Excretion of citalopram in breast milk

Abstract

Aims The objective of this study was to measure the secretion of the selective serotonin uptake inhibitor citalopram in breast milk. Methods The excretion of citalopram in breast milk was studied at steady-state conditions in two patients with depression and in one healthy volunteer after ingestion of a single dose citalopram. Results Milk/serum concentration ratios based on single pairs of samples from the two patients ranged from 1.16 to 1.88. Based on milk concentration data from the patients, the absolute dose ingested by a suckling infant would be 4.3-17.6 mg kg −1 day −1 , and the relative dose 0.7-5.9% of the weight-adjusted maternal dose. Based on area-under-the-time-concentration curves from the healthy volunteer, the milk/serum ratio was 1.00, the absolute dose to the infant during steady-state conditions would be 11.2 mg kg −1 day −1 and the relative dose 1.8% of the weightadjusted maternal dose. Conclusion The study shows that the relative dose to a suckling infant is close to that reported for fluoxetine, and higher than reported for fluvoxamine, paroxetine and sertraline.

Pharmacotherapy of Depression in Pregnancy

“…the concentration of the drug in the infant was minimal or undeteetable for fluoxetine (67)(68)(69)(70)(71)(72)(73)(74), paroxetine (75)(76)(77)(78)(79), sertraline (74,79 81,83-85,87). fluvoxamine (75,(89)(90)(91)(92) or citalopram (93)(94)(95)(96)(97), Moreover, when mother was taking therapeutic doses of sertraline, serotonin transporter bloekade in the fetus was found to be far lower than would be expected from that observed in the mother, suggesting that clinical doses of sertraline in the mother do not appreciably affect the fetus (81). Similarly Wisner et al (98) and Birnbaum et al (99) have critically reviewed the literature and reported that tricylie antidepressants were found in negligible quantities in breast fed infants.…”

The Use of Selective Serotonin Reuptake Inhibitors During Pregnancy and Breast-feeding

“…[50][51][52][53] In all of them, there were detectable levels of citalopram and/or its desmethyl metabolite in breast milk. In 1 case, the mother noted sleep disturbances in her child.…”

Neonatal Administration of Fluoxetine Decreased Final Sertoli Cell Number in Wistar Rats

“…Serotonin selective uptake inhibitors are highly lipidsoluble compounds and cross the placenta as well as are excreted to breast milk; however, in humans the relative concentration to a suckling infant for fluoxetine is higher than others SSRIs (Ohman et al, 1999;Spigset et al, 1997). Pharmacological evidence demonstrated also that the elevation of the cerebral levels of 5-HT affects the secretion of FSH and luteinizing hormone (LH), for inhibiting the liberation of gonadotrophins releasing factor (GnRH) in the hypothalamus, with subsequent effects on the process of spermatogenesis and steroidogenesis in adult rats (Das et al, 1982(Das et al, , 1985Naumenko & Shishkina, 1978;Urry & Dougherty, 1975).…”