Treatment options

Comment

Antipsychotics

·    No serious side effects reported

·    Excreted in breast milk (1/3 of maternal plasma)

Anticholinergics

·    Sufficient data not available

Antidepressants

·    Amounts excreted in breast milk unlikely to harm neonate; no reported long term adverse effects

·    More data supports the safety of nortriptyline and desipramine in long term usage

Lithium

·    Not recommended; excreted in breast milk (1/2 of maternal plasma); infant’s kidneys cannot metabolize

Anxiolytics

·    Not recommended; excreted in breast milk; behavioral effects and temperature dysregulation in infant

Anticonvulsants

·    Valproic acid is compatible with breast feeding (1.2-4% of maternal plasma); no adverse effects reported

·    Carbamazepine is “probably safe” as reported by WHO (25-75% of maternal plasma); hepatitis and hyperbilirubinemia reported

Calcium-Channel Blockers

·    Increased risk to infant heart; long term effects of impotence

Buspirone

·    Sufficient data not available