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I have tried Zoloft, Prozac, and now Cymbalta 60mg and Ativan 1mg 3 times a day as needed. None of the medications have helped other than the Ativan taking a little bit of the edge off. I have anxiety, social anxiety, extreme irritability, mood issues, and we're now leaning towards a diagnoses of bipolar. My doctor suggested abilify, lamictal, and even lithium. She said I could not breastfeed if we went with lithium. She also said I would likely need to wean if we went with abilify or lamictal. Is that true? I am nursing my 19 month old son and want him to self wean.
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Tricials09,
Abilify is rated and L3-limited data-probably ok. The amount that transfers into breast milk is 0.7-6.44% of your dose. There are currently four case reports with data about the transfer of Abilify into human milk. The relative infant doses reported have ranged from 0.7-6.44%. None of the infants followed in these case reports had any reported adverse events from Abilify in breastmilk. However, several reports (personal communication) of somnolence have been reported. Monitor your infant for sedation or irritability, apnea, not waking to feed, poor feeding, extrapyramidal symptoms and weight gain.
Lamictal is rated an L2-significant data-compatible. The amount that transfers into breast milk is 9.2-18.27% of your dose. The use of Lamictal in breastfeeding mothers produces significant plasma levels in some breastfed infants, although they are apparently not high enough to produce side effects in most cases. Nevertheless, it is advisable to monitor the infant's plasma levels closely to ensure safety. Also monitor your infant for sedation or irritability, not waking to feed/poor feeding, weight gain and rash. Based on clinical symptoms some infants may require monitoring of liver enzymes or CBC.
Lithium is rated an L4-significant data-possibly hazardous. The amount that transfers into breast milk is 0.87-30% of your dose. Lithium readily transfers to the infant via milk. Infant plasma levels can be significant. Because there are better alternatives than the Lithium such as Lamictal, the Lamictal should be preferred. However if you decide to breastfeed on the Lithium you should monitor your infant for neurobehavioral development, drowsiness, irritability, dry mouth or excessive salivation, thyroid function, vomiting, constipation, hydration, renal function, urination, tremor. It is also strongly suggested that the infant be closely monitored with a BUN/creatinine and serum Lithium levels.
Sandra Lovato R.N.
InfantRisk Center
806-325-2519 -
Would abilify be the best choice?Comment
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Tricials09,
Lamictal or Abilify would be preferred over Lithium, that choice is up to you and your Dr to decide which would work better for you.
Sandra Lovato R.N.Comment
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