Researchers have identified a potential method for limiting the exposure of infants to sertraline in their mother’s breast milk.
Analyzing breast milk, maternal and infant serum levels of sertraline, the team, led by Zachary Stowe (Emory School of Medicine, Atlanta, Georgia, USA), found that discarding all breast milk produced 9 hours after the mother has taken the antidepressant could reduce the infant’s daily dose by an average of 17.1%.
“All nursing women should be informed that the ‘pump and dump’ option would decrease the infant daily dose,” say Stowe et al in the Journal of Clinical Psychiatry. In total, 26 nursing women with major depressive disorder, treated with 25200 mg/day of sertraline, took part in the study, and 182 breast milk samples and 22 maternal/infant serum pairs were available for analysis.
Despite none of the infants showing any signs of adverse effects, sertraline was detectable in four (18%) babies, at a maximum dose of 0.67 mg/day, whilethe drug’s major metabolite desmethylsertraline was found in 11 (50%) infants, at a maximum dose of 1.44 mg/day. These doses represented 0.54% of the maternal daily drug dose.
The maximum infant dose of desmethylsertraline from breast milk was significantly correlated with infant serum doses, but not with maternal daily dose, highlighting the importance of breast milk and maternal serum concentrations in the interpretation of infant serum measures, say the researchers.
Confirmed limits of these concentrations “will enable the clinician to ascertain if the infant serum concentrations represent potential outliers” enabling them to decide whether breastfeeding should continue, they conclude.
J Clin Psychiatry 2003; 64: 7380
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