[The transfer of selective serotonin reuptake inhibitors to human milk].
BACKGROUND
This article presents an overview of the excretion of the SSRIs citalopram, paroxetine, fluoxetine, fluvoxamine and sertraline in breast milk.


METHODS
Published articles on selective serotonin reuptake inhibitors and excretion in breast milk were identified and reviewed. In addition, drug concentrations were measured in milk from eight women using paroxetine (n = 4), citalopram (n = 3) or fluvoxamine (n = 1).


RESULTS
Data from the literature indicate that the relative dose to the infant is lowest for fluvoxamine and sertraline, somewhat higher for paroxetine and highest for citalopram and fluoxetine. Adverse effects were reported in three of the 119 breastfed infants. Our own results show minimal excretion of fluvoxamine, small excretion of paroxetine and higher excretion of citalopram into breast milk.


CONCLUSIONS
If treatment with a selective serotonin reuptake inhibitor is started during the postpartum period, fluoxetine should not be the first alternative. High doses of citalopram should also be used with caution. However, when the use of an SSRI is clearly indicated in a breastfeeding woman, available data generally indicate that the positive effects of breast-feeding outweigh the risks for pharmacological effects in the infant.
Nordeng
H
H
Institutt for farmakoterapi Postboks 1065 Blindern 0316 Oslo. h.m.e.nordeng@farmasi.uio.no
Bergsholm
Y K
YK
Bøhler
E
E
Spigset
O
O
D000928:Antidepressive Agents / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics*; D001942:Breast Feeding; D015283:Citalopram / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D019052:Depression, Postpartum / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D016666:Fluvoxamine / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry / Q000378:metabolism; D017374:Paroxetine / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics*; D020280:Sertraline / Q000009:adverse effects / Q000032:analysis / Q000493:pharmacokinetics
D000928:Antidepressive Agents; D015283:Citalopram; D005473:Fluoxetine; D016666:Fluvoxamine; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline