Infant Safety With Antipsychotic Therapy in Breast-Feeding: A Systematic Review
J Clin Psychiatry 2008;69(4):666-673
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: A relatively high number of women may suffer from
psychotic symptoms at postpartum onset. Such symptoms may have devastating
effects not only on the mothers but also on the later infant's well being.
Children born to mothers with psychosis are at increased risk of physiologic,
psychological, and personality development disturbance, whereas children born
to mothers with bipolar disorder are at increased risk of early-onset
psychiatric disorders. Hence, clinicians should consider it imperative to
prevent or manage effectively psychotic and affective relapses in new mothers.
Objectives: To analyze the literature for information about
the safety of first- and second-generation antipsychotics for breast-fed
infants in order to individuate the safest treatment option for women who need
such medications during puerperium.
Data Sources: A computerized search was carried
out on MEDLINE/PubMed/TOXNET (1950-January 2008). The following key words were
used: breast-feeding, lactation, puerperium,
psychotropic drugs, atypical antipsychotics, typical antipsychotics,
Conclusions: No conclusions can be drawn about the
risk/benefit profile of the majority of antipsychotic medications in
breast-feeding. Hence, when clinicians are forced to start antipsychotic
treatment in drug-naive patients, the choice of the safest option should be
based on the general effectiveness profile of each agent, with 2 possible
exceptions: clozapine (the drug should be considered contraindicated during
breast-feeding because of its liability of inducing potential life-threatening
events in the infant), and olanzapine (the drug seems to be associated with an
increased risk of inducing extrapyramidal reactions in the breast-fed babies).
Conversely, in patients who need to continue antipsychotic therapy during
breast-feeding, it is suitable to maintain the previous pharmacologic regimen,
if known as effective.