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Help for new mother with mania symptoms

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  • Help for new mother with mania symptoms

    I have been working as a postpartum doula with a family whose child is about a month old now. Until last week the mother was caring for her newborn, breastfeeding well and adjusting to parenting in the ways that all seem on target based on my training and experience.

    She began not being able to sleep late last week, has been feeling increasingly anxious and is experiencing racing thoughts and is currently experiencing a mania episode as part of her bipolar symptoms. They visited her doctor today. We have searched your forum for information about the medications she is currently taking and those suggested for her to take. She is taking:
    1) Lovoxyl 1.5 mg for hypothyroid condition
    2) Zolpidem (Ambien) 10mg for sleep (at night)
    3) Clonazepam (she has taken 1 pill last night)
    4) Benedryl (as needed).

    The doctor also has suggested Zyprexa but she has not filled this Rx yet.

    So far the above have not helped abate her symptoms and she has been unable to sleep much.

    If it is possible to continue to breastfeed it would be great but at this point it looks like regaining her mental balance and ability to function is actually more important for all involved.

    If you have suggestions of medications and/or strategies that would address her issues and allow for breastfeeding (or not), we would very much appreciate hearing from you.

    Thank you in advance.
    Last edited by cald1905; 04-09-2012, 11:06 PM.

  • #2
    Dear cald1905,

    We need more specifics on this medication regimen to give you an accurate answer, so please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday 8 to 5 Central Daylight Time.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

    Comment


    • #3
      Dear Cindy,

      The mom I spoke with you about has been hospitalized and has begun taking Zyprexa. The family is in the process of sorting out the plan for the next few days, weeks, etc. The dad is concerned about the possible side effects of Zyprexa on the mom and of course there is still a desire on the mom's part to be able to breastfeed her baby if possible. The patient information insert says that breastfeeding is not recommended for those using Zyprexa. I can't tell if that is just a standard precaution (CYA) or has merit. Do you have any information about it?

      Thank you in advance.

      Sandy

      Comment


      • #4
        Dear cald1905,

        Olanzapine (Zyprexa) is an atypical antipsychotic agent. The RID (amount of mother's dose that enters breastmilk) is 0.3 to 2.2 percent. Usually, RID's less than 10 percent are compatible with breastfeeding. The time olanzapine is highest in breastmilk is 5 to 8 hours after the dose is taken, and mom should avoid breastfeeding during this time to decrease infant exposure. Observe infant for sedation and constipation. The addition of zolpidem and clonazepam to olanzapine are more concerning than the olanzapine alone. Because when infants who are younger than 2 months of age or premature are exposed to several medications that cause sedation, this may increase the risk of apnea. These medications should only be used short term and in a low dose. Zolpidem has a RID of 4.7 percent to 19.1 percent with half life (time it takes for half of the drug to be eliminated from the body-it takes 5 half lives for 98 percent of the drug to be eliminated) of 2.5 to 5 hours. Because the RID of zolpidem is higher than 10 percent in some mothers, the risk of sedation for the infant is higher. Two alternative medications are zopiclone and eszopiclone that have RID's of 1.5 percent. Also the half-life of clonazepam is 18 to 50 hours so the drug stays in the mother's system a long time. The RID is small at 2.8 percent. Lorazepam (Ativan) has a shorter half-life of 12 hours, and the RID is also small at 2.6 to 2.9 percent. Lorazepam would be a preferred alterantive to clonazepam. Hopefully after the mother starts olanzapine she can wean off zolpidem and clonazepam, but if not the alternatives as listed above would be more compatible with breastfeeding and still observing closely for sedation. Hope this information helps.

        Sincerely,
        Cindy Pride, MSN, CPNP
        TTUHSC InfantRisk Center
        Last edited by cpride; 04-13-2012, 10:35 AM.

        Comment


        • #5
          More questions on this topic

          Hi Cindy,

          Here is the current prescription for the new mom for the next few weeks

          1) 15mg Zyprexa at 10pm
          2) 5mg Zyprexa at 7am
          3) .75 Lovoxyl at 7am

          The doc is looking to drop the morning dosage of 5mg Zyprexa in the next few days completely. Please let me know of your thoughts on breastfeeding with this prescription. Also, it would be helpful to know the the RID on this dosage.

          Thanks
          newmadre

          Comment


          • #6
            Dear newmadre,

            The typical dose of olanzapine is 5 to 10 mg daily, but breastfeeding studies have been done on women who were taking 20 mg daily with no untoward effects. The RID of a mother taking 20 mg per day was calculated at 4 percent (milk/plasma ratio 0.35). The time she should avoid breastfeeding would be 5 to 8 hours after her dose (when dose is highest in her breastmilk). Observe the infant for sedation and constipation. Lovoxyl is compatible with breastfeeding. The main concern with hypothyroidism is the condition not to be diagnosed. As long as the mother's thyroid studies are within normal limits, there should not be a problem for the infant.

            Sincerely,
            Cindy Pride, MSN, CPNP
            TTUHSC InfantRisk Center

            Comment


            • #7
              If it is possible to continue to breastfeed it would be great but at this point it looks like regaining her mental balance and ability to function is actually more important for all involved.

              If you have suggestions of medications and/or strategies that would address her issues and allow for breastfeeding (or not), we would very much appreciate hearing from you.

              Thank you in advance.

              Comment

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