A Case of Decreased Milk Production Associated With Aripiprazole

Yskes, Russell; Thomas, Robi; Nagalla, Madhavi-Latha

doi:10.4088/pcc.18l02303

Cited by 6 publications

(6 citation statements)

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“…15 Several cases with insufficient milk production after aripiprazole treatment have been reported, which may be a problem for breastfeeding mothers. 17,18 Thus, it is possible that aripiprazole-induced hypoprolactinemia carries a potential health risk. CYP2D6 and CYP3A4 metabolize aripiprazole, 7 and there are large interindividual variations in the activities of both these enzymes.…”

Section: Discussionmentioning

confidence: 99%

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Relationship of Prolactin Concentrations to Steady-State Plasma Concentrations of Aripiprazole in Patients With Schizophrenia

Tasaki

Yasui‐Furukori

Kubo

et al. 2021

Therapeutic Drug Monitoring

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Background: Aripiprazole is regarded as the first-line antipsychotic medication. Long-term aripiprazole therapy can cause hypoprolactinemia, which may result from its activity as a dopamine agonist. However, there is little information on hypoprolactinemia and steady-state aripiprazole concentrations. Methods:The subjects included 66 male and 177 female patients diagnosed with schizophrenia who were treated with aripiprazole. The plasma concentrations of aripiprazole and dehydroaripiprazole and the plasma concentration of prolactin were measured using highperformance liquid chromatography and enzyme immunoassay, respectively. A prolactin concentration of ,5 ng/mL was defined as hypoprolactinemia.Results: Fifty-two of the 66 male patients (79%) and 58 of the 177 female patients (33%) had hypoprolactinemia. There were significant inverse correlations between plasma prolactin levels and plasma concentrations of aripiprazole (r s = 20.447, P , 0.001) and the active moiety (aripiprazole plus dehydroaripiprazole) (r s = 20.429, P , 0.001) in men. In women, significant inverse correlations were also found between plasma prolactin levels and plasma concentrations of aripiprazole (r s = 20.273, P , 0.01) and the active moiety (r s = 20.275, P , 0.01).Conclusions: These findings suggest that lower prolactin levels are, to some extent, associated with higher plasma drug concentrations in male and female patients with schizophrenia treated with aripiprazole.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relationship of Prolactin Concentrations to Steady-State Plasma Concentrations of Aripiprazole in Patients With Schizophrenia

Tasaki

Yasui‐Furukori

Kubo

et al. 2021

Therapeutic Drug Monitoring

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“…Because our patient had had a good therapeutic response to aripiprazole during her first psychotic episode, the clinical decision was made to continue with this medication. However, some case reports have noted lactation difficulties and low levels of aripiprazole in milk, [24][25][26] and definitive evidence on the safety of aripiprazole during lactation is lacking. 27 Therefore, the treatment team worked with the patient to continue the weaning process.…”

Section: Discussionmentioning

confidence: 99%

Add-on Oxytocin in the Treatment of Postpartum Acute Schizophrenia: A Case Report

Medved

Janović

Štimac

et al. 2021

Journal of Psychiatric Practice

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An increasing body of research has been published concerning the potential impact of oxytocin (OT) in the pathophysiology of neuropsychiatric disorders that affect social functioning, such as schizophrenia. The possible therapeutic effect of OT in promoting mother-child bonding could be valuable in the management of postpartum psychosis. Studies on the efficacy of OT as an add-on therapy in the treatment of schizophrenia have found reductions in both positive and negative symptoms. The patient in the case reported here developed her second psychotic episode at the age of 22, a month after delivering her first child. Four weeks after treatment with aripiprazole was initiated, the patient’s negative symptoms persisted, causing problems in the mother-child interaction. Intranasal OT (40 IU/d) was then added to the aripiprazole. Assessment scales [the Positive and Negative Syndrome Scale (PANSS), the Disability Assessment Schedule (WHODAS 2.0), and the Barkin Index of Maternal Functioning (BIMF)] and qualitative data from her caregiver were obtained at baseline and in the third and eighth weeks after the end of the OT therapy. Improvement was observed on almost all of the domains of the WHODAS 2.0 and the BIMF, as well as on the PANSS negative and general psychopathology scales. Data from the patient’s caregiver indicated an overall improvement in mother-child interaction. These results, especially the improvement in results on the PANSS scale, are similar to findings from previous studies in patients with schizophrenia. OT seems to boost the antipsychotic effect on positive symptoms through the OT dopamine pathway, while the effect on negative symptoms probably involves a more general mechanism. Because the postpartum period is of immense significance for child development and mental well-being, future research to investigate the therapeutic efficacy of OT in the management of postpartum psychosis is warranted.

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“…Two additional case reports discuss a decrease in maternal milk supply associated with aripiprazole initiation in the postpartum period with milk supply improving after discontinuation of the medication, but these reports do not discuss the pregnant patient taking aripiprazole [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Aripiprazole and lactation failure: The importance of shared decision making. A case report

Komaroff

2021

Case Reports in Women's Health

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Bipolar disorder is a chronic and severe psychiatric illness affecting many patients during their childbearing years. Bipolar disorder is often managed with aripiprazole, a generally well tolerated second-generation antipsychotic medication. Published data regarding its safety profile are reassuring and aripiprazole is prescribed during pregnancy, postpartum and during lactation. Pregnancy and the postpartum period represent times of increased vulnerability for patients with bipolar disorder, especially those who are untreated, highlighting the need for medical management. However, aripiprazole may interfere with human milk production. Currently, there is limited evidence to understand lactation failure in patients who take aripiprazole. This case reinforces the need for shared decision making regarding the potential impact on lactation when aripiprazole is being considered for the pregnant patient with bipolar disorder.

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A Case of Decreased Milk Production Associated With Aripiprazole

Cited by 6 publications

References 0 publications

Relationship of Prolactin Concentrations to Steady-State Plasma Concentrations of Aripiprazole in Patients With Schizophrenia

Relationship of Prolactin Concentrations to Steady-State Plasma Concentrations of Aripiprazole in Patients With Schizophrenia

Add-on Oxytocin in the Treatment of Postpartum Acute Schizophrenia: A Case Report

Aripiprazole and lactation failure: The importance of shared decision making. A case report

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