To:  "Barbara Wilson-Clay, Ibclc"        Re:  Trazodone(Desyrel)

You guys always come up with the hard ones.  Trazodone is a unique
antidepressant...it does not belong to the tricyclic family(although it acts
like one),  and it does not necessarily belong to the serotonin reuptake
inhibitor family(although it acts like one).   Following a 50 mg dose in 6
moms,  the milk:plasma ratio averaged  0.142.   Assuming a daily intake of
500 cc/12 hrs,  infants would be exposed to less than 0.005 mg/Kg  as
compared to 0.77 mg/Kg for the mothers.  Approximately 1% of the maternal
dose would enter into breast milk. So the exposure would be quite small.
Trazodone exhibits a biexponential half-life with a terminal half-life of
6-12 hrs.  in adults.   Trazodone is highly protein bound(95%) which
probably accounts for the limited milk levels.

I must warn you however,  that this study's one limitation was that they
used but one single dose of trazodone in each mom,   and the plasma levels
were not steady state,   nor had the volume of distribution been adequately
filled.  Doing so may have increased the transfer to the milk.  In some
individuals,  plasma levels tend to increase over time...no mention is made
of pediatric patients.   Nevertheless,  the levels would probably still be
rather low.    Observe the infant for drowsiness, fatigue, weakness,  dry
mouth,  priapism in male infants, nausea and vomiting.

If you need a copy of this article,  send me your FAX.

Verbeeck, R.K. et.al.  Excretion of trazodone in breast milk.
Br.J.Clin.Pharmac. (1986), 22:367-370.


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T.W. Hale, Ph.D.
Associate Professor of Pediatrics
Texas Tech University School of Medicine

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