Possible Association between Fluoxetine Hydrochloride and Colic in an Infant

Lester, Barry M.; Cucca, Jayne; Andreozzi, Lynne; Flanagan, Patricia; Oh, William

doi:10.1097/00004583-199311000-00020

Cited by 154 publications

(70 citation statements)

References 5 publications

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“…Our results extend the findings of a previous case report (22) and underscore the need to determine drug metabolite concentrations. These concentrations are in marked contrast to a single case report for fluoxetine (20) in which the infant serum concentration was similar to the maternal concentration. Our study confirms the conclusions of Wisner and colleagues (17) that the low concentrations of antidepressants and their metabolites present in infant sera require the use of research-quality assays with welldocumented lower limits of sensitivity.…”

Section: Discussioncontrasting

confidence: 99%

“…The observed breast milk gradient suggests that sertraline and desmethylsertraline are concentrated in the more lipophilic (later) fractions of breast milk. In contrast, a previous report on fluoxetine (20) reported higher fore milk concentrations, although the sample collection procedures in the two studies differed markedly. The effects of a gradient in breast milk may account, in part, for the large variability observed in the time course data for fluoxetine (23).…”

Section: Discussioncontrasting

confidence: 64%

“…The same group did not find detectable serum concentrations of clomipramine and its major metabolites in four nursing infants (17). Case reports are available on fluoxetine (18)(19)(20), fluvoxamine (21), and sertraline (22). Recently, a more detailed study (23) demonstrated an effect of the amount of time after maternal dose on the concentration of fluoxetine and norfluoxetine in breast milk.…”

mentioning

confidence: 99%

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Sertraline and desmethylsertraline in human breast milk and nursing infants

Stowe

Owens

Landry

et al. 1997

AJP

138

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Objective: The purpose of this study was to determine the concentrations of sertraline and desmethylsertraline in both human breast milk and infant serum. Method: Breast milk samples from 12 women were collected at specific time intervals after oral doses of sertraline P regnancy and childbirth represent a period of unique neuroendocrine and psychosocial adjustment during which up to 10% of women meet criteria for major depression. Comprehensive reviews of the management of major depression during pregnancy and lactation focus predominantly on pregnancy (1-5). However, the increasing number of nursing mothers (6) and the numerous professional groups that support breast milk as the ideal form of infant nutrition underscore the need to conduct definitive studies of the transmission of antidepressants to infants during lactation. In a review of the available breast-feeding data, Wisner and colleagues (7) demonstrated the limited quantity of meaningful data.Medications enter breast milk primarily by passive diffusion of the free fraction (8), while specific physiochemical properties of a drug appear to be the best predictor of drug concentrations present in breast milk (9). These properties include: 1) degree of ionization, which is a function of the pKa, 2) molecular weight, 3) blood protein binding, and 4) lipid solubility. The pH gradient between maternal serum and breast milk is a major determinant of the quantity of drug excreted into the milk.Neonatal physiology exhibits unique characteristics that may result in increased circulating drug concentrations after oral dosing relative to that in older individuals. Hepatic maturation in the infant appears to occur at a highly variable rate (10) and is even more delayed in premature infants. Both glucuronidation and oxidative systems are immature at birth (as low as 20% of adult levels); the latter system typically matures by 3

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 64%

mentioning

confidence: 99%

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Sertraline and desmethylsertraline in human breast milk and nursing infants

Stowe

Owens

Landry

et al. 1997

AJP

138

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“…Exceptions to this were relatively high infant levels of nefazodone in 1 infant 68 and fluoxetine in 3 other infants. 32,33 In each of these cases, disconcerting symptoms were seeneg, increased crying, vomiting, diarrhea, colic, and decreased sleep with fluoxetine, 32,33 and drowsiness, lethargy, hypothermia, and poor feeding with nefazodone. 68 The infant whose mother had taken nefazodone was preterm, which may have contributed to the problem.…”

Section: Antidepressant Treatment In Breastfeeding Mothersmentioning

confidence: 98%

The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing Infants

Gjerdingen¹

2003

The Journal of the American Board of Family Medicine

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Background: Postpartum depression is seen in approximately 13% of women who have recently given birth; unfortunately, it often remains untreated. Important causes for undertreatment of this disorder are providers' and patients' lack of information about the effectiveness of various treatments, and their concerns about the impact of treatment on nursing infants. This article presents research-based evidence on the benefits of various treatments for postpartum depression and their potential risks to nursing infants.Methods: The medical literature on postpartum depression treatment was reviewed by searching MEDLINE and Current Contents using such key terms as "postpartum depression," "treatment," "therapy," "psychotherapy," and "breastfeeding.

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“…There are also single case reports of breast-fed infants of mothers on higher doses showing sideeffects such as irritability, cyanosis, somnolence, fever, hypotonia and unresponsiveness (Lester et al, 1993;Nulman et al, 2003). But the general understanding is that although such infants may have gained less weight, they showed no clinical symptoms and did not have cognitive dysfunction when assessed with a standardised development scale (Yoshida et al, 1998;Chambers et al, 1999).…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Psychotropic medication and breast-feeding

Kohen¹

2005

Adv. psychiatr. treat

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The physical and psychological benefits of breastfeeding for the mother and the infant are numerous and range from improved and stronger bonding to better immunological protection. Breast-fed infants have fewer episodes of middle-ear and urinary tract infections and lower mortality rates than bottle-fed babies (Nulman et al, 2003). Breast milk contains nucleotides and enzymes that promote digestion and absorption of nutrients. Breast-feeding has been associated with better cognitive functioning and better performance on IQ measures at age 7-8 years (Fergusson et al, 1982;Lucas et al, 1992).For the mother, breast-feeding causes oxytocin and prolactin release, precipitates postnatal uterine involution and suppresses ovulatory cycles.Breast-feeding has been successfully promoted in recent decades and a significantly large group of women now believe in its benefits and enquire about the possibilities of breast-feeding even when they are on psychotropic medication. It is the duty of the prescribing psychiatrist to guide the mother, the carers, the community mental health team, the general practitioner (GP), the obstetricians and the paediatricians through the intricacies of this complex area of psychopharmacology, in which there is an increasing interest but only scant research, few case studies and limited publications. Pharmacokinetics of psychotropics in breast milkResearchers need information on four factors in order to understand problems related to breastfeeding by mothers taking psychotropic medication: the prescribed dose; the level of the drug in the mother's blood plasma; the level in the breast milk; and the levels in the infant's serum. The amount of drug excreted in the milk is important in evaluating any drug-induced toxicity in the infant.The medication's diffusion across membranes, its molecular weight and its lipophilicity each play an important role in determining the amount that enters the breast milk (Nulman et al, 2003).The milk that comes out towards the end of a feed (hind milk) has a higher concentration of lipids than the thinner foremilk. Consequently, hind milk will contain a greater concentration of any lipid-soluble drug. Colostrum, produced only during the first few days after birth, has a higher protein level and will therefore contain a greater concentration of proteinbound drugs.To evaluate infant exposure to a drug the concentration of the medication or its metabolite are measured simultaneously in the mother's plasma and breast milk. A milk/plasma ratio greater than 1 Psychotropic medication and breast-feeding Dora KohenAbstract Adverse effects of psychotropic medication on breast-fed infants have not been studied in controlled and systematic research. Existing information comes from small case series and single case reports. These limited data confirm that psychotropics are excreted into breast milk and that the infant is exposed to them. In recent decades sufficient data have accumulated to allow psychiatrists to prescribe tricyclic antidepressants, selective serotonin reuptake in...

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Possible Association between Fluoxetine Hydrochloride and Colic in an Infant

Cited by 154 publications

References 5 publications

Sertraline and desmethylsertraline in human breast milk and nursing infants

Sertraline and desmethylsertraline in human breast milk and nursing infants

The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing Infants

Psychotropic medication and breast-feeding

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