Antidepressants and breastfeeding

Antidepressants and Breastfeeding

Question:

What levels of prescribed antidepressants are present in breast milk?

Response:
A clinical protocol (1) for managing antidepressants in nursing mothers can be found at
http://www.bfmed.org/Media/Files/Protocols/Protocol_18.pdf.

The following is a summary of antidepressant concentrations found in breast milk:

Class: tricyclic antidepressant (TCA)
Amitriptyline (Other names: Elavil, Tryptizol, Laroxyl, Sarotex, Lentizol) The mean maternal dose of
129 mg/day (range 75-175) resulted in a mean level of 80 ng/ml (range 38-43) in the mother’s breast
milk (2). No detectable levels of this drug have been reported in infant serum (3).
Clomipramine (Other names: Anafranil) The mean maternal dose of 96 mg/day (range 75-125)
resulted in a mean level of 141 ng/ml (range 139-143) in the mother’s breast milk (2). No detectable
levels of this drug have been reported in infant serum (3).

Desipramine (Other names: Norpramin, Pertofane) The mean maternal dose of 177 mg/day (range 37-
300) resulted in a mean level of 322 ng/ml in the mother’s breast milk (2). No detectable levels of this
drug have been reported in infant serum (3).
Dothiepin (Other names: Prothiaden, Dothep, Thaden and Dopress) The mean maternal dose of 142
mg/day (range 50-225) resulted in a mean level of 130 ng/ml (range 0-1119) in the mother’s breast milk
(2). No detectable levels of this drug have been reported in infant serum (3).
Doxepin (Other names: Adapin, Silenor, Sinequan) A maternal dose of 150 mg/day resulted in a level
of 61 ng/ml in the mother’s breast milk (2). Hypotonia, poor feeding, emesis, and sedation associated
with nursing have been reported (4)

Imipramine (Other names: Antideprin, Deprimin, Deprinol, Depsol, Depsonil, Dynaprin, Eupramin,
Imipramil, Irmin, Janimine, Melipramin, Surplix, Tofranil) The mean maternal dose of 129 mg/day
(range 75-200) resulted in a mean level of 190 ng/ml (range 16-435) in the mother’s breast milk (2). No
detectable levels of this drug have been reported in infant serum (3).
Nortriptyline (Other names: Pamelor, Aventyl) The mean maternal dose of 78 mg/day (range 50-150)
resulted in a mean level of 230 ng/ml in the mother’s breast milk (2). Undetectable levels of this drug
have been reported in infant serum (3). While detectable levels of this drug have not been found in
infant serum, its metabolites have been though no adverse effects have been reported (3,5).
Page 1 of 3

Antidepressants and Breastfeeding

Class: selective serotonin reuptake inhibitor (SSRI) antidepressant

Fluoxetine (Other names: Prozac, Sarafem, Fontex ) The mean maternal dose of 28 mg/day (range 10-
80) resulted in a mean level of 76 ng/ml (range 23-189) in the mother’s breast milk (2). Fluoxetine has
also been associated with colic, irritability, feeding and sleep disorders, slow weight gain (6)
Fluvoxamine (Other names: Luvox) The mean maternal dose of 159 mg/day (range 50-300) resulted in
a mean level of 174 ng/ml (range 18-478) in the mother’s breast milk (2). No adverse effects to infants
have been reported (7).

Paroxetine (Other names: Aropax, Paxil, Seroxat, Sereupin) The mean maternal dose of 21 mg/day
(range 10-50) resulted in a mean level of 28 ng/ml (range 0-153) in the mother’s breast milk (2). No
detectable levels of this drug were reported in infant serum (8,9,10).

Sertraline (Other names: Zoloft and Lustral) The mean maternal dose of 83 mg/day (range 25-200)
resulted in a mean level of 45 ng/ml (range 7-207) in the mother’s breast milk (2). No detectable levels
of this drug were reported in infant serum (3,11,12).
Class: norepinephrine-dopamine reuptake inhibition
Bupropion (Other names: Wellbutrin, Zyban, Voxra, Budeprion, or Aplenzin; and formerly known as
amfebutamone) A maternal dose of 300 mg/day resulted in a level of 78 ng/ml in the mother’s breast
milk (2). Bupropion accumulates in human breast milk in concentrations much higher than in maternal
plasma. Two metabolites are also excreted into the milk, however, neither bupropion nor its metabolites
were detected in the infant's plasma (13). A seizure was reported in an infant exposed to bupropion
through nursing (14).
Class: serotonin antagonist and reuptake inhibitor
Trazodone (Other names: Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran,
Trazorel, Trialodine, Trittico, and Mesyrel) A single maternal dose of 50 mg resulted in a mean level of
100 ng/ml in the mother’s breast milk (post 1 hr) which fell to 10 ng/ml (post 24 hr) (15).

References

1. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants
in nursing mothers.Breastfeed Med. 2008 Mar;3(1):44-52.
2. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of
antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004
Jun;161(6):1066-78.
3. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996
Sep;153(9):1132-7.
4. Frey OR, Scheidt P, von Brenndorff AI. Adverse effects in a newborn infant breast-fed by a mother treated
with doxepin. Ann Pharmacother 1999;33:690–693.
Page 2 of 3

Antidepressants and Breastfeeding
5. Wisner KL, Perel JM. Serum nortriptyline levels innursing mothers and their infants. Am J Psychiatry 1991;148:1234–1236. 6. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. 7. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Sep;52(3):483-97. 8. Misri S, Kim J, Riggs KW, et al. Paroxetine levels in postpartum depressed women, breast milk, and infant serum. J Clin Psychiatry 2000;61:828–832. 9. Stowe ZN, Cohen LS, Hostetter A, et al. Paroxetine in human breast milk and nursing infants. Am J Psychiatry 2000;157:185–189. 10. Berle JO, Steen VM, Aamo TO, et al. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: Infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry 2004;65:1228–1234. 11. Wisner KL, Perel JM, Blumer J. Serum sertraline and N-desmethylsertraline levels in breast-feeding mother-infant pairs. Am J Psychiatry 1998;155:690–692. 12. Dodd S, Stocky A, Buist A, et al. Sertraline analysis in the plasma of breast-fed infants. Aust N Z J Psychiatry 2001;35:545–546. 13. Briggs GG, Samson JH, Ambrose PJ, Schroeder DH. Excretion of bupropion in breast milk. Ann Pharmacother. 1993 Apr;27(4):431-3. 14. Chaudron LH, Schoenecker CJ. Bupropion and breastfeeding: a case of a possible infant seizure.J Clin Psychiatry. 2004 Jun;65(6):881-2. 15. Verbeeck RK, Ross SG, McKenna EA. Excretion of trazodone in breast milk. Br J Clin Pharmacol. 1986 Sep;22(3):367-70. Page 3 of 3

Source: http://www.caduceusquest.com/sg_userfiles/Antidepressants_and_Breastfeeding-071212.pdf