P.2.d.032 Management of postpartum manic episode without cessation of breastfeeding: a longitudinal follow up of drug excretion into breast milk

The quality of lactation studies including antipsychotics

“…Forty-one of the 51 selected studies were case reports. Eight studies investigated multiple antipsychotics [26][27][28][29][30][31][32][33].…”

“…Furthermore, the M:P ratio was properly determined for one risperidone study [35] and two publications including paliperidone and risperidone [26,27]. The AID was correctly assessed in two amisulpride studies [37,38], one aripiprazole study [39], one flupenthixol study [28], three olanzapine studies [29,30,34], one perphenazine study [40], three quetiapine studies [29,30,35], and two case reports that investigated paliperidone and risperidone transfer in breast milk [27].…”

“…Three of the nine studies calculated the RID of quetiapine properly [30,35,41]. In addition, the RID was correctly determined in two studies for amisulpride [37,38], olanzapine [29,33], and risperidone [26,36]. In one aripiprazole [39], one flupenthixol [28], one paliperidone [26], and one perphenazine study [40], the RID was correctly calculated.…”

“…2 Flow charts of studies included in this review using the LactMed and the PubMed database Table 3 Results of the quality determination. The numbers in the correspond to the number of correctly performed studies according to Table 2 Amisulpride [37,38] Aripiprazole [39,[42][43][44] Chlorpromazine [31,32,[45][46][47][48][49] Chlorprothixene [50] Clozapine [51] Flupenthixol [28,52] Haloperidol [31,32,[53][54][55][56] Olanzapine [29,30,34,[57][58][59][60][61][62] Number of included studies Perphenazine [40] Quetiapine [29, 30, 35, 41 63-67] Risperidone [26,27,33,36] Sulpiride [68,69] Trifluoperazine [31,70] Ziprasidone [71] Zonisamide [32,...…”

Resources for Psychiatric Clinicians Working With Breastfeeding Mothers

“…Conclusions about safety involve small samples, correlations rather than causations, focus on the psychiatric drug alone rather than other variables that could affect the same infant outcome, or rely on self-report rather than toxicology screening for substances such as tobacco, alcohol, and others associated with adverse effects on infants. Some studies include mothers taking a variety of medications, making it diffi cult if not impossible to isolate the effect of any one drug (Klinger, Stahl, Fusar-Poli, & Merlob, 2013;Liu et al, 2017;Var, Ince, Topuzoglu, & Yildiz, 2013). Increasingly, guidelines for medication use are based on examining studies together as a conglomerate rather than examining any one small set of case studies (Whitworth, 2017).…”