Can I take escitalopram while pregnant or breastfeeding?

8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844- 405-6185 or visiting online at https://womensmentalhealth.org/clnical-and-research-programs/pregnancyregistry/antidepressants/. Risk Summary Based on data from published observational studies, exposure to SSRIs, particularly in the month before delivery, has been associated with a less than 2-fold increase in the risk of postpartum hemorrhage [see Warnings and Precautions (5.7) and Clinical Considerations]. Available data from published epidemiologic studies and postmarketing reports have not established an increased risk of major birth defects or miscarriage. There are risks of persistent pulmonary hypertension of the newborn (PPHN) (see Data) and poor neonatal adaptation (see Clinical Considerations) with exposure to selective serotonin reuptake inhibitors (SSRIs), including ESCITALOPRAM, during pregnancy.

Prescribing label, section “8.1 Pregnancy” (opening excerpt): Escitalopram Oxalate (oral), Legacy Pharmaceutical Packaging, LLC. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.

Escitalopram is the active S-isomer of the antidepressant, citalopram. Limited information indicates that maternal doses of escitalopram up to 20 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. No adverse effects on development have been found in infants followed for up to 5 years of age. If the mother requires escitalopram, it is not a reason to discontinue breastfeeding. A safety scoring system finds escitalopram use to be possible during breastfeeding.[1] Monitor the infant for excess drowsiness, restlessness, agitation, poor feeding and poor weight gain, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.

Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state.[2] These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy are at risk for neonatal withdrawal syndrome consisting of hypoglycemia, tremors, tachycardia, or hypotonia, and might be at a greater risk of readmission due to jaundice.[3,4]

“Summary of Use during Lactation”, LactMed record “Escitalopram” (LM404), quoted verbatim. Everything LactMed reports about Escitalopram while breastfeeding.

8.2 Lactation Risk Summary Data from the published literature report the presence of escitalopram and desmethylescitalopram in human milk (see Data). There are reports of excessive sedation, restlessness, agitation, poor feeding and poor weight gain in infants exposed to escitalopram, through breast milk (see Clinical Considerations). There are no data on the effects of escitalopram or its metabolites on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ESCITALOPRAM and any potential adverse effects on the breastfed child from ESCITALOPRAM or from the underlying maternal condition.

Prescribing label, section “8.2 Lactation” (opening excerpt): Escitalopram Oxalate (oral), Legacy Pharmaceutical Packaging, LLC. Read the full section on DailyMed. Quoted verbatim; US labels are written for US prescribers and patients.