BreastMilk and Medications
Because psychotropic medications are excreted in breast milk, women who take them should be discouraged from breast feeding, according to Dr. Zachary N. Stowe, of Emory University School of Medicine in Atlanta. Dr. Stowe presented a talk on this subject to the recent annual meeting of the American Psychiatric Association in New York, and his comments were reported in the July 3 issue of Obstetrics and Gynecology News by Erik L. Goldman, the publication's northeast bureau chief.
According to Goldman, Dr. Stowe qualified his caution to the audience. "Many patients will breast-feed despite physician warnings...leaving clinicians with a difficult decision: continue drug therapy and risk potential adverse effects for the infant or stop treatment and risk relapse of the mother's mental illness."
Goldman says that Stowe explained that "...available data suggest that the risk of recurrent maternal illness far exceeds the risk of psychotropic-related side effects in the infant...There is little evidence that exposure to any psychotropic medication during lactation has an adverse impact on infant health and development."
On the other hand, Goldman reports, it is clear that discontinuation of a psychotropic regimen for the duration of lactation will markedly increase the risk of maternal relapse and possibly even produce behavior that is dangerous to the infant.
Dr. Stowe advised that a breast-fed infant of a mother on psychotropic medication be monitored in the same way the patient is monitored, with measurements of serum concentrations of the drug as well as any drug-specific laboratory tests. Goldman also reports that, according to Dr. Stowe, if an infant serum assay indicates that the drug is not detected, the assay is probably not sensitive enough.
Finally, reports Goldman, Dr. Stowe concluded, "Lactation is not
the time for experimentation...If a breast-feeding woman is responding
to her medication, don't change it."
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