has a significant negative
effect on infant emotional development. I used informed consent with
these drugs, and feel it is important to treat maternal depression
including the use of medications if indicated. I believe Paxil may be the
best choice of the SSRI's for breastfeeding mothers, as less of it gets in
the milk. In general, I think the advantages of breastmilk plus a happy
mother probably outweigh the potential disadvantages of using
antidepressant meds, but a cautious approach (lowest possible dose, etc.)
is warranted.
--
Anne Montgomery, M.D.
[log in to unmask]
St.Peter Hospital Family Practice Residency
From: Jack Newman <[log in to unmask]>
Subject: Antidepressants
Comments: cc: "Ray L. Henninger & Ann Trebon" <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset=us-ascii
Content-Transfer-Encoding: 7bit
Paxil is one antidepressant which is probably one of the safest for
breastfeeding mothers. Very little gets into the milk. Zoloft is
another which is very safe, showing no effect on the baby (New England
Journal of Medicine, April 17, 1997).
Jack Newman, MD, FRCPC
From: Alicia Dermer <[log in to unmask]>
Subject: tricyclic antidepressants and breastfeeding
Comments: To: Kelly Jean Stauss <[log in to unmask]>
To: [log in to unmask]
X-UIDL: 877044614.000
Kelly: There was an excellent review article by Wisner, et al, in the Aug
1996 American Journal of Psychiatry. Sorry, I don't have the full
reference with me (I can get it for you if you can't find it in the
archives). I just found two even more recent references:
Wisner KL, Perel JM, Findling RL, Hinnes RL. Nortriptyline and its
hydroxymetabolites in breastfeeding mothers and newborns.
Psychopharmacology Bulletin. 33(2):249-51, 1997.
The authors, who previously had not detected nortriptyline in breastfed
babies, report on two infants aged 10 weeks or less who were found to
have low concentrations of the metabolite, and 6 more dyads with babies 4
weeks of age, and one premature baby. One infant had quantifiable
nortriptyline levels, and another had metabolites, but still the levels
were very low and no adverse clinical effects were noted.
Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics
and of possible adverse effects in infants exposed to tricyclic
antidepressants in breast-milk. Journal of Affective Disorders.
43(3):225-37, 1997 May.
Ten dyads were compared with a bottle-feeding group (presumably with
mothers on tricyclics), and monitored for health and development for 30
months. The breastfed infants got a daily dose of about 1% of the
maternal dose, very small amounts of the meds were detected in the babies.
No adverse effects nor developmental delays were noted.
There is now a good body of evidence that tricyclic antidepressants pose
little, if any, risk to breastfed babies. We always need to remember all
the known risks of artificial feeding and balance them against the small
risk of the medication. Hope this helps. Alicia Dermer, MD, IBCLC.
mailto:[log in to unmask]
|
