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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Vida on April 8, 2003, at 19:12:29
I'm pregnant and take Effexor, 225 mg a day. I plan to stay on the Effexor. Does anyone know if it's safe to breastfeed while on Effexor? My doctor said he wasn't sure, but Zoloft would be safe for the baby. But Effexor is working well for me, so I don't plan to switch. The pharmacist at the supermarket where I get my meds said, "Well, just breastfeed until the baby shows signs of neurological problems, then stop"-- which I didn't find particularly reassuring!
Posted by fayeroe on April 8, 2003, at 19:31:29
In reply to Effexor and breastfeeding?, posted by Vida on April 8, 2003, at 19:12:29
go to google and put in breastfeeding on effexor and you'll have your pharmaceutical answer immediately.......best, pat
Posted by fayeroe on April 8, 2003, at 19:32:48
In reply to Effexor and breastfeeding?, posted by Vida on April 8, 2003, at 19:12:29
> I'm pregnant and take Effexor, 225 mg a day. I plan to stay on the Effexor. Does anyone know if it's safe to breastfeed while on Effexor? My doctor said he wasn't sure, but Zoloft would be safe for the baby. But Effexor is working well for me, so I don't plan to switch. The pharmacist at the supermarket where I get my meds said, "Well, just breastfeed until the baby shows signs of neurological problems, then stop"-- which I didn't find particularly reassuring!
CHANGE YOUR PHARMAICST IMMEDIATELY. THAT WAS IRRESPONSIBLE AND UNETHICAL!!
Posted by Larry Hoover on April 8, 2003, at 22:37:36
In reply to Effexor and breastfeeding?, posted by Vida on April 8, 2003, at 19:12:29
> I'm pregnant and take Effexor, 225 mg a day. I plan to stay on the Effexor. Does anyone know if it's safe to breastfeed while on Effexor? My doctor said he wasn't sure, but Zoloft would be safe for the baby. But Effexor is working well for me, so I don't plan to switch.
There is better evidence for the safety of sertraline (Zoloft) than vanlafaxine (Effexor) during breast-feeding, but the data available are really sparse. Abstracts below.
>The pharmacist at the supermarket where I get my meds said, "Well, just breastfeed until the baby shows signs of neurological problems, then stop"-- which I didn't find particularly reassuring!
What a twit!
The first abstract below doesn't directly address either of the two mentioned antidepressants, but I think it comes to a particular conclusion that needs saying: Untreated maternal depression can have adverse effects on the child, while there is no compelling evidence for adverse effects in children being breast-fed by mothers using antidepressants.
Am J Psychiatry 2002 Nov;159(11):1889-95
Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study.Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G.
Motherisk Program, Division of Pediatrics and Psychology and the Reseaarch Institute, The Hospital for Sick Children, Toronta, Ont. Canada.
OBJECTIVE: Previous work suggested that first-trimester exposure to tricyclic antidepressants or fluoxetine does not affect adversely child IQ and language development. However, many women need antidepressants throughout pregnancy to avoid morbidity and suicide attempts. Little is known about the fetal safety of tricyclic antidepressants and fluoxetine when taken throughout pregnancy. The goal of this study was to assess the effects of tricyclic antidepressants and fluoxetine used throughout gestation on child IQ, language, and behavior. METHOD: In a prospective study, mother-child pairs exposed throughout gestation to tricyclic antidepressants (N=46) or fluoxetine (N=40) and an unexposed, not depressed comparison group (N=36) were blindly assessed. The three groups were compared in terms of the children's IQ, language, behavior, and temperament between ages 15 and 71 months. The authors adjusted for independent variables such as duration and severity of maternal depression, duration of pharmacological treatment, number of depression episodes after delivery, maternal IQ, socioeconomic status, cigarette smoking, and alcohol use. RESULTS: Neither tricyclic antidepressants nor fluoxetine adversely affected the child's global IQ, language development, or behavior. IQ was significantly and negatively associated with duration of depression, whereas language was negatively associated with number of depression episodes after delivery. CONCLUSIONS: Exposure to tricyclic antidepressants or fluoxetine throughout gestation does not appear to adversely affect cognition, language development, or the temperament of preschool and early-school children. In contrast, mothers' depression is associated with less cognitive and language achievement by their children. When needed, adequate antidepressant therapy should be instituted and maintained during pregnancy and postpartum.
