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Re: Cam?- can I take anything and nurse? » judy1

Posted by Cam W. on December 20, 2001, at 17:50:23

In reply to Cam?- can I take anything and nurse?, posted by judy1 on December 19, 2001, at 11:01:28

Judy - I found a couple really good articles in the February, 2000 Journal of Clinical Psychiatry called "Mood Stabilizers During Breastfeeding: A Review" and the July, 2001 American Journal of Psychiatry called "The Use of Psychotropic Medications During Breastfeeding". I'll just quote some of the conclusions and recommendations. If you would like anything explained further, just ask. The stuff in square brackets - [] - are notes that I have added.

I also had printed off an article that is available online from Medscape (I printed it on April 25, 2001) called "Treating Mental Illness in Lactating Women". You will have to sign up for the site at:

The article is a short description of a several medications used to treat psychiatric disorders and the implications of using them in breastfeeding. The actual article is (I believe) available for printing at:

Okay, on with the show!

1) Chaudron LH, Jefferson JW. Mood Stabilizers During Breastfeeding: A Review. J Clin Psychiatry 2000; 61: 79-90.


"...we reached the following general conclusions... The recommendations for valproate [Depakote™, Depakene™, Epival™] and carbamazepine [Tegretol™] are based primarily on women treated for epilepsy, many of whom also received other anticonvulsants, thus limiting the generizability to women treated with those medications for psychiatric purposes. Most of the reports of infants' serum levels were based on newborn data, thus limiting generizability to older infants who may metabolize and excrete the medications more easily... Furthermore, in newborns, the relationship between the amount of medication in milk and in infant serum is confounded by medication exposure in utero. In at least 2 cases, the combination of breastfeeding and in utero exposure may have contributed to adverse events."

"In summary, nursing infants exposed to valproate receive the lowest concentration of medication with a mean infant serum to maternal serum ratio of 0.09 [to 1 - very low; babies serum level is less than 10% of mother's serum level of valproate] ... carbamazepine and lithium are 0.31 [31%] and 0.43 [43%], respectively. At least one adverse event in a breastfed infant has been reported with lithium, valproate, and carbamazepine. In each case the infant recovered without sequalae."

"Lithium may not have as much propensity for toxicity as was once thought. Valproate and carbazepine may not be as benign as they appeared initially. Insufficient information exists to suggest recommendations for gabapentin [Neurontin™] and lamotrigine [Lamictal™] except to reinforce the concern about exposing infants to lamotrigine given the increased risk of life-threatening rashes in children under 16. Finally, more data must be collected and reported on psychiatric patients who breast-feed while taking mood stabilizers so that informed decisions can be made about the use of medications in this population."


"Given the paucity of information on all mood stabilizers and the reports of adverse events with lithium [3 out of 14 babies reported], valproate [1 out of 28 babies reported], carbamazepine [10 out of 50], our recommendations are as follows. If a woman requires pharmacologic treatment during the postpaartum period, the choice of mood stabilizer should be based on the clinical status of the patient and the patient's historical response regardless pf breastfeeding status. All new mothers should be given the available information about the risks of nursing while taking medication. This discussion should include the known risks including behavioral teratogenicity and future psychiatric disorders in the child. Furthermore, mothers should be made aware of the risks and benefits of breastfeeding and the risks of not taking medication."

"... The psychiatrist should inform the mother of potential signs of toxicity so that she canmonitor the infant carefully. In the case of lithium, symptoms of toxicity should be described and a detailed explanation provided of the risks of infant dehydration and it's effects on lithium levels. ... If, at any time, toxicity is suspected, infant and maternal serum levels should be obtained, and breastfeeding should be suspended."

"For valproate, the mother should be informed of signs of hepatic [liver] dysfunction or hematological [blood] abnormalities."

"... For carbamazepine, the mother should be informed of signs of hepatic dysfunction and central nervous system effects such as sedation and poor feeding."

"... The psychiatrist should try to avoid polypharmacy [mkother taking more than 1 drug] and should keep the mother on the lowest effective dose to minimize infant exposure."

2) Burt VK, et al. The Use of Psychotropic Medications During Breastfeeding. Am J. Psychiatry 2001; 158: 1001-1009.


"... The early date for olanzapine [Zyprexa™] come from one report of three infants exposed both in utero and through nursing; no adverse effects attributable to olanzapine ingestion through breast-feeding were noted."


"... Maternal use of lithium and carbamazepine has been associated with serious difficulties in nurslings. There has been a single recorded case of serious blood abnormalities following exposure to sodium valproate through breast milk, and this agent has been associated with hepatotoxicity when directly administered to infants. Therefore, when administering valproate to breast-feeding mothers, pediatric clinical status, liver enzymes, and platelets should be carefully monitored."


There is also a journal article available online in the March, 2001 Southern Medical Journal called "Effects of Antimanic Mood-Stabilizing Drugs on Fetuses, Neonates, and Nursing Infants". It can be found at

Also, I have my notes from a lecture that Dr.Linda Miller, from the University of Chicago, (Dr.Bob should be able to vouch for her) gave at the 1999 Update on the Management of Psychosis Conference in Edmonton. She said that valproate was reasonably safe, as there is only low concentrations in breat milk. She said that there were no side effects seen in infants when nursing mothers were taking valproate.

As for antipsychotics, she recommended high potency traditional antipsychotics, like haloperidol (Haldol™) or trifluoperazine (Stelazine™), because there was a low incidence of side effects in nursed infants. She said that the low potency phenothiazines, like chlorpromazine (Largactil™) cause too much drowsiness. She also said to avoid clozapine (Clozaril™) because it accumulates in the fetus, decreases the seizure threshold, and you can't test fetus bone marrow.

Anyway, that's most of the latest of what I got. The rest of my studies are a few years old, now.

I hope that this is of some help. - Cam




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