Is Quetiapine safe while breastfeeding?

Effects on the breastfed infant

One mother took quetiapine 25 mg daily orally during pregnancy and continued to take quetiapine 50 mg daily orally during lactation. At 6 weeks the infant was doing well. No further follow-up was reported.[ 17 ] Another infant whose mother was taking 200 mg daily of quetiapine began to exclusively breastfeed at 8 weeks of age. The infant was developing well at 4.5 months of age and no adverse effects were reported.[ 5 ] A nursing mother with postpartum psychosis was started on quetiapine at 6 weeks postpartum at a dose of 25 mg daily along with unspecified benzodiazepines. The quetiapine dosage was increased gradually to 200 mg daily over the next 6 weeks and up to 300 mg daily over the ensuing 4 weeks (16 weeks postpartum). Mirtazapine 15 mg daily was also started at 8 weeks postpartum. Breastfeeding (extent not specified) was continued until 16 weeks postpartum when it was stopped because of reduced milk production. During this time, the infant was excessively drowsy until the benzodiazepine dosage was decreased at the same time as the quetiapine dosage was increased. The infant was followed for at least 2 months after breastfeeding ended and no effects on the infant's growth, motor or psychological development or signs of infant withdrawal were noted.[ 18 ] A nursing mother with bipolar disorder began taking 20 mg of paroxetine at 4 months postpartum and then started quetiapine 200 mg twice daily at 6 months postpartum. She breastfed regularly (extent not stated) and no obvious adverse effects were noted in the infant.[ 19 ] A woman who was treated chronically with quetiapine 400 mg and fluvoxamine 200 mg daily took the drugs throughout pregnancy and postpartum. She partially breastfed her infant (extent not stated) for 3 months from birth. No adverse events were seen and the infant developed normally.[ 20 ] Six nursing mothers took quetiapine in doses of 25 to 400 mg daily in addition to an antidepressant (usually paroxetine) for major depression postpartum. The

Effects on milk supply

Unlike the phenothiazines, quetiapine has a minimal effect on serum prolactin levels.[ 27 - 29 ] However, galactorrhea has been reported.[ 30 ] The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed. Galactorrhea occurred in a woman who was not breastfeeding while she was taking venlafaxine 112.5 mg daily and quetiapine. Galactorrhea occurred 10 days after her quetiapine dose was increased to 50 mg daily a few days after starting the drug at 12.5 mg daily. Her serum prolactin level was 27.3 mcg/L (normal 2 to 30 mcg/L) and decreased to 8.5 mcg/L 2 weeks after discontinuing the drug. Galactorrhea ceased 1 week later.[ 31 ] Patients enlisted in the National Pregnancy Registry for Atypical Antipsychotics who were taking a second-generation antipsychotic drug while breastfeeding (n = 576) were compared to control breastfeeding patients who had primarily diagnoses of major depressive disorder and anxiety disorders, most often treated with SSRI or SNRI antidepressants, but not with a second-generation antipsychotic (n = 818). Among women on a second-generation antipsychotic, 60.4% were on more than one psychotropic compared with 24.4% among women in the control group. Of the women on a second-generation antipsychotic, 59.3% reported ever breastfeeding compared to 88.2% of women in the control group. At 3 months postpartum, 23% of women on a second-generation antipsychotic were exclusively breastfeeding compared to 47% of women in the control group.[ 26 ] The number of women taking quetiapine was not reported. A woman began using quetiapine 4 weeks postpartum for intrusive thoughts. She took her daily dose of 50 mg at 11 pm after the last nursing of the day. Every night she experienced a tingling sensation and milk ejection about 30 to 40 minutes after the dose over a period of 6 months. On one occasion she did not take the dose and the milk ejection did not occur. When she resumed the drug the next night, the milk ejec

Levels in milk

Maternal Levels. One mother took oral quetiapine 200 mg daily throughout pregnancy and postpartum. At 3 weeks postpartum, milk samples were taken. The average milk level over the 6-hour dosage interval was 13 mcg/L. A peak milk quetiapine level of 62 mcg/L occurred at 1 hour after the dose. The authors estimated that an exclusively breastfed infant would receive 0.09% of the weight-adjusted maternal dosage on average, with a "worst-case" dosage (assuming all nursing was at the peak concentration) of 0.43% of weight-adjusted maternal dosage.[ 5 ] Six nursing mothers who were 6.5 to 18.5 weeks postpartum were taking quetiapine in doses of 25 to 400 mg daily in addition to an antidepressant for major depression postpartum. Milk samples obtained at various times after the dose had undetectable ( 11.5 mcg/L) levels of quetiapine in the 4 mothers taking 75 mg daily or less. A mother taking 100 mg daily had a milk quetiapine level of 12.3 mcg/L and another taking 400 mg daily had a level of 101 mcg/L. The authors estimated that exclusively breastfed infants would receive less than 0.01 mg/kg daily with maternal doses of 100 mg daily or less and less than 0.1 mg/kg daily with a maternal dose of 400 mg daily.[ 6 ] A woman who was 3 months postpartum and taking quetiapine 400 mg daily, fluoxetine 40 mg daily, and oxycodone 20 mg 3 times daily had 16 milk samples taken over 24 hours starting immediately before a daily dose of quetiapine; 12 were paired fore- and hindmilk and the other 4 samples were mixtures of fore- and hindmilk. The highest quetiapine level measured in milk of about 170 mcg/L occurred within 1 hour after the dose. Milk levels dropped to nearly zero by 12 hours after the dose. No differences were noted between fore- and hindmilk concentrations. The authors estimated that the infant received 6.2 mcg/kg daily and that a fully breastfed infant would receive 0.09% of the maternal weight-adjusted dosage.[ 7 ] A nursing mother was taking quetiapine in a dosage of 2

Alternatives LactMed lists

• Olanzapine
• Lithium
• Olanzapine
• Risperidone
• Valproic Acid