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Risperdal with breastfeeding

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  • Risperdal with breastfeeding

    We have a mother of a NICU baby who was on Risperidal in her first trimester. Her psychiatrist has taken her off of it due to breastfeeding. The baby is term and is here for CHD. The baby's nurse tells me that this mother needs to be back on her medication. She's not taking anything else other than pain meds at the moment. Risperdal is an L3 but I see that the RID is 2.8% - 9.1%, the MW is 410, and PB is 90%. Am I safe to believe that little gets into the breastmilk? Is there anything that would prohibit this mom from going back on the Risperdal?
    Thank you so much!

  • #2
    Dear klmas,

    Risperidone is probably okay to use in breastfeeding in most cases. No adverse effects have been reported in breastfeeding infants. The amount of mother's dose that enters breastmilk (RID) is between 2.8 to 9.1 percent. The usual adult dose is 3 mg twice daily. One of the side effects though is cardiac arrhythmia and since the infant has CHD, this drug may not be the best choice. An alternative would be quetiapine (Seroquel) or olanzapine (Zyprexa). Quetiapine RID is 0.07 to 0.1 percent of mother's dose and olanzapine RID is 0.3 to 2.2 percent of mother's dose. Observe infant for sedation. This mother may want to talk with her physician about the possibility of using one of these alternatives. Also, discussing the potential risk for arrhythmia with the neonatal team would be appropriate if this mother does have to be on risperidone. Let me know if you have further questions.

    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center


    • #3
      Risperidone and Breastfeeding

      I saw a post-partum psychiatrist today who told me that I should not breastfeed because I take 0.75 mg of Risperidone daily. I also have cholestasis and she said that because the baby is being induced at 37 weeks, this leaves him even more vulnerable for transference. She said if it was going full term to 40 weeks, they would suggest breast feeding but that the effect of meds on the baby is 5X the effect on me. She said that the baby can become lethargic and difficult to awake for feedings. She was pretty adamant about me not breastfeeding. I spoke to my midwife and she suggests following the doctor's suggestion. I've spent the last 9 months having everyone tell me how important breastfeeding is to babies and now, one week before the birth, it's switched. We're inducing birth next Wednesday. Would really appreciate any professional opinions on this.


      • #4
        Hi, thanks for your post.

        Under "normal" circumstances, we give risperidone our second-best safety rating when it comes to breastfeeding. Multiple direct studies of breastfeeding women have demonstrated that only 3-9% of the mother's daily dose is delivered to the infant via the milk, and this did not seem to be enough to cause problems for the babies studied. In a few cases, the drug was completely undetectable in the babies' blood.

        Your situation is different for two reasons:
        1. You are on a very low dose of this drug. A typical adult dose for schizophrenia ranges from 2-8 mg per day. The women in the published studies were taking 6 mg. The side-effects of this drug are dose-dependent.
        2. Your baby will be early-term. This may amplify the effects of the drug in your baby. Mainly, this is due to the liver being a little slow in clearing the medication.

        I would not anticipate you having problems with breastfeeding immediately while on this dose of risperidone. However, a reasonable compromise is to pump and discard your milk until your baby is stable and has an adjusted gestational age of at least 38 weeks. At that point, introduce your milk diluted 50/50 with formula and watch for changes in your baby's wakefulness or other behavior. Once you are satisfied that all is well, transition to full breastfeeding and observe for further changes.

        Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

        -James Abbey, MD
        -Thomas W. Hale, Ph.d.