Breastfeeding during maternal antidepressant treatment with serotonin Reuptake inhibitors: Infant exposure, clinical symptoms, and cytochrome P450 genotypes
Breastfeeding during maternal antidepressant treatment with serotonin Reuptake inhibitors: Infant exposure, clinical symptoms, and cytochrome P450 genotypes
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DOI：
10.4088/jcp.v65n0911
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发表时间：
2004-09-01
影响因子：
5.3
通讯作者：
Spigset, O
中科院分区：
文献类型：
--
作者：
Berle, JO;Steen, VM;Spigset, O
背景：这项研究的目的是量化接受抗抑郁药物治疗的母亲母乳喂养婴儿的药物暴露，确定可能的不良事件，并将这些变量与母婴药物代谢相关的基因型和乳三酸甘油酯含量相关联。方法：研究包括25名哺乳妇女，分别接受西酞普兰(N=9)、舍曲林(N=6)、帕罗西汀(N=6)、氟西汀(N=1)或文拉法辛(N=3)治疗，以及她们26名母乳喂养的婴儿。用液相色谱质谱联用法分析母婴血清和乳汁中的药物浓度；用商业试剂盒测定乳酸甘油三酯水平。采用聚合酶链式反应对母婴进行基因分型，检测细胞色素P450(CYP)2D6和细胞色素P2C19活性。对68名接受药物治疗的母亲和68名非药物哺乳母亲进行婴儿不良事件问卷调查。结果：所有药物暴露的婴儿均未检出舍曲林和帕罗西汀。婴儿西酞普兰血药浓度未检出(N=4)或低水平(N=6)。所有接触文拉法辛的婴儿都有可测量的药物浓度。我们确定了一名接受帕罗西汀治疗的母亲和她的婴儿，他们都是CYP2D6代谢不良者，以及一名接受西酞普兰治疗的母亲，他们的CYP2C19代谢不良状态，但他们婴儿的血清药物水平仍然检测不到(帕罗西汀)或低(西酞普兰)。结论：接受抗抑郁药物治疗的母亲的母乳喂养婴儿的血清药物浓度很低或检测不到。这项研究为之前发表的数据提供了进一步的证据，表明在使用5-羟色胺再摄取抑制剂抗抑郁药的妇女中，一般不应阻止母乳喂养。
Background: The aims of the study were to quantify the drug exposure in breastfed infants of antidepressant-treated mothers, to identify possible adverse events, and to correlate these variables to maternal and infant drug metabolism-relevant genotypes and milk triglyceride content.Method: The study included 25 lactating women treated with citalopram (N = 9), sertraline (N = 6), paroxetine (N = 6), fluoxetine (N = 1), or venlafaxine (N = 3) and their 26 breastfed infants. Drug concentrations in maternal and infant serum and milk were analyzed using liquid chromotography mass spectrometry methods; milk triglyceride levels were measured with a commercial kit. Cytochrome P450 (CYP) 2D6 and CYP2C19 activity was determined by polymerase chain reaction-based genotyping of the mothers and infants. An infant adverse event questionnaire was completed by the medication-treated mothers as well as by a control group of medication-free breastfeeding mothers of 68 infants.Results: Sertraline and paroxetine were not detected in any of the drug-exposed infants. The infant serum level of citalopram was either undetectable (N = 4) or low (N = 6). All venlafaxine-exposed infants had measurable drug concentrations. We identified a paroxetine-treated mother and her infant who were both CYP2D6 poor metabolizers, as well as a citalopram-treated mother with CYP2C19 poor metabolizer status, but the serum drug levels of their infants were still either undetectable (paroxetine) or low (citalopram). There was no evidence of adverse events in the drug-exposed infants.Conclusion: Serum drug levels in breastfed infants of antidepressant-treated mothers were undetectable or low. This study adds further evidence to previously published data indicating that breastfeeding should not be generally discouraged in women using serotonin reuptake inhibitor antidepressants.