About Effexor:Br J Clin Pharmacol 2002 Jan;53(1):17-22
Distribution of venlafaxine and its O-desmethyl metabolite in human milk and their effects in breastfed infants.Ilett KF, Kristensen JH, Hackett LP, Paech M, Kohan R, Rampono J.
Department of Pharmacology, University of Western Australia, Nedlands 6009 Western Australia. kilett@receptor.pharm.uwa.edu.au
AIMS: To characterize milk/plasma (M/P) ratio and infant dose, for venlafaxine (V) and its O-desmethyl metabolite (ODV), in breastfeeding women taking venlafaxine for the treatment of depression, and to determine the plasma concentration and effects of these drugs in their infants. METHODS: Six women (mean age 34.5 years, mean weight 84.3 kg) taking venlafaxine (median dose 244 mg day(-1), range 225-300 mg day(-1)) and their seven infants (mean age 7.0 months, mean weight 7.3 kg) were studied. V and ODV in plasma and milk were measured by high-performance liquid chromatography over a 12 h dose interval at steady-state. Infant exposure was estimated as the product of estimated milk production rate (0.15 l kg(-1)day(-1)) and average drug concentration in milk, normalized to body weight and expressed as a percentage of the weight-adjusted maternal dose. RESULTS: Mean M/PAUC values of 2.5 (range 2.0-3.2) and 2.7 (range 2.3-3.2) were calculated for V and ODV, respectively. The mean maximum concentrations (95% CI) of V and ODV in milk were 1161 (95% CI, 588, 1734) microg l(-1) and 796 (362, 1230) microg l(-1). Mean infant exposure was 3.2% (1.7, 4.7%) for V and 3.2% (1.9, 4.9%) for ODV (as V equivalents). V was detected in the plasma of one out of seven infants studied (5 microg l(-1)), while ODV was detected in four of the infants, at concentrations ranging from 3 to 38 microg l(-1). All of the infants in the study were healthy, as reported by their mothers and/or by clinical examination on the study day. CONCLUSIONS: The concentrations of V and ODV in breast milk were 2.5 and 2.7 times those in maternal plasma. The mean total drug exposure (as venlafaxine equivalents) of the breastfed infants was 6.4% (5.5-7.3%), which is below the 10% notional level of concern. There were no adverse effects in any of the infants. The data support the use of V in breastfeeding. Nevertheless, since low concentrations of ODV were detected in the plasma of four out of the seven infants studied, we recommend breastfed infants should be monitored closely. Each decision to breast feed should be made as an individual risk:benefit analysis.
Br J Clin Pharmacol 1998 May;45(5):459-62
Distribution and excretion of venlafaxine and O-desmethylvenlafaxine in human milk.Ilett KF, Hackett LP, Dusci LJ, Roberts MJ, Kristensen JH, Paech M, Groves A, Yapp P.
Department of Pharmacology, University of Western Australia, Nedlands.
AIMS: To characterise the transfer of venlafaxine (V) and its O-desmethyl metabolite (ODV) into human milk by measuring milk/plasma (M/P) ratio, and to estimate the likely dose received by a breast-fed infant. METHODS: Milk and plasma samples were collected from three lactating women who were taking venlafaxine for depression, and were at steady-state. In two of the patients, venous blood and milk samples were collected 0, 1, 2, 3, 4, 6, 8 and 12 h post dose, while in the third patient a single pair of blood and milk samples was obtained 0.83 h post dose. A plasma sample was obtained from each of their infants. V and ODV were measured in plasma and milk by high performance liquid chromatography. M/P was calculated and infant dose estimated as drug concentration in milk x a milk intake of 0.15 l kg(-1) day(-1), relative to the weight-adjusted maternal dose. RESULTS: Mean M/P for V was 4.1 (range 2.8-4.8) and 3.1 for ODV (range 2.8-3.8). The mean total infant dose (as V equivalents) was 7.6% (range 4.7-9.2%) of the maternal weight-adjusted dose, with approximately equal amounts of V (3.5%) and ODV (4.1%) in the dose. ODV (median 100 microg I(-1)) was detected in the plasma of all three infants. The infants were healthy and showed no acute adverse effects. CONCLUSIONS: These preliminary data show that the total dose of V and ODV ingested by breast-fed infants can be as high as 9.2% of maternal intake. Moreover there were measurable concentrations of ODV in the infants' plasma. We recommend that exposed infants should be observed closely.
