Duloxetine transfer across the placenta during pregnancy and into milk during lactation
Duloxetine transfer across the placenta during pregnancy and into milk during lactation
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DOI：
10.1007/s00737-011-0215-5
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发表时间：
2011-04-01
影响因子：
4.5
通讯作者：
Ilett, Kenneth F.
中科院分区：
文献类型：
--
作者：
Boyce, Philip M.;Hackett, L. Peter;Ilett, Kenneth F.
度洛西汀是一种有效的抗抑郁药；然而，其在围产期的安全性是不确定的。本研究的目的是评估通过胎盘的转移，并提供婴儿通过母乳接触度洛西汀的数据。一位31岁的多产女性，患有复发性忧郁症，先前的抗抑郁药物治疗效果不佳，但服用度洛西汀后完全缓解。她选择在第三次怀孕和哺乳期间继续服用度洛西汀。她生下了一个健康的足月婴儿，并没有注意到婴儿暴露于度洛西汀的不良事件。用色谱法测定出生时采集的母婴血清中度洛西汀的浓度，18 d后计算母乳、血浆和婴儿血浆中度洛西汀的浓度比（C/M）。估计了婴儿通过母乳摄入的绝对剂量和相对剂量，并计算了婴儿和母亲血浆中药物的百分比。脐带/母体血清度洛西汀浓度比为0.12。婴儿经乳绝对剂量为7.6 μ g/L，婴儿相对剂量为0.81%。婴儿血浆中药物含量与哺乳期母体血浆中药物含量之比也显示婴儿暴露估计为0.82%。低C/M比值表明通过胎盘的转移有限。与大多数其他抗抑郁药相比，母乳中的相对婴儿剂量较低，这一估计证实了哺乳期间婴儿血浆中的药物量。我们的数据表明，度洛西汀可用于妊娠和哺乳期的选定患者，其他抗抑郁药没有成功。
Duloxetine is an efficacious antidepressant; however, its safety during the perinatal period is uncertain. The objective of this study was to assess the transfer across the placenta and provide data on infant exposure to duloxetine via breast milk.A multiparous 31-year-old woman with recurrent melancholic depression had responded poorly to previous antidepressants, but had a full remission on duloxetine. She elected to remain on duloxetine for her third pregnancy and while breastfeeding. She gave birth to a healthy term infant and there were no adverse events noted for the infant exposed to duloxetine. Duloxetine concentration was measured chromatographically in maternal and infant serum collected at birth, and in maternal milk and plasma and infant plasma 18 days later, (C/M) concentration ratio was calculated. Absolute and relative infant doses via milk were estimated and the percent drug in infant versus mother's plasma was calculated.Cord/maternal serum concentration ratio for duloxetine was 0.12. Absolute infant dose via milk was 7.6 mu g/L and relative infant dose was 0.81%. The ratio of drug in the infant's plasma to that in maternal plasma during lactation also gave a 0.82% infant exposure estimate.The low C/M ratio suggests a limited transfer across the placenta. The relative infant dose via milk was low by comparison to most other antidepressants, and this estimate confirmed the amount of drug in infant plasma during lactation. Our data suggest that duloxetine may be used in pregnancy and lactation for selected patients in whom other antidepressants have not been successful.