Breastfeeding newborn with Haloperidol and Olanzapine

[solhum]

What are the recommendations for treating a postpartum psychotic breastfeeding woman who is given 5 mg Haldol TID and 10 mg Olanzapine daily ?
These medications were not used during pregnancy, but to treat an acute situation.
They each seem to have long half-lives: Haldol 12-38 hours and Olanzapine 21-54 hours.
How does this combination of medications affect the newborn?
And is pump and dump a good recommendation if Haldol is a temporary dose? If so, how long?

Solhum

[admin]

Solham,

Haldol is a strong antipsychotic agent and can increase the prolactin levels in some patients. Levels in milk range from low to significant. The amount that transfers into breast milk is 0.2-12% of the mothers dose. Some caution is recommended in breastfeeding mothers. Since this infant was not exposed in utero and the Haldol is going to be short term use we would recommend to pump and dump for 12 hours after her last dose of the Haldol then she could breastfeed with the olanzapine. Monitor the infant for sedation or irritability, insomnia, apnea, not waking to feed/poor feedings extrapyramidal symptoms, tremor and weight gain. If mom is going to need to stay on the Haldol we would recommend starting with half breast milk and half formula to see how the infant tolerates the combination of these two medications since they both have the same side effects, our main concern would be apnea in this infant, if the infant is not symptomatic she could slowly increase to full breastfeeding as the infant gets older and becomes tolerant to the medication. Seroquel might be a suitable alternative since it has a low transfer rate of 0.02-.0.1% of mothers dose.

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[solhum]

Thank you very much.
Is the Infant Risk center phone available to parents as well as medical professionals?
Are there certain days/hours that you're open?

Solhum

[admin]

Solhum,

The InfantRisk Center hotline is available to parents. We are open from 8-5 M-F central time 806-352-2519.

[Carol Palmer]

It is rrisky because unidentifiable amounts have been found in the mothers milk which inturn passes to the baby