And, about Zoloft:Br J Clin Pharmacol 1998 May;45(5):453-7
Distribution and excretion of sertraline and N-desmethylsertraline in human milk.Kristensen JH, Ilett KF, Dusci LJ, Hackett LP, Yapp P, Wojnar-Horton RE, Roberts MJ, Paech M.
Department of Pharmacy, King Edward Memorial Hospital, Subiaco, Western Australia.
AIMS: To characterise milk/plasma (M/P) ratio and infant exposure, for sertraline and N-desmethylsertraline, in breast-feeding women taking sertraline for the treatment of depression. METHODS: Eight women (mean age 28 years) taking sertraline (1.05 mg kg(-1) day(-1)) and their infants (mean age 5.7 months) were studied. Sertraline and N-desmethylsertraline in plasma and milk were measured by high-performance liquid chromatography over a 24 h dose interval at steady-state. M/P values were estimated from area under the plasma and milk concentration-time curves. All milk produced was collected over the dose interval. Infant exposure was estimated as the product of actual or estimated milk production, and average drug concentration in milk, normalized to body weight and expressed as a percentage of the weight-adjusted maternal dose. RESULTS: Mean milk production was 321 ml day(-1) (range 34-974 ml). Mean M/P values of 1.93 and 1.64 were calculated for sertraline and N-desmethylsertraline respectively. Infant exposure estimated from actual milk produced was 0.2% and 0.3% of the weight-adjusted maternal dose for sertraline and N-desmethylsertraline (as sertraline equivalents) respectively. When calculated from estimated milk production (0.15 l kg(-1) day(-1)), infant exposure was significantly greater (P<0.0001) at 0.90% and 1.32% for sertraline and N-desmethylsertraline respectively. Neither sertraline nor its N-desmethyl metabolite could be detected in plasma samples from the four infants tested. No adverse effects were observed in any of the eight infants and all had achieved normal developmental milestones. CONCLUSIONS: Irrespective of the method of calculation of infant exposure, the mean total dose of sertraline and its N-desmethyl metabolite transmitted to infants via breast-feeding is low and unlikely to cause any significant adverse effects.
Am J Psychiatry 2001 Oct;158(10):1631-7
Comment in:
Am J Psychiatry. 2001 Oct;158(10):1555-7.
Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs.Epperson N, Czarkowski KA, Ward-O'Brien D, Weiss E, Gueorguieva R, Jatlow P, Anderson GM.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA. neill.epperson@yale.edu
OBJECTIVE: Pharmacological treatment of postpartum depression is frequently complicated by the mother's desire to breast-feed. Although breast milk levels of several selective serotonin reuptake inhibitors (SSRIs) have been reported to be relatively low, a critical question is whether SSRI exposure during nursing results in clinically significant blockade of serotonin (5-HT) reuptake in infants. This study determined the degree of transporter blockade in infants exposed to sertraline through maternal breast milk. METHOD: The extent of maternal and infant transporter blockade was assessed by measurement of platelet levels of 5-HT in 14 breast-feeding mother-infant pairs before and after 6-16 weeks of maternal treatment with sertraline for major depression with postpartum onset. Plasma sertraline and desmethylsertraline levels were obtained in 13 of these mothers and 11 of their infants. RESULTS: Marked declines in platelet 5-HT levels of 70%-96% were observed in mothers after sertraline treatment, 25-200 mg/day. In contrast, infants showed little or no change in platelet 5-HT levels after exposure through breast-feeding. Mean levels of maternal plasma sertraline and its major metabolite, desmethylsertraline, were 30.7 ng/ml and 45.3 ng/ml, respectively. Drug and drug metabolite concentrations in the infants were at or below the lower limit of quantitation. CONCLUSIONS: The data indicate that while mothers receiving clinical doses of sertraline experience substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers is unaltered. The observations suggest that mothers taking sertraline can breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.
Good luck,
Lar
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