High dose Seroquel in breast feeding mother

[SGrubnich]

I currently have a mother in our NICU who is on 600mg/day of Seroquel for bipolar issues. All studies that I have looked at have been with doses ranging from 25-400mg. According to Dr. Hale's book, minimal excreation is noted via milk supply with no side effects on infant. Due to possiblility of sedation for mother, I was concerned with the risk (if any) to the infant with a higher dose. Our pharmacist was discussing half lifes and pumping/dumping some of the milk supply. If you would please get back to me with any additional information about this higher dose, I would appreciate it.
Thank you,
Sarah

[cpride]

Dear Sarah,

Quetiapine (Seroquel) has a low relative infant dose of 0.07 % to 0.1 % of mother's dose. In the studies available, no adverse effects were noted in the infants. It is suggested to monitor the infant for muscle twitching (tardive dyskinesia), facial grimicing, and sedation. The authors of one study suggest to monitor infant serum levels. Since this mother is on a high dose of quetiapine, plasma levels probably should be monitored on this infant. We would suggest that the mother pump and discard 3 hours from her dose. At 6 hours from her dose, she may pump and save her milk. This allows the first half-life to pass. Let me know if you have further questions.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[Alair55]

Information indicates that maternal quetiapine doses of up to 400 mg daily produce low levels in milk.

[Vsmislewwwwe]

Thank you for*your posts!*Very interesting!

[Nathalie Gagnon]

Hi, we have here a mom-to-be on quetiapine 600 mg daily who wants to breastfeed when baby will be born.. Is there new information since this post in 2012? Thank you very much and have a nice day.

[Sandra]

Nathalie Gagnon,

Quetiapine (Seroquel) is rated an L2 and has a very low RID range of only 0.02-0.1% of the maternal dose, however this will be a function of how high a dose the mother is on. The infant will be probably be exposed to more in utero than through breast milk, however with this high of dose I worry about the sedating effects. This medication is usually taken at night because of the sedating effects in the mother, so the infant will probably not be monitored as closely during the night time hours. I would suggest this mother supplement during the first 6 hours to get to a half-life to reduce exposure of this medication especially in the newborn phase. Monitor the infant for sedation or irritability, apnea, not waking to feed/poor feeding, extrapyramidal symptoms and weight gain. As the infant gets older she could probably forgo waiting a half-life if the infant is tolerating the medication and not symptomatic.

Sandra Lovato R.N.
InfantRisk Center