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Potential medications in pregnancy and breastfeeding

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  • Potential medications in pregnancy and breastfeeding

    Hello,
    I am sorry if this message ends up in the wrong inbox - I am having trouble emailing it through.
    I have a question about medications in pregnancy and breastfeeding. I suffered from severe anxiety during pregnancy and after the birth of my first child and am contemplating falling pregnant with Bub #2. Before conceiving, I want to have a wellness plan in case I become ill again.
    I tried Zoloft post-pregnancy when I became unwell last time and despite taking it for a number of weeks and increasing my dosage, it was not successful. I ended up taking Prozac 10mg which worked well but I lost weight on this drug and more importantly, was extremely concerned about the level of the drug passing through my breast milk. My concern about the level of Prozac passing through my breast milk meant that I delayed treatment for much longer than I should have. My doctor has suggested I trial Citalopram (Celexa or Cipramil) prior to falling pregnant as it has a better profile for pregnancy and breastfeeding.
    Firstly, does it have a better safety profile for pregnancy? I understand that Prozac has been around a lot longer and therefore I would have thought that it potentially was better in pregnancy? I also thought that it would be better to take 10mg of Prozac than potentially a higher dosage of another drug but my doctor said that I can't think about it like this as each drug has a different molecular structure?
    I understand that Citalopram is better in breastfeeding but thought it might be better to trial Lexapro as it has an even better profile? Or is the Lexapro better for breastfeeding and not necessarily for pregnancy?
    I completely understand that the overall advice would be to take the drug that works. However, given that I have time to trial drugs prior to falling pregnant, and that weight loss was an issue with the Prozac (I don't want to be pregnant and losing weight!), I want to use this time to make an informed evidenced based decision whilst I am well so that if I became extremely anxious again, I would already have a potential plan in place. My doctor could not answer these questions when I asked and suggested I do my own research and that ultimately it was my decision.I would phone your help-line but I live outside of the USA.
    Help and advice would be most welcome!

  • #2
    Hi Jules

    Fluoxetine (Prozac) crosses the human placenta. Although some studies refute it, others suggest that there is an association between the use of Fluoxetine in the first trimester and cardiovascular malformations. In the third trimester, Fluoxetine use does not seem to cause any complications to the fetus and neonate. Fluoxetine has been used many years with minimal reports of complications. It is probably compatible with breastfeeding. Observe your infant for colic symptoms. The half-life is long for this medication so will be in your system about the same daily so you don't have to avoid certain times for breastfeeding.

    Citalopram (Celexa, Cipramil) is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRI). It is commonly used to treat symptoms of depression. Although studies show that citalopram crosses the human placenta, it has not been linked with major malformations in the fetus. Studies indicate that using Citalopram during pregnancy does not increase the risk of major malformations compared with the 1-3% baseline risk in the general population. Experience with the use of this drug in breastfeeding women is limited but continually growing. While the original anecdotal data suggested that symptoms such as somnolence, colic and restlessness may occur in breastfed infants exposed to citalopram, the majority of new data suggests these symptoms are minimal and may not be associated with the drug therapy.

    Escitalopram (Lexapro) is an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRI). Human studies linking the use of this product with birth defects are not available. Experience with the use of this drug in breastfeeding women is limited; thus far, there is no evidence that the use of this drug could cause an adverse effect in a breastfed infant. Recent data shows that levels in milk are low, and that plasma levels of escitalopram are low to undetectable in most infants. While the number of case reports in the literature are still low, it would appear this medication is suitable to use in breastfeeding mothers.

    Hope this helps, please contact the InfantRisk Center at 806-352-2519 for further information.

    Tassneem Abdel Karim MD
    InfantRisk Center

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    • #3
      Thank you so much for your prompt reply. So I have started the Celexa 10mg and it seems to be effective - since both Prozac & Celexa work, which one would have a better safety profile in breastfeeding?

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