Use of Psychotropics in Breastfeeding
General Principles
Perform a thorough evaluation, including maternal psychiatric history.
Perform risk-benefit analysis (of mother and infant) to determine need for medication, keeping in mind the postnatal period is a highrisk time for onset or relapse of psychiatric illness.
Factors to consider in selecting a psychotropic medication include:
Data limited and often conflicting.
Staying apprised of evidence-based data on safety of use during breastfeeding, including FDA risk category and American Academy of Pediatrics recommendations.
Properties such as low milk-to-plasma ratio, short half-life, high molecular weight, high protein binding in maternal serum, relatively nonlipophilic, few or no metabolites, drug interactions, and adverse effects.
Minimize exposure to infant by:
Using the minimum dosage to achieve remission of maternal target symptoms.
Having mother take medication immediately after breastfeeding and/or just before infant’s longest sleep period.
Avoiding multiple medications.
Keeping in mind premature infants are at increased risk for adverse effects of medication due to their immature livers.
Supplementing with formula, which may reduce exposure to medication.
Monitoring:
Continuous monitoring of maternal psychiatric target symptoms with ongoing risk-benefit analysis.
Documentation to support improvement of symptoms with pharmacologic treatment.
Consultation and coordination with infant’s pediatrician.
Recommend monitoring of infant’s well-being (e.g., feeding) and serum levels by pediatrician:
Lithium—serum levels, complete blood cell count (CBC).
Valproate/carbamazepine—liver function, CBC with platelets.
Antidepressants
Paroxetine and sertraline appear to have low serum levels of medication exposure.Related posts:
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