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Paroxetina and breastfeeding

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  • #1

    Paroxetina and breastfeeding

    I'm writing from Italy.

    My daughter is 2 months old and I'm breastfeeding her.
    I'm taking 20 mg paroxetine daily due to panic attacks, I'm likely to take even more.
    My doctor says that more than 20 mg are not compatible with breastfeeding.

    What is your opinion about that?
    Do you have any evidence of increased risks?
    What would you recommend me?

    Thank you in advance for your help.
    Sara
    Tags: None
  • #2
    Dear Sara,

    Paroxetine is a typical serotonin reuptake inhibitor. Levels in milk are quite low and average less than 2.8% of the maternal dose. Probably quite safe in breastfeeding mothers. Observe your infant for sedation. The usual adult dose is 20 to 50 mg daily.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

    Comment

    • #3
      Thank you. So if I understand if I take 20 mg of paroxetine daily, my daughter assumes less than (20/100)*2.8=0,56 mg daily?
      If yes it seems to be not so low.
      But do you think that benefits of breastmilk are more than risks due to paroxetine in milk even if the mather takes more than 20 mg daily?

      Moroeover my doctor said that I have to wait al least 8 hours before breastfeeding my baby after taking paroxetine. Is it right?
      Is it the same if I will take more than 20 mg or do I have to wait more?

      And what about long-term risks of paroxetine? On behaviour for example?
      Are there any studies on long term effects of paroxetine in milk or we don't know nothing about them?

      Did you meet mothers who breastfed their babies taking paroxetine more than 20 mg? And if yes, any problems for their children?

      Thank you in advance.

      Sara

      Comment

      • #4
        Dear Sara,

        The range of breastmilk levels for paroxetine are 1.2% to 2.8% of your dose which is quite low. In the studies done, the blood levels of paroxetine in the infants were generally undetectable. The time the medication would be highest in your system is 5 to 8 hours after your dose so avoiding breastfeeding during this time would reduce risk when taking the usual adult dose. We do not have long term infant neurobehavioral data, but since the levels are usually undetectable in the infant's blood, then the risk would be low. Sertraline (Zoloft) has lower breastmilk levels at 0.4% to 2.2% of the maternal dose which is an alternative you may want to talk with your physician about. We believe the benefits of breastfeeding outweigh the risks of this medication but in the end you have to decide what is best for you and your infant. You may want to talk with your pediatrician also.

        Sincerely,
        Cindy Pride, MSN, CPNP
        TTUHSC InfantRisk Center

        Comment

        • #5
          Sara:

          First, very little paroxetine gets to the infant via milk. And there is no question, that the risks of maternal depression are far worse than the negligible risk of this much paroxetine. As far as we know, and its been studied, we have not found any risk at all to the exposure of the SSRIs in breastfed infants.

          In these cases, untreated depression is far worse than the treatment with drugs.

          So, keep yourself healthy and keep breastfeeding your infant.

          Tom Hale Ph.D.

          Comment

          • #6
            Thank you.

            At the moment the greatest pause between a breastfeed and another is six hours. I have to pump the milk or is it enough?

            Comment

            • #7
              Dear Sara,

              To avoid the time of highest concentration for paroxetine (5 to 8 hours), you may breastfeed as needed up to 4 hours after the dose then not breastfeed 5 to 8 hours after the dose then return to breastfeeding 9 hours after the dose. Even if you needed to breastfeed between the 5 to 8 hour period, the amount of paroxetine in your breastmilk is low and would not likely cause clinical symptoms in your infant. If you have further questions, call the InfantRisk Center at 806-352-2519. We are open Monday through Friday, 8 to 5, CDT.

              Sincerely,
              Cindy Pride, MSN, CPNP
              TTUHSC InfantRisk Center

              Comment

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