Review Article

Antipsychotic Drugs and Safety Concerns for Breast-Feeding Infants

Authors: Tapan Parikh, MD, MPH, Dharmendra Goyal, MD, Jonathan R. Scarff, MD, Steven Lippmann, MD

Abstract

Antipsychotic drugs prescribed to treat psychiatric symptoms during the postpartum period are secreted into breast milk. Because breast-feeding is crucial to infant development, it is important to select a medication that poses the fewest adverse consequences. Aripiprazole, haloperidol, perphenazine, and trifluoperazine demonstrate no known developmental dangers. Olanzapine, quetiapine, and risperidone are cited as safe, although monitoring is recommended. Chlorpromazine and clozapine may induce developmental concerns. There are limited safety data for asenapine, fluphenazine, iloperidone, loxapine, lurasidone, paliperidone, pimozide, thioridazine, thiothixene, and ziprasidone. Clinicians should choose medications considered to be the safest and prescribe them at the lowest effective doses.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Usher K, Foster K, McNamara P. Antipsychotic drugs and pregnant or breastfeeding women: the issues for mental health nurses. J Psychiatr Ment Health Nurs 2005;12:713-718.
 
2. Winans EA. Antipsychotics and breastfeeding. J Hum Lact 2001;17:344-347.
 
3. Robinson GE. Treatment of schizophrenia in pregnancy and postpartum. J Popul Ther Clin Pharmacol 2012;19:e380-e386.
 
4. Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry 2007;164:1817-1824.
 
5. Risbood V, Lee JR, Roche-Desilets J, et al. Lurasidone: an atypical antipsychotic for schizophrenia. Ann Pharmacother 2012;46:1033-1046.
 
6. Iqbal MM, Kunwar A, Lee K, et al. Effects of commonly used antipsychotics (typical and atypical) in pregnancy and lactation. J La State Med Soc 2005;157:94-97.
 
7. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506.
 
8. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol 2004;11:e257-e266.
 
9. Tenyi T, Csabi G, Trixler M. Antipsychotics and breast-feeding: a review of the literature. Paediatr Drugs 2000;2:23-28.
 
10. Yoshida K, Smith B, Craggs M, et al. Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants. Psychol Med 1998;28:81-91.
 
11. Wiles DH, Orr MW, Kolakowska T. Chlorpromazine levels in plasma and milk of nursing mothers. Br J Clin Pharmacol 1978;5:272-273.
 
12. Patton SW, Misri S, Corral MR, et al. Antipsychotic medication during pregnancy and lactation in women with schizophrenia: evaluating the risk. Can J Psychiatry 2002;47:959-965.
 
13. Whalley LJ, Blain PG, Prime JK. Haloperidol secreted in breast milk. Br Med J (Clin Res Ed) 1981;282:1746-1747.
 
14. Olesen OV, Bartels U, Poulsen JH. Perphenazine in breast milk and serum. Am J Psychiatry 1990;147:1378-1379.
 
15. Lutz UC, Hiemke C, Wiatr G, et al. Aripiprazole in pregnancy and lactation: a case report. J Clin Psychopharmacol 2010;30:204-205.
 
16. Gentile S. Clinical utilization of atypical antipsychotics in pregnancy and lactation. Ann Pharmacother 2004;38:1265-1271.
 
17. Barnas C, Bergant A, HummerM, et al. Clozapine concentrationsin maternal and fetal plasma, amniotic fluid, and breast milk. Am J Psychiatry 1994;151:945.
 
18. Meyer JM, Loebel AD, Schweizer E. Lurasidone: a new drug in development for schizophrenia. Expert Opin Investig Drugs 2009;18:1715-1726.
 
19. Sanford M. Lurasidone: in the treatment of schizophrenia. CNS Drugs 2013;27:67-80.
 
20. Croke S, Buist A, Hackett LP, et al. Olanzapine excretion in human breast milk: estimation of infant exposure. Int J Neuropsychopharmacol 2002;5:243-247.
 
21. Whitworth A, Stuppaeck C, Yazdi K, et al. Olanzapine and breast-feeding: changes of plasma concentrations of olanzapine in a breast-fed infant over a period of 5 months. J Psychopharmacol 2010;24:121-123.
 
22. Brunner E, Falk DM, Jones M, et al. Olanzapine in pregnancy and breastfeeding: a review of data from global safety surveillance. BMC Pharmacol Toxicol 2013;14:38.
 
23. Gardiner SJ, Kristensen JH, Begg EJ, et al. Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry 2003;160:1428-1431.
 
24. Goldstein DJ, Corbin LA, Fung MC. Olanzapine-exposed pregnancies and lactation: early experience. J Clin Psychopharmacol 2000;20:399-403.
 
25. Rampono J, Kristensen JH, Ilett KF, et al. Quetiapine and breast feeding. Ann Pharmacother 2007;41:711-714.
 
26. Misri S, Corral M, Wardrop AA, et al. Quetiapine augmentation in lactation: a series of case reports. J Clin Psychopharmacol 2006;26:508-511.
 
27. Hill RC, McIvor RJ, Wojnar-Horton RE, et al. Risperidone distribution and excretion into human milk: case report and estimated infant exposure during breast-feeding. J Clin Psychopharmacol 2000;20:285-286.
 
28. Ilett KF, Hackett LP, Kristensen JH, et al. Transfer of risperidone and 9-hydroxyrisperidone into human milk. Ann Pharmacother 2004;38:273-276.
 
29. Schlotterbeck P, Leube D, Kircher T, et al. Aripiprazole in human milk. Int J Neuropsychopharmacol 2007;10:433.
 
30. Gentile S. Infant safety with antipsychotic therapy in breast-feeding: a systematic review. J Clin Psychiatry 2008;69:666-673.
 
31. Klinger G, Stahl B, Fusar-Poli P, et al. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev 2013;10:308-317.
 
32. Iqbal MM, Aneja A, Rahman A, et al. The potential risks of commonly prescribed antipsychotics: during pregnancy and lactation. Psychiatry (Edgmont) 2005;2:36-44.