Article

Quetiapine augmentation in lactation - A series of case reports

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada
Journal of Clinical Psychopharmacology (Impact Factor: 3.76). 11/2006; 26(5):508-11. DOI: 10.1097/01.jcp.0000236656.70544.f3
Source: PubMed

ABSTRACT Treating psychiatric disorders with pharmacotherapy in the breast-feeding period presents a dilemma as such treatment carries the risk of infant exposure to medication through breast milk. However, failure to institute pharmacotherapy in postnatal women in need of such treatment exposes both mother and baby to detrimental effects of the illness. Because women presenting with psychiatric disorders during the postpartum period often have complex sets of symptoms, monotherapy may not be sufficient for symptom resolution. In this case series of 6, we examined levels of psychotropic medications secreted in breast milk and performed developmental assessments of the exposed babies with the Bayley Scales of Infant Development, Second Edition. In 3 of the 6 cases, no medication was detected in the breast milk; in all but 1 case, estimated levels of infant medication exposure were calculated to be less than 0.01 mg/kg per day for each medication. Four of the 6 babies scored as being within normal limits on the Bayley Scales of Infant Development, Second Edition, whereas 2 showed mild developmental delays. In comparison to the 4 cases of typical development, the 2 showing mild delays did not have higher estimated levels of psychotropic medication exposure through breast milk. Based on these results, in our limited sample, there appears to be low levels of infant exposure to the medications through breast milk; no association was seen between developmental outcomes and exposure through breast milk of multiple pharmacological agents. These results should be interpreted with caution, and vigilance should be exercised when advising women on combinations of medications for severe mental illness who choose to nurse.

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    • "ants . Dosages varied from 225 to 300 mg / day . Mean total drug exposure in percent of weight - adjusted dose of the mother was 6 . 4% ; no adverse events were observed in the infants . The excretion of VEN in breast milk was examined in a previous study in which VEN and ODV were detected in breast milk ( RID : 7 . 6% ) ( Ilett et al . , 1998 ) . Misri et al . , ( 2006 ) reported two cases treated with quetiapine during lactation , which included two women taking additionally VEN ( 75 and 225 mg / day , respectively ) . The two babies scored as being within normal limits on the Bayley Scales of Infant Development . Likewise , other two case - reports did not report any adverse effects in breastfed inf"
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    ABSTRACT: OBJECTIVE: The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation. METHODS: Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE. RESULTS: Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding. CONCLUSIONS: Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established
    Human Psychopharmacology Clinical and Experimental 03/2015; DOI:10.1002/hup.2473. · 1.85 Impact Factor
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    • "ants . Dosages varied from 225 to 300 mg / day . Mean total drug exposure in percent of weight - adjusted dose of the mother was 6 . 4% ; no adverse events were observed in the infants . The excretion of VEN in breast milk was examined in a previous study in which VEN and ODV were detected in breast milk ( RID : 7 . 6% ) ( Ilett et al . , 1998 ) . Misri et al . , ( 2006 ) reported two cases treated with quetiapine during lactation , which included two women taking additionally VEN ( 75 and 225 mg / day , respectively ) . The two babies scored as being within normal limits on the Bayley Scales of Infant Development . Likewise , other two case - reports did not report any adverse effects in breastfed inf"
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation. Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE. Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding. Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 03/2015; 30(3). DOI:10.1002/hup.2473 · 1.85 Impact Factor
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    • "Some case studies suggest there are no adverse events observed with QTP administration during breastfeeding (Gentile 2006b, Misri et al. 2006). Mild neurodevelopmental delay was observed in 2 babies in a study conducted with 6 babies exposed to QTP during the breastfeeding period (Misri et al. 2006). The breast milk/serum ratio of RIS varies between 0.21 and 0.42, and the breast milk/serum ratio of 9-hydroxyris- peridone, a metabolite of RIS, varies between 0.24 and 0.39. "
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    ABSTRACT: The prevalence of bipolar disorder (BD) in males and females is almost equal. The onset of BD in females typically occurs during the reproductive years, complicating its treatment. Although it was once believed that pregnancy prevents recurrence, studies have shown that recurrence is common and severe during pregnancy. On the other hand, the effects of pharmacological treatment on obstetrical outcome are not well known and some of these agents are considered teratogenic. Thus, the decision to treat pregnant patients with psychotropic agents requires solving an ethical dilemma. Risk-benefit decisions should be made while considering both the risk of relapse of BD and its morbidity, and the risk of fetal exposure to psychotropic medications. Moreover, the risk of recurrence increases dramatically in the postpartum period. It is well known that all of the psychotropic medications studied enter the breast milk. Thus, their effects on infants should be considered while prescribing for a breastfeeding mother. The aim of this review was to discuss the safety profiles of the treatment options for pregnant and breastfeeding BD patients. Firstly, each medication's effects on organ dysgenesis, neonatal toxicity, and neurobehavioral development, and their associated adverse events during pregnancy and the postpartum period are discussed, with a focus on the emerging literature. Given this background, practical suggestions on tailoring treatment in BD patients, from preconception to breastfeeding are highlighted.
    Turk psikiyatri dergisi = Turkish journal of psychiatry 06/2010; 21(2):155-66. DOI:10.5080/u6131 · 0.43 Impact Factor
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