Article

Serum clomipramine and metabolite levels in four nursing mother-infant pairs.

Mood Disorders Program, Case Western Reserve University, Cleveland, Ohio 44106.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 02/1995; 56(1):17-20.
Source: PubMed

ABSTRACT Women with postpartum-onset obsessive compulsive disorder may elect treatment with clomipramine. There is minimal information to guide the clinician who must advise breastfeeding women about clomipramine therapy.
Four clomipramine-treated breastfeeding mother-infant pairs were assessed for serum concentrations of clomipramine, N-desmethylclomipramine, and corresponding 8-hydroxymetabolites.
Although the mothers exhibited a wide range of serum concentrations, the parent drug and metabolites were either nondetectable or below the quantifiable limit in the sera of all infants. No adverse clinical effects were observed.
This report adds to the growing literature that suggests that tricyclic use during breastfeeding rarely results in measurable drug levels in infant sera.

0 Followers
 · 
65 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: For every antidepressant so far investigated in the breast milk of mothers prescribed these medications, findings indicate that some amount of drug will be excreted into the breast milk. Nursing infants will be exposed to some, usually a very low, amount of drug and drug metabolites. Levels of drug exposure to infants for the many antidepressants available are examined, discussing milk to plasma drug concentration ratios and the infant dose as a percentage of the maternal dose. Drug concentrations in infant plasma and adverse effects of drug exposures to infants are reviewed. Factors influencing the decision on whether to breast or bottle feed an infant nursed by a mother taking antidepressants are discussed, concluding that the decision needs to be made on an individual basis. The lactating mother, in consultation with her doctor, should be in a position to make an informed decision on whether or not to breast feed. Under certain circumstances the decision to bottle feed may be wise, but more commonly the advantages of breast-feeding will outweigh the very low risk of an adverse event from drug exposure to the infant.
    Paediatric Drugs 2(3):183-92. · 1.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Riassunto. Il puerperio, così come la gravidanza, è associato ad un maggior rischio di disturbi d'ansia e/o disturbi depressivi. La depressione post-partum (DPP), frequente-mente in comorbilità con sintomi d'ansia, è il disturbo che si manifesta più frequente-mente dopo il parto, con tassi di prevalenza compresi tra il 5 e il 15%. Tra gli antide-pressivi (AD), gli inibitori selettivi della ricaptazione della serotonina (SSRI) sono con-siderati farmaci di prima scelta nel trattamento dei disturbi depressivi puerperali e in particolare della DPP. È quindi fondamentale stabilire, per quelle madri che necessiti-no di un trattamento con SSRI, il profilo di sicurezza di questi farmaci durante l'allat-tamento. I vantaggi dell'allattamento al seno, sia per la madre che per il bambino, sono infatti ben documentati. Se, da un lato, tutti gli AD, compresi gli SSRI, passano nel lat-te, è comunque vero che il rapporto tra concentrazioni ematiche del farmaco e concen-trazioni nel latte, proposto per valutare il rischio di una determinata molecola durante l'allattamento, appare un parametro che non è in grado di predire in modo accurato la sicurezza di questi farmaci. Da un'analisi delle evidenze presenti nella letteratura si può concludere che, tra gli SSRI, paroxetina e sertralina offrono il miglior profilo di sicurez-za, non essendo fino ad oggi stati segnalati effetti collaterali per il neonato in corso di al-lattamento con tali AD. Nonostante questi risultati rassicuranti, appaiono comunque ne-cessari ulteriori studi che permettano di definire meglio il profilo di sicurezza. Come re-gola generale, è importante monitorare con molta attenzione le condizioni di un neonato la cui madre assuma un AD in corso di allattamento, in modo da poter riconoscere pre-cocemente eventuali effetti collaterali farmaco-indotti. Parole chiave. Depressione post-partum, allattamento, antidepressivi, inibitori seletti-vi della ricaptazione della serotonina, tossicità neonatale. Summary. Antidepressant drugs and breastfeeding. The post-partum period, as well as pregnancy, is associated with an increased risk of anxiety and/or affective disorders. Postnatal depression, frequently in co-morbidity with anxiety symptoms, is recognised as the most frequent form of maternal morbidity after delivery, with a prevalence rate estimated between 5% to 15%. Among antidepressant drugs, the SSRIs are considered the drugs of choice in the treatment of post-partum af-fective disorders, particularly in the major depression. It is, thus, crucial from a clinical standpoint to establish, in the newborn whose mother needs to be treated with an SSRI, the safety profile of these drugs during breastfeeding. The benefits of breastfeeding, on the other hand, both for the nursing mother and the infant, are in fact very well docu-mented. Unfortunately, all antidepressant drugs, including SSRIs, cross into breast milk and the milk-to-plasma ratio, a measure proposed to establish the amount of drug trans-ferred to maternal milk, does not seem to be a reliable parameter to predict the safety of these drugs. From the available literature, however, it seems that among SSRIs, parox-etina and sertralina offer the best safety profile, as these drugs has never been associat-ed with unsafe reports in suckling infants. Despite these reassuring but preliminary da-ta, more studies are needed to better assess the safety of the antidepressant drugs in the infants exposed during breastfeeding. As general rule, it is important to recommend if the mother wishes to breastfeed her infant while taking an antidepressant, that the baby should be closely monitored in order to detect, as soon as possible, any unwanted drug-related side effect.
  • Source
    Psychiatric Bulletin 09/1995; 19(9):551-552. DOI:10.1192/pb.19.9.551
Show more