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I am currently 9 months pregnant with my baby and hoping to breastfeed. I have Bipolar I and am experiencing an intense amount of depression and the baby isn't even here yet! I am currently taking 60 mg of Geodon a day. I am on a low dose because of the pregnancy. How high a dose could I safely take without posing a risk to my infant. Is there any advantage to taking lower dosages twice a day as oppose to all at once one time a day? I just want to know if my psychiatrist ups my dosage whether or not I can continue nursing. Ultimately, I want to do what is best for my child while remaining healthy. I will only continue nursing if that is in the best interest of my child.
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Rhapsody:
Below is all the data we have on Geodon (ziprasidone).
Ziprasidone is an atypical antipsychotic agent chemically unrelated to phenothiazines or butyrophenones.[1] In a brief case report of 1 patient receiving a dose of 160 mg/day with a plasma level of 177 ng/mL, milk levels were undetectable until day 10 of therapy which was 11 ng/mL and 170 ng in maternal plasma.[2] Milk/plasma ratio was 0.06. The authors estimated the relative infant dose to be 1.2% of the weight-normalized maternal dose. No untoward effects were noted in the infant. In another case report of an infant exposed throughout pregnancy and subsequently breastfed for 6 months, the infant (2.64 kg) was delivered at 39 weeks, and did not exhibit withdrawal symptoms or any other drug-related symptoms.[3] While milk levels were not determined, no adverse effects of ziprasidone were noted. The infant developed normally over the following 6 months.
The amount of Ziprasidone that gets to the infant is about 0.07% - 1.2% of the maternal dose. This is about average for all the atypical antipsychotics. Since your fetus has already been exposed to this drug, it will probably have significant tolerance to it, and will handle the smaller amounts in milk quite well. I'd suggest to your psychiatrist, that the dose via milk will be much lower than the dose in utero.
Regards
Tom Hale Ph.D.
1.##Pharmaceutical manufacturer prescribing information, 2003.
2.##Schlotterbeck P, Saur R, Hiemke C, et al. Low concentration of ziprasidone in human milk: a case report. Int J Neuropsychopharmacol. Apr 2009;12(3):437-438.
3.##Werremeyer A. Ziprasidone and citalopram use in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry. Nov 2009;166(11):1298.
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