Fluoxetine Pregnancy/Breastfeeding

[dearnicole]

Good afternoon,

I have been treated in the past with celexa and cymbalta at different times for anxiety. I weaned off cymbalta with the plan to start a family. Anxiety and depression came back and doctor prescribed Zoloft which she considered safer during pregnancy. Unfortunately the Zoloft didn’t seem to have the same effect and have adjusted the dose for the past six months.

Since both celexa and Zoloft haven’t worked in the past, doc would like to try Prozac. I have concerns about this drug during pregnancy and breastfeeding. Should I proceed with treatment or try something else?

Thank you,

[Sandra]

dearnicole,

Prozac is rated an P3-unknown-risk to fetus cannot be ruled out. Most of the antidepressants are rated a 3 or higher in pregnancy. "Fluoxetine crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of fluoxetine in the first trimester and cardiovascular malformations.[2] In the third trimester, fluoxetine use does not seem to cause any complications to the fetus and neonate. Meta-analysis reviews have not proven any relationship between fluoxetine usage in the first trimester and congenital malformations in humans.[5] Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Compared with other drugs used in the treatment of depression, SSRIs have less side effects. [1] Fluoxetine crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of fluoxetine in the first trimester and cardiovascular malformations.[2] In the third trimester, fluoxetine use does not seem to cause any complications to the fetus and neonate.[3] It is important for mothers to continue using their antidepressant medication postpartum since there seems to be an association between depression in pregnancy and postpartum depression.[4] Meta-analysis reviews have not proven any relationship between fluoxetine usage in the first trimester and congenital malformations in humans.[5]"

1.##Morrison JL, Riggs KW, Rurak DW. Fluoxetine during pregnancy: impact on fetal development. Reprod Fertil Dev. 2005;17(6):641-650.
2.##Diav-Citrin O, Shechtman S, Weinbaum D, et al. Paroxetine and fluoxetine in pregnancy: a prospective, multicentre, controlled, observational study. Br J Clin Pharmacol. Nov 2008;66(5):695-705.
3.##Goldstein DJ. Effects of third trimester fluoxetine exposure on the newborn. J Clin Psychopharmacol. Dec 1995;15(6):417-420.
4.##Cohen LS, Heller VL, Bailey JW, Grush L, Ablon JS, Bouffard SM. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry. Nov 15 2000;48(10):996-1000.
5.##Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med. Jan 2000;30(1):89-94.


In lactation Prozac is an L2-limited data-probably compatible. The amount that transfers into breast milk is 1.6-14.6% of your dose. We think it is ok to nurse while taking Prozac if your dose is within the normal dose range of 20-60mg a day, and as long as your infant is not symptomatic. Monitor your infant for sedation or irritability, not waking to feed/poor feeding and weight gain.

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

[dearnicole]

Thank you for that information.

if the mother is on a lower dose of fluoxetine (10-20mg) would the risks be reduced for the infant in both pregnancy and breastfeeding?

Feeling discouraged since Setraline was not therapeutic yet it seems to have the lowest known risks associated with it. Hoping fluoxetine is still a suitable choice.

[Sandra]

dearnicole,

Yes the lower the dose the less the infant is exposed to.

Sandra