title: Antipsychotic drugs and breastfeeding.
abstract: OBJECTIVE
  The incidence of psychotic disorders during the postpartum period is higher than at any other time during a women's life and coincides with the time when breastfeeding is most recommended. As a result, safety data on use of antipsychotic drugs during lactation is essential. Our aim was to analyze the medical literature for information on antipsychotic drug use during breastfeeding and to determine the safety of their use for the exposed infant.
  
  
  METHODS
  Medline (U.S. National Library of Medicine), LactMed (U.S. National Library of Medicine) and Reprotox (Reproductive Toxicology Center) databases were searched to identify all relevant medical literature on antipsychotic medications and lactation. The database search, updated to March, 2012, used the generic name of each antipsychotic drug in combination with the terms breastfeeding or lactation or breast-milk.
  
  
  METHODS
  4 prospective studies, 12 case series, 28 case reports and 1 pharmaceutical registry were included.
  
  
  METHODS
  Infant outcomes focusing on long-term outcome were summarized from all reports of breastfeeding mothers taking antipsychotic medications. Recommendations for drug use during breastfeeding were based on safety data and on pharmaco kinetic drug properties. Recommendatins were categorized as acceptable, possible under medical supervision, or, not recommended.
  
  
  RESULTS
  Among 21 antipsychotic drugs used in clinical practice, for 7 there are no data at all regarding breastfeeding and for 6 others the data are based only on few infant exposures. Only few prospective studies assessing'use of haloperidol, chlorpromazine and olanzapine during breastfeeding were identified. Olanzapine and quetiapine were categorized as acceptable for breastfeeding. Chlorpromazine, haloperidol, risperidone and zuclopenthixol were categorized as possible for breastfeeding under medical supervision. Breastfeeding cannot be currently recommended for the following medications: aripiprazole, asenapine, chlorprothixene, clozapine, droperidol, fluphenazine, flupenthixol, iloperidone, lurasidone, paliperidone, perphenazine, pimozide, trifluoperazine, thiothixene and ziprasidone.
  
  
  CONCLUSIONS
  With a limited number of infants exposed to antipsychotic drugs during breastfeeding, for most drugs a firm and evidence-based conclusion cannot be reached. Counseling of breastfeeding mothers should be carefully assessed. Pharmacokinetic drug characteristics, disease severity, behavioral or psychosocial alternatives, preventative interventions and possible impact of discontinuing breastfeeding on the maternal-infant relationship should all be considered.
authors.affiliation: Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Rabin Medical Center, Petah Tikva, Israel. gilkl@post.tau.ac.il
authors.forename: Gil
authors.initials: G
authors.lastname: Klinger
authors.forename: Bracha
authors.initials: B
authors.lastname: Stahl
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
authors.forename: Paul
authors.initials: P
authors.lastname: Merlob
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000145:classification / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001942:Breast Feeding / Q000009:adverse effects / Q000706:statistics & numerical data; D016022:Case-Control Studies; D000075202:Contraindications; D019052:Depression, Postpartum / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018811:Maternal Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents