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Use of sertraline, paroxetine and fluvoxamine by nursing women

UCLA Neuropsychiatric Institute and Hospital, Los Angeles, California

ALAN FUKUCHI, MT (ASCP)

Clinical Laboratory, UCLA Center for Health Sciences, Los Angeles, California

LORI ALTSHULER, MD and MEL WIDAWSKI, PhD

UCLA Neuropsychiatric Institute and Hospital and West L.A. Veterans Administration Medical Center, Los Angeles, California

AMY WERTHEIMER, BA and MARTINA V. BRUNHUBER, MA

UCLA Neuropsychiatric Institute and Hospital, Los Angeles, California, USA

Correspondence: Dr Victoria Hendrick, Department of Psychiatry, UCLA, 300 Medical Plaza, Suite 2345, Los Angeles, CA 90095, USA

Declaration of interest This study was supported by the National Institute of Mental Health, Smith Kline Beecham and Pfizer.

Background The pharmacological treatment of depression in nursing women requires information on the magnitude of medication exposure to the infant that may occur through breast milk.

Aims To examine serum concentrations of antidepressants in infants exposed to these medications through breast-feeding.

Method Maternal and infant serum concentrations of sertraline, paroxetine and fluvoxamine were determined with high-performance liquid chromatography (limit of detection=1 ng/ml).

Results No detectable medication was present in any infant exposed to paroxetine (n=16) or fluvoxamine (n=4). Among infants exposed to sertraline (n=30), detectable medication was present in 24% of serum samples. A significant negative correlation was found between infant age and infant serum concentration. Sertraline was significantly more likely to be detected in an infant if the mother's daily dose was 100 mg or higher. No adverse sequelae occurred in any infant.

Conclusions This study shows that paroxetine, fluvoxamine and sertraline produce minimal exposure to infants when taken by nursing mothers.

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ELIZABETH WALSH
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