Sertraline and donor milk

[Betsy]

Greetings, I have a client with a chest freezer full of expressed milk that is high in lipase. Her baby will not take it. Mom is on 50 mg of sertraline. Mom would love to donate this milk but I'm having a hard time explaining to parents what the relative amount of sertraline that might possibly be in the milk that might possibly be transferred to the baby, and what the relative risk might be. If I found a mom with low supply who was on sertraline, I would feel confident about suggesting a donation of milk with sertraline in it. With a baby who does not have aaseline of sertraline in their system from their mom, what would be the relative risk of accepting donor milk in this situation?
is this clear as mud?
Obviously I'm not brokering milk deals.
Warmly,
Betsy Hoffmeister, IBCLC

[kaytlin]

Hi Betsy,

We work with HMBANA to develop safe medications lists for milk banks and sertraline at all doses is on this list. I'd suggest she donate to a milk bank who will do a thorough screening, pool the milk with other donors, and pasteurize the milk using best practices to keep everyone safe. As for your direct question, I wouldn't expect to observe any adverse events in a baby suddenly exposed to sertraline via breastmilk - there just isn't enough drug there. Sertraline's relative infant dose is well below 5% (this means an infant on average would get less than 5% of an infant-sized dose of sertraline from a full diet of breastmilk).

Dr. Krutsch