Combination of Medications

[Kelly]

Dear Dr. Hale,
An expectant mom in her third trimester sought lactation advice and regarding taking the following medications during the pregnancy,she has been advised to not make changes by her psychiatrist, as achieving the right balance for her has been a challenge and she wants to breastfeed baby. We looked at each Medication individually in your "Medications and Mother's Milk Book", however, all together in the higher range dosage is where we are concerned, Can you advise? The medications are as follows:

Prozac 80 mg
Wellbutrin 300 mg
Fentanyl Patch 75 mcg (changing the patch every 72 hours)
Ambien 10 mg prn @ HS
Zanax up to 4 mg daily prn

Thank-you, Kelly

[admin]

Kelly:

This in my opinion is a risky mixture of sedative drugs for a newborn infant, and postpartum, it might increase the risk of apnea significantly.

I'd advise against breastfeeding with this mixture. One particular concern is the varying amounts (prn) of Zanax.

Tom Hale PhD.

[admin]

Kelly:

I think the major part of the risk here, is the mother taking or not taking a dose or more than one dose every day. A constantly changing situation is hazardous for an infant rather naive to the drug. If she were to take few if any doses for a week, and then all of a sudden take 3 doses in one day, this is the risky situation.

If she decides to breastfeed, you must warn here to use a stable dosing regimen and not change back and forth, thus exposing the infant to a higher dose one day and lower the next. I don't think she is a very good risk for breastfeeding.

Tom Hale Ph.D.