Prozac and Wellbutrin

[ma0613]

Hello! I am a 28 y/o female trying to conceive my first child. I also suffer from major depressive disorder, and take Prozac 60mg and Wellbutrin XL 300mg daily. This combination is working well for me. I've been on the same Prozac dosage since 2010, and added the Wellbutrin 6 months ago when I had an increase in symptoms.

My psychiatrist had stated that she would not prescribe these medications for me during pregnancy, reporting a significant risk of birth defects. My OBGYN, however, assured me that there are minimal risks throughout pregnancy and will prescribe them for me. But I have always been told that breastfeeding on Prozac is a no-no, and it is only recently that I have been told my some other women who have children that this is not necessarily true.

Would these medications at these dosages be compatible with breastfeeding?

Thank you!

[admin]

ma0613,

Prozac (fluoxetine) is rated an L2-limited data-probably compatible. A normal dose is 20-60mg a day. The amount transferred into breast milk is 1.6-14.6% of your dose. The infant is usually exposed to more in utero than through breast milk and that the infant becomes accustom to metabolizing the medication in utero, so switching to a different antidepressant midstream is not advised unless the medication is not working for you. However the infant can be born with a full steady state of this medication so careful monitoring for side effects such as sedation or irritability, not waking to feed/poor feeding and weight gain is important. On the other hand if you do not breastfeed the infant could have withdrawal symptoms.

Current data on sertraline and escitalopram suggest these medications have difficulty entering milk, and more importantly, the infant. Therefore, they are preferred agents over fluoxetine for therapy of depression in breastfeeding mothers. However, it is important to remember that the risks to the infant of maternal fluoxetine use are still far less than the benefit derived from breastfeeding. Women who can only take fluoxetine should be advised to continue breastfeeding and observe the infant for side effects. Fluoxetine therapy during breastfeeding is by no means contraindicated and has been used in many thousands of women.

Wellbutrin is rated an L3-limited data-probably compatible. A normal dose is 150mg twice a day. The amount transferred into breast milk is 0.11-1.99% of your dose. Again the infant is exposed to more in utero than through breast milk. There have been two case reports of possible seizures. Monitor the infant for sedation or irritability, seizures, not waking to feed/poor feeding and weight gain. There are also reports that it can reduce milk supply in some women.

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