Is Perphenazine safe while breastfeeding?

Effects on the breastfed infant

One infant was breastfed from 1 month to 4.5 months of age during maternal intake of perphenazine 16 mg daily. The infant grew normally and no adverse drug effects were seen.[ 1 ]

Effects on milk supply

Galactorrhea has been reported with perphenazine.[ 2 , 3 ] Hyperprolactinemia appears to be the cause of the galactorrhea.[ 4 - 6 ] The hyperprolactinemia is caused by the drug's dopamine-blocking action in the tuberoinfundibular pathway. [ 7 ] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Levels in milk

Maternal Levels. Steady-state perphenazine milk levels were measured in one woman while she was taking perphenazine at two different dosages. At a dose of 12 mg every 12 hours (480 mcg/kg daily) the drug concentration in a 24-hour milk collection was 3.2 mcg/L. At a dose of 8 mg every 12 hours, the average milk concentration in each of two 12-hour collection periods was 2.1 mcg/L. Milk was collected at this dosage in three 4-hour collection periods. Levels in fractionated 4-hour periods were as follows: 0 to 4 hours: 1.8 mcg/L; 4 to 8 hours: 3.1 mcg/L; and 8 to 12 hours: 2 mcg/L. The authors calculated that the breastfed infant would receive 0.1% of the maternal weight-adjusted dosage.[ 1 ] Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Haloperidol
• Olanzapine
• Quetiapine
• Risperidone