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Fluvoxamine, Buspiron, and Klonopin

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  • Fluvoxamine, Buspiron, and Klonopin

    Prior to pregnancy I was on Wellbutrin 150 mg, Fluvoxamine 200mg, and Buspar 15mg for chronic anxiety, depression, and OCD. I was encouraged by multiple doctors to be on lowest dose possible and as few medications as possible for pregnancy. At beginning of pregnancy I was on 100mg Fluvoxamine and 15mg Buspar. Relapse occurred during first trimester and I was taking .25/day of Klonopin while increasing Fluvoxamine to 200mg and Buspar to 45mg. Remained at this dosage through second and third trimester and discontinued Klonopin. Son (born at 36 weeks) experienced abstinence syndrome after birth. Predominantly excessive jitteriness and poor nursing. Exclusively breastfeeding for 3 months now after initial supplementation - milk was delayed coming in - but persisted due to it possibly helping with withdrawal. I am concerned about continued exposure though and future withdrawal symptoms when weaning. I was also advised I could take .25mg of Klonopin here and there as needed for excessive anxiety. Son still has slight tremors now and then, but I am assuming it will completely go away. Your input is greatly appreciated!
    Last edited by SoCalMoM88; 07-26-2019, 07:38 AM.

  • #2

    Fluvoxamine is rated an L2- limited data-probably compatible. The amount that transfers into breast milk is only 0.3-1.4% of your dose. A normal dose is 50-300mg a day. We think you can continue to nurse while taking this medication as long as your infant is not symptomatic, watch for sedation or irritability, not waking to feed/poor feeding and weight gain.

    Buspar is rated an L3- no data-probably compatible. We do not know how much transfers into breast milk, but several properties of this medication suggest it will have a difficult time entering the breast milk such as high protein binding, large volume of distribution, low oral bioavailability, and a minimally active metabolite. The half-life is only 2-3 hours. Take it after nursing and monitor for changes in behavior (sedation or irritability), poor feedings and poor weight gain.

    Klonopin is rated an L3-limited data-probably compatible. The amount that transfers into breast milk is 2.8% of your dose. The half-life of this medication is long 18-50 hours. If you are just taking Klonopin on occasion and using low doses such as the 0.25mg we think it is ok to continue nursing, Monitor for sedation, slowed breathing rate, poor feedings and poor weight gain.

    Individually these medications are probably safe to use while breastfeeding; however, according to Lexicomp there are 3 drug to drug interactions with these medications :
      • D BusPIRone – FluvoxaMINE (Selective Serotonin Reuptake Inhibitors)
        C BusPIRone (CNS Depressants) – KlonoPIN (CNS Depressants)
        C FluvoxaMINE (Selective Serotonin Reuptake Inhibitors) – KlonoPIN (CNS Depressants)
    D = Consider therapy modification
    C = Monitor therapy
    These drug interactions pertain to the person taking them; however, the question is if there is enough transferred through the breast milk to possibly effect your infant ? probably not, but we cannot say for sure. I think you could continue to breastfeed your infant monitor for possible side effects and as long as your infant is not symptomatic there should not be a problem. As far as your infant having withdrawal symptoms again it is unlikely as long as you wean them off the breast milk slowly or wean off the meds slowly and do not stop abruptly. We do not have any long term data about the use of these medications, but we think that as long as they are not symptomatic now that they are not receiving enough through the breast milk to effect them later in life.

    Sandra Lovato R.N.
    InfantRisk Center