Risperidone Distribution and Excretion Into Human Milk: Case Report and Estimated Infant Exposure During Breast-Feeding

Journal of clinical psychopharmacology 05/2000; 20(2):285-6. DOI: 10.1097/00004714-200004000-00036
Source: PubMed
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    • "The issue of breastfeeding and the use of antipsychotic medication has been well reported (Yoshida et al. 1998a,b, Hill et al. 2000, Kirchheiner et al. 2000, Friedman & Rosenthal 2003, Nordeng & Spigset 2003, Gentile 2004, Misri et al. 2006). Successful use has been described in relation to risperidone (Hill et al. 2000), olanzapine (Kirchheiner et al. 2000, Friedman & Rosenthal 2003) and quetiapine (Misri et al. 2006). However, while no association has been reported between the babies' development and the exposure to antipsychotics used during breast feeding, most the authors still advise caution. "
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    ABSTRACT: Women who are pregnant and who have a history of psychosis are commonly managed with antipsychotic medications. The evidence regarding the use of antipsychotics in pregnancy has been insufficient to provide adequate support for this practice and is a concern for clinicians and women alike. This review presents literature surrounding the use of antipsychotic medications in pregnancy, providing an overview of the historical and contemporary perspectives which influence clinicians prescribing practices. Data were sourced from Medline, CINAHL, PsycINFo, using the terms antipsychotics with pregnancy and psychosis or schizophrenia. This was expanded to include the most common atypical antipsychotics: olanzapine, risperidone, clozapine, quetiapine, ziprasidone and aripiprazole. Literature was found reporting the use of antipsychotic medications in pregnancy since the introduction of antipsychotics in the 1950s, comprising mainly of authors' reviews of the literature, case studies, retrospective reports, drug company registries and more recently a prospective comparative study. This review identifies that the literature provides no clear answer for clinicians as to the risk associated with the use of antipsychotics in pregnancy. To this effect, recently in Australia, the National Register of Antipsychotic Medications in Pregnancy was established to prospectively collect information regarding outcomes for mother and baby, when antipsychotic medications have been used during pregnancy.
    Full-text · Article · Mar 2010 · Journal of Psychiatric and Mental Health Nursing
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    • "The recommendation for safe breast-feeding is that the ratio of infant dose exposure to maternal dose not be greater than 10%. Hill et al.[30] calculated the estimated infant dose exposure during breast-feeding and found that both olanzapine and risperidone were well below the “attention critical” concentration. "
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    ABSTRACT: Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation.
    Full-text · Article · Feb 2009 · Indian Journal of Psychiatry
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    • "With respect to the newer or ' atypical ' antipsychotic agents the body of available information is even smaller, despite these agents rapidly becoming the most commonly prescribed antipsychotics in many parts of the world. However, to our knowledge, the only published data for this group are single case reports of risperidone (Hill et al., 2000) and clozapine (Barnas et al., 1994) excretion in human milk. Furthermore there are no controlled studies, which have followed the progress of infants into early childhood, to assess the outcome of exposure to antipsychotics by breastfeeding. "
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    ABSTRACT: Newer antipsychotic drugs offer significant clinical advantages for the treatment of psychosis. In particular for the treatment of postpartum disorders newer agents may be suited due to their favourable side-effect profiles. Of concern is the passage of the drugs into breast milk and what potential risks this poses for an infant who is breastfed. The excretion of olanzapine into the breast milk of five lactating women with postpartum psychosis was examined in this study. Nine pairs of plasma and breast-milk samples were collected and the concentration of olanzapine determined by high-performance liquid chromatography. Single-point milk-to-plasma ratios were calculated and ranged from 0.2 to 0.84 with a mean of 0.46. The median relative infant dose was 1.6% (range 0-2.5%) of the weight-adjusted maternal dose. During the study period, there were no apparent ill effects on the infant as a consequence of exposure to these doses of olanzapine. As with other antipsychotic drugs this study demonstrates that olanzapine passes into breast milk. The long-term effects of exposure in infants exposed to olanzapine requires further investigation.
    Full-text · Article · Oct 2002 · The International Journal of Neuropsychopharmacology
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