Is Bupropion safe while breastfeeding?

Effects on the breastfed infant

Three partially to fully breastfed infants who were 15 weeks to 14 months of age had no clinically detectable adverse effects during maternal bupropion therapy. Dosages were 100 mg 3 times daily of the immediate-release product in one mother, and 150 mg daily in the other two, one as the SR product and one as the immediate-release product.[ 4 , 8 ] Two women of 8 in an open-label clinical trial of bupropion SR for postpartum depression breastfed their infants. The median dosage of bupropion SR in the 8 women was 262.5 mg (range 37.5-300 mg). Seven women completed the 8-week study and 1 took the drug for 6 weeks. No specific details were given on the 2 women who breastfed their infants, but neither noted any adverse effects in their infants.[ 9 ] A woman who started taking sustained-release bupropion 150 mg daily fed her 6-month-old infant by breastfeeding and stored breastmilk in addition to solid foods. After 3 days and 2 doses of the drug, the infant had symptoms consistent with a seizure, but no infant serum levels were obtained. The seizure was possibly related to the bupropion in breastmilk.[ 10 ] An uncontrolled online survey compiled data on 930 mothers who nursed their infants while taking an antidepressant. Infant drug discontinuation symptoms (e.g., irritability, low body temperature, uncontrollable crying, eating and sleeping disorders) were reported in about 10% of infants. Mothers who took antidepressants only during breastfeeding were much less likely to notice symptoms of drug discontinuation in their infants than those who took the drug in pregnancy and lactation.[ 11 ] In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. One mother who was taking bupropion 1 mg daily, flurazepam 15 mg daily, clonazepam 0.25 mg twice daily, and risperidone 0.75 mg daily reported sedation in her breastfed infant.[ 12 ] A 6.5-month-old infant developed severe vomiting and an appare

Effects on milk supply

A 34-year-old non-pregnant woman diagnosed with depression was started on bupropion 150 mg daily. During the second week of therapy, she presented with galactorrhea and an elevated serum prolactin level of 98 mcg/L. A cranial MRI found no abnormalities. Bupropion was discontinued and the galactorrhea disappeared in 2 days. One week later, her serum prolactin level was 3 mcg/L. Fluoxetine 20 mg daily was started and continued for 4 months with no signs of galactorrhea.[ 15 ] An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[ 16 ] The antidepressants used by the mothers were not specified. A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[ 17 ] None of the mothers were taking bupropion. In a study of 80,882 Norwegian mother-infant pairs from 1999 to 2008, new postpartum antidepressant use was reported by 392 women and 201 reported that they continued antidepressants from pregnancy. Compared with the unexposed comparison group, late pregn

Levels in milk

Bupropion is metabolized to 3 metabolites (hydroxybupropion, erythrohydroxybupropion, threohydroxybupropion) with the antidepressant activity of each considered to be about 50% of bupropion's.[ 3 ] Maternal Levels. A mother who was 14 months postpartum was taking bupropion 100 mg three times daily. Milk samples were obtained before and at 1, 2, 4 and 6 hours after the first daily dose of 100 mg. Peak bupropion levels of 181 and 189 mcg/L occurred at 1 and 2 hours after the dose, respectively. A peak hydroxybupropion level of 132 mcg/L occurred in milk 2 hours after the dose and peak threohydroxybupropion levels of 443 and 442 mcg/L occurred at 1 and 2 hours after the dose, respectively.[ 4 ] Ten women who were an average of 12.5 months postpartum and who did not nurse their infants after the start of bupropion therapy took sustained-release bupropion 150 mg daily for 3 days, then 300 mg daily for 4 days. On the seventh day, breastmilk levels of the drug and metabolites were measured at a median 2.5 hours (range 1 to 12 hours) after the last dose. Breastmilk levels were as follows: bupropion 45.2 mcg/L (range 4 to 168 mcg/L); hydroxybupropion 104.6 mcg/L (range 9 to 242 mcg/L); erythrohydroxybupropion 72.1 mcg/L (range 25.4 to 143 mcg/L); and threohydroxybupropion 459 mcg/L (range 193 to 1052 mcg/L). There was no correlation between the amount of these drugs excreted in milk and maternal or infant age, maternal body mass or breastfeeding frequency prior to the study. The authors estimated that an exclusively breastfed infant would receive an average of 0.2% of the maternal weight-adjusted dosage of bupropion and an average of 2% of the maternal weight-adjusted dosage of bupropion plus metabolites with this maternal dosage regimen.[ 5 ] Four women were taking bupropion SR 150 mg or 300 mg for depression or smoking cessation. Maternal milk and serum concentrations were measured before a dose at steady-state and 2 hours after the dose; 2 women had samples taken on 2 sep

Alternatives LactMed lists

• Dextroamphetamine
• Lisdexamfetamine
• Paroxetine