Psychotropic drug use during breastfeeding: a review of the evidence.
OBJECTIVE
The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.


METHODS
A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the "compatibility level" of each drug with breastfeeding.


RESULTS
A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach. For 28 drugs, the available data do not permit an evaluation of the drug's safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.


CONCLUSIONS
Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding.
Fortinguerra
Filomena
F
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological Research, Milan, Italy. fortinguerra@marionegri.it
Clavenna
Antonio
A
Bonati
Maurizio
M
D001942:Breast Feeding; D019052:Depression, Postpartum / Q000188:drug therapy*; D064420:Drug-Related Side Effects and Adverse Reactions; D004784:Environmental Monitoring; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation / Q000187:drug effects; D018811:Maternal Exposure; D008991:Monitoring, Physiologic; D011247:Pregnancy; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment
D011619:Psychotropic Drugs