Are Psychotropic Drugs Safe to Use During Lactation?

摘要

The literature on the safety of psychotropic drug use during lactation is limited. All psychotropic drugs are secreted in breast milk, but most psychotropic drugs are present only in low concentrations. Most psychotropics fall into Hale and Rowe's lactation risk categories of L2 and L3 (ie, probably compatible with lactation). Although all selective serotonin reuptake inhibitors are generally safe in lactation, sertraline is increasingly being recommended as the first choice. Among tricyclic antidepressants, the recommendation to avoid doxepin is universal. Monoamine oxidase inhibitors are best avoided given the lack of data and known significant drug interactions. Because of lithium's high concentration in breast milk and the potential for hazardous toxicity in the neonate, it is considered as incompatible with breast-feeding, although some authors advocate cautious rehabilitation. Given clozapine's potentially fatal side effect of agranuiocytosis, breast-feeding while on clozapine cannot be recommended. Infants exposed to benzodiazepines through breast milk are at risk for developing central nervous system depression and apnea, but with judicious use the risk generally appears to be low.