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UK
Drugs in Lactation Advisory Service
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Antidepressants
- Individual
maternal and infant situations must be taken into account before any
drug is prescribed for the mother.
- In
general, all drugs should be avoided in premature or low birth weight
infants, or in those who have any underlying conditions.
- If
a drug is prescribed, it should be at the lowest practical dose and
for the shortest time.
|
Drugs
|
Suitability
for use in lactation
|
Comments
|
|
Choice of class of drug should be made on clinical grounds
Monitor
for drowsiness and poor feeding
Avoid
exposure of premature infants. Caution in neonates
|
| Tricyclics
and related drugs |
Non-sedating
agents e.g imipramine, nortriptyline |
Yes
|
Short
term use e.g for postnatal depression |
| |
Sedating
agents e.g. amitriptyline dothiepin |
?
|
|
| |
Doxepin |
No
|
Single
report of apnoea and sedation |
| SSRIs |
Fluvoxamine,
paroxetine, sertraline |
Yes
|
Second-line
to non-sedating tricyclic agent. Infant withdrawal symptoms seen after
abrupt discontinuation of maternal sertraline. |
| |
Fluoxetine,
citalopram |
No
|
Long
half-lives. Risk of infant drug accumulation ADRs (irritability, reduced
weight gain) reported for fluoxetine |
| MAOIs |
|
No
|
No
clinical data available |
| Others |
Nefazodone |
No
|
Single
report of infant hospitalisation due to drowsiness and poor feeding
in a premature infant |
| |
Venlafaxine |
?
|
|
Drugs
classified with '?' should be used with caution and only after an assessment
of benefit to the mother versus risk, real or potential, to the infant.
These drugs either have insufficient clinical data on their use in lactation
to regard as absolutely safe or they have had minor, reversible side effects
reported in a breast-fed infant.
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