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Abilify and Zoloft and Others

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  • #1

    Abilify and Zoloft and Others

    Dear Dr. Hale, I am an IBCLC working with a mother who is presently undelivered. She is taking Abilify 10 mg daily and Zoloft 100 mg daily. Is she safe to breastfeed with this combination? If she needs further treatment for depression after the birth she will be taking Wellbutrin and Provigil as well. What would the safety of this combination be? Many thanks in advance!
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  • #2
    Dear Paw100,

    Sertraline (Zoloft) has been extensively studied in many breastfeeding mothers. The data is consistent that levels in milk are quite low and do not normally affect an infant. Studies of platelet function further suggest that sertraline is poorly absorbed by the infant and at levels too low to affect platelet function. Sertraline is one of the preferred antidepressants. Nevertheless, we still advise the mum to observe the baby for sedation or irritability.

    There are currently two case reports with data about the transfer of aripiprazole (Abilify) into human milk. In a case report of a patient who started therapy on 10 mg daily and then had a subsequent dose increase to 15 mg daily. Levels of aripiprazole in milk were reported to be 13 and 14 ?g/L on the two consecutive days and the relative infant dose was estimated to be about 1%. In a second case report of a mother who took aripiprazole 18 mg daily in pregnancy and while breastfeeding, the maternal breast milk and infant plasma levels were found to be 38.7 ?g/L and 7.6 ?g/L. The infant should be monitored for somnolence.

    Generally speaking, usually if the mum is on the drug while pregnant, the baby will get more in utero than from breastmilk. I would suggest she breastfeeds the baby, while observing the baby for somnolence and sleepiness, make sure baby is waking up every 2-3hours for feeds, and is gaining adequate weight.

    If mum needs any more medications, you can call us at 806-352-2519, and we will be able to give you an accurate answer depending on the baby's age at that point, the dose she will be started on, and many other factors.

    Tassneem Abdel Karim, MD
    InfantRisk Center

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