CHAPTER 38 -DRUGS AFFECTING THE FEMALE REPRODUCTIVE SYSTEM

Question 1

Jane, a 24-year-old, is diagnosed with post-natal depression, which is to be treated with selective serotonin reuptake inhibitors (SSRI). Jane switches to continue breast feeding, but is concerned about exposing her child to an antidepressant

Answer 1

Jane, a 24-year-old, is diagnosed with post-natal depression, which is to be treated with selective serotonin reuptake inhibitors (SSRI). Jane switches to continue breast feeding, but is concerned about exposing her child to an antidepressant

Question 2

1. What are the properties of a drug that influence its transfer into breast milk?

Answer 2

CNS-active drugs, being lipid soluble, are likely to partition into breast milk, and hence need caution in prescribing. CNS depressants may sedate the baby and depress suckling.

Question 3

2. Do selective SSRIs cross into breast milk?

Answer 3

Yes however SSRI depressants appear to be the most safest when it comes to breastfeeding. Because of the low levels of sertraline in breastmilk, amounts ingested by the infant are small and is usually not detected in the serum of the infant, although the weakly active metabolite norsertraline (desmethylsertraline) is often detectable in low levels in infant serum.

Question 4

3. Is Fluoxetine suitable for use in lactating mother?

Answer 4

The average amount of drug in breastmilk is higher with fluoxetine than with most other SSRIs, and the long-acting active metabolite, norfluoxetine, is detectable in the serum of most breastfed infants during the first 2 months postpartum and in a few thereafter. No adverse effects on development have been reported in a few infants followed for up to one year.

Question 5

4. What are the SSRIs recommended for use in breast feeding women?

Answer 5

The safest SSRI’s reported are sertraline and paroxetine when a woman is breastfeeding as it is either not detected or found in low levels in infant serum.