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Lactation Information and Discussion

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Subject:
From:
Jack Newman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 7 Apr 1997 06:54:27 -0500
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I do not have much experience with this particular drug, a tricyclic
antidepressant.  The information is conflicting.  The drug is completely
absorbed after oral administration, and has a long half life (21 hours).
This tends to make it likely that it is less desirable for breastfeeding
mothers.  On the other hand, it is highly protein bound (96-97%), and
has a large volume of distribution (12 L/kg).  This makes it likely that
little will appear in the milk.

When in doubt about a particular medication, use one about which we have
less doubt.  If the mother and physician prefer a tricyclic
antidepressant, nortryptiline is supposed to result in very little
intake by the baby.  If another type is preferred, paroxetine (Paxil) or
sertraline (Zoloft), are the SSRI antidepressants which should be best
during breastfeeding.  Note, though that paroxetine should not be
started until after the baby is born, because it gets distributed to the
peripheral tissues, good when the mother is taking during lactation, but
maybe not when she is taking it while pregnant.  Nefaxodone (Serzone) is
another, which in theory, should result in little intake by the baby.

Jack Newman, MD, FRCPC

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