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Anti-psychotics and Prozac

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  • Anti-psychotics and Prozac

    I'm 34 weeks pregnant and taking 20 mg daily of Prozac and 300 mg daily of Seroquel XR. Can I breastfeed? My follow up question is: after I have the baby, my doctor would like to experiment with some other anti-psychotics because the Seroquel isn't as effective as he would like it to be. Is there a list of ones that would be ok to try while breastfeeding a new baby and at what doses? I've already tried olanzapine and Geodon (before the pregnancy) and neither have been effective.

  • #2
    Hi, thanks for your post.

    Yes, you can breastfeed on both Prozac and Seroquel XR. Watch the baby for signs of sedation. Switching antipsychotics should be a fairly low-risk endeavor as nearly all of them are equally compatible with breastfeeding. The notable exception is Depakote (valproic acid) which is discussed here:

    You may also be interested in our other articles on antidepressants during pregnancy and breastfeeding:

    For anyone reading this, please post again or call us at the InfantRisk Center, (806)352-2519, if this has not completely answered your question. I would also appreciate you filling out a 2 minute survey about your time on the forum:

    -James Abbey, MD


    • #3
      Conferences with respect to the wellbeing of psychiatric prescriptions in breastfeeding ladies ought to incorporate an examination of the known advantages of breastfeeding to mother and baby and the likelihood that presentation to medicines in the bosom milk may happen. Albeit routine measure of newborn child serum medication levels was suggested in before treatment rules, this method is most likely not justified; in many examples low or non-noticeable baby serum medication levels will be apparent and genuine antagonistic reactions are once in a while reported. This testing is demonstrated, in any case, if neonatal lethality identified with medication presentation is suspected. Baby serum observing is additionally demonstrated when the mother is nursing while taking lithium, valproic corrosive, carbamazepine, or clozapine.

      We have changing measures of study relating to individual medicines, with SSRIs being among the best contemplated drugs in breastfeeding. Additionally, information that is accessible educates most particularly on the transient wellbeing of these drugs, and long haul efficient information are distracted. In this way, in every individual case, the known and obscure dangers of introduction must be adjusted with the dangers of untreated maternal ailment in the mother and her yearning to breastfeed.


      • #4
        In April, the National Toxicology Program's Center for the Evaluation of Risks to Human Reproduction, established by the NTP and the National Institute of Environmental Health Sciences, issued a final report on the reproductive and developmental toxicity of fluoxetine (Prozac). The report concluded that "third-trimester exposure to therapeutic doses of fluoxetine ... is associated with an increased incidence of poor neonatal adaptation," which includes jitteriness, tachypnea, poor tone, and other symptoms, "as well as increased admissions to special care nurseries."
        Having reviewed the report in draft and final form and having testified at the meeting of the expert panel convened to write the report, my greatest concern is what patients and some clinicians may do with the panel's conclusions. Information in the report, while comprehensive and technically correct in most cases, might easily be misconstrued by women and their families.
        The report provides a summary and review of existing data, with a thorough review of the animal and human literature on reproductive safety of fluoxetine. It does not adequately address the clinical context in which fluoxetine or other selective serotonin reuptake inhibitors (SSRIs) are used. While this may not be the aim of the project, failure to address this issue limits the report's value with respect to its ability to inform clinical care; the absence of a clinical context with which to interpret the report may lead to incorrect conclusions and clinical treatment decisions, putting women at risk for the sequelae of untreated or relapsing depressive illness.
        The report criticizes much of the literature regarding reproductive safety of fluoxetine, which is understandable because controlled studies of exposures to any medication during pregnancy are not done for ethical reasons. Conclusions regarding reproductive safety of medications come from various sources, such as case series, postmarketing surveillance registries, and teratovigilance programs. These sources can sometimes provide large enough numbers of drug exposures to allow for useful conclusions regarding reproductive safety.
        The panel's conclusions regarding the risk for major congenital malformations associated with prenatal exposure to fluoxetine are consistent with the literature and suggest an absence of increased risk with first-trimester exposure to the medicine. The report also addresses the risk for "perinatal toxicity," which typically includes symptoms of jitteriness and autonomic reactivity in the newborn.


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