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  • Cymbalta

    Dr. Hale - I am curious if you have any thoughts about cymbalta and breastfeeding. I have been on the medication train long enough to know that it is the only drug that is effective for me. I quit it when trying to conceive and have been off of it since then. My baby is now 8 months old, and I am REALLY struggling without medication.

    I have a friend whose doctor kept her on cymbalta through pregnancy and now breastfeeding. I'm still worried though and am having a hard time knowing whether I should stay depressed in order to breastfeed, stop breastfeeding in order to medicate, or medicate while breastfeeding. I wish the safer, more tested drugs worked for me!

    Thanks for any thoughts you can share. My husband is afraid to drug the baby and is encouraging me just to keep nursing, but he has never experienced depression before, so he doesn't know how I'm feeling (although he tries to be very understanding).

  • #2
    Mary:

    First, it is MOST important that you deal with your health. NOTHING is worse for your infant's neurobehavioral develoment than maternal depression. We now consider this the greater risk of depression, far worse than the exposure to drugs.

    Secondly, we have some good on the transfer of Cymbalta and it is quite good. Very very little gets into breastmilk and the fact that your infant is 8 months old is even better for your situation, as he will get and retain very limited quantities. Only about 0.14% of your dose enters breastmilk. This is one of the lowest I know of.

    Please confer with your physician and I recommend you start a low dose and taper upwards over a month or so. I think all will be fine for you and your infant.

    Tom Hale PH.D.
    Professor
    Department of Pediatrics
    TTUHSC
    InfantRisk Center



    --------From the InfantRisk Center---------------

    The transfer of duloxetine into breastmilk was studied in 6 women who were at least 12 weeks postpartum and taking 40 mg twice daily for 3.5 days.[2] Paired blood and breastmilk samples were taken at 0, 1,2,3,6,9, and 12 hours postdose. The milk/plasma ratio was reported to be about 0.267. The daily dose of duloxetine was estimated to be 7 µg/day (range=4-15 µg/day). According to the manufacturer, the weight-adjusted infant dose would be approximately 0.141% of the maternal dose. Further, even this is unlikely absorbed, as duloxetine is unstable under acid conditions of the infants stomach.

    In a more recent study in a mother consuming duloxetine (60 mg daily), levels in milk were 31 µg/L and 64 µg/L at trough and peak respectively.[3] The Milk/plasma ratios were 1.29 (trough) and 1.21 (peak). These authors suggest an RID of 0.14%.

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    • #3
      Thank you!

      Thank you so much, Dr. Hale. I read your response to my husband, and I think we're going to talk to the doctor and give the meds & nursing a try. It really helps to get input straight from you - especially with a husband who has a PhD. We both appreciate your time and expertise! Thanks again.

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      • #4
        Mary:

        This is from the Cymbalta package insert.

        Cymbalta should be administered at a total dose of 40 mg/day (given as 20 mg twice daily) to 60 mg/day (given either once daily or as 30 mg twice daily). For some patients, it may be desirable to start at 30 mg once daily for 1 week, to allow patients to adjust to the medication before increasing to 60 mg once daily. While a 120 mg/day dose was shown to be effective, there is no evidence that doses greater than 60 mg/day confer any additional benefits. The safety of doses above 120 mg/day has not been adequately evaluated [see Clinical Studies (14.1)].

        Tom Hale Ph.D.

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        • #5
          I know this is an old thread, but I just want to reassure moms who are struggling with the "Cymbalta vs breastfeeding" dilemma. I've been on Cymbalta 30mg daily for the duration of my pregnancy and now at 10 months breastfeeding. There have been NO side effects in my son. He's incredibly healthy, developing normally, and has a mentally healthy mom! Both my OB and his doctor left the decision up to me and I came to this site for information to help ease my fears.

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          • #6
            Breastfeeding - hi doctor ,,i am 29 year woman...i am taking anti depressant esitalopram 20mg,duloxentine40 mg,lemotrigine 100 mg per day,,and i am lactating mother,,my baby is 15 days old on breast feed,,, are these drugs are harmfull to baby??? please reply

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            • #7
              jigisha:

              The combination of all of these drugs is a bit worrisome. I'd suggest you watch your infant closely for symptoms of sedation, sleepiness or difficulty in feeding. I imagine as the infant ages pass one month that the risks will decline.

              Tom Hale Ph.D.

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              • #8
                thank you admin sir.....sir right now my baby has no any problem....sir if any symptom will not develop till 1 month of age,,,then should i coontinue???and what will be risk after 1 month of age??? sir is there any chance for neuro-psychiatric devlopmental delay for my baby?? sir please reply .....thanks...

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                • #9
                  Hello,
                  my baby was affected by cymbalta use during pregnancy and I amstl facing complications at 12 weeks postpartum.
                  Details are:
                  I needed to stay on the 30mg cymbalta through pregnancy. Baby boy was born naturally, no epidural or drugs, at 39 weeks, with strong respiratory effort, suck/nurse & cry, and declined in the first 24 hours after birth. Baby withdrew from medication over the course of 7 days, was lethargic, poor tone, tachyapnea, grunting, retractions, heightened startle response, drowsiness and difficulty to wake. It was very scary. Problems were compounded by tongue & lip tie which was Lazer revised on day 5 after birth, allowing baby to suck more effectively & causing less pain to me.
                  I have taken the cymbalta continuesly, and baby is 12 weeks. We have continued to face problems nursing, baby has lost ability to suck, has a high narrow palette, strong gag reflex and bites the nipple to attempt to stimulate milk flow.
                  Baby tires at the breast, gives up, falls asleep (despite rigorous attempts to keep him awake & nursing) then wakes several minutes later, hungry. Bottle feeding breastmilk is even more difficult due to gag response & rejection but we are being persistent because baby needs the ounces. Baby is otherwise bright, cheery, and alert.

                  We we have seen many specialists; 5 Lactation consultants/RN’s, physical therapists, dental specialists, 2 pediatricians, and two midwives. our latch is as good as it can be, we are following all advice, breastfeeding educated, and genetic disorders have been ruled out. Feeding problems are perplexing the experienced professionals.
                  A neonatal pharmacist at poison control denied any possibility that the cymbalta could have caused the problems.

                  The cymbalta side effects on newborns indicates “respiratory distress and problems breastfeeding”, however, that is vague at best, and doesn’t elaborate on the details of what kind of distress/ problems occur or duration of problems. Could you tell me anything more about these side effects?

                  I would like to keep baby on breastmilk, but I am concerned that the cymbalta might be causing the problems.

                  i have severe depression and getting off cymbalta would be dangerous myself & family. Please tell me what you think.

                  Thank you for your thoughts,
                  J & baby W

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