Use of Duloxetine in Pregnancy and Lactation
Use of Duloxetine in Pregnancy and Lactation
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DOI：
10.1345/aph.1m317
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发表时间：
2009-11-01
影响因子：
2.9
通讯作者：
Padilla, Guadalupe
中科院分区：
文献类型：
--
作者：
Briggs, Gerald G.;Ambrose, Peter J.;Padilla, Guadalupe
目的：报道一例妇女在怀孕和哺乳期间使用度洛西汀的病例。她在足月产下了一个健康的女婴。出生时采集脐带血样本。这位母亲在纯母乳喂养婴儿的同时继续服用抗抑郁药。一个月后，我们从母亲身上采集了血液和牛奶样本，从婴儿身上采集了一份血液样本。所有样本都被分析了度洛西汀的存在和浓度。讨论：度洛西汀在足月穿过胎盘并被排泄到母乳中。在婴儿出生时或出生后32天内，没有观察到发育或其他类型的毒性的证据。已发表的文献详细描述了人类使用这种抗抑郁药的怀孕经历，仅限于11例女性在服用度洛西汀期间怀孕的病例。在10个病例中，当诊断为怀孕时，药物停止使用，没有报告结果数据。在第11例中，一名婴儿每天接触度洛西汀90 mg，出现新生儿行为综合征。其中一项研究检测了度洛西汀在母乳中的排泄情况，但母亲们停止了对这项研究的护理。在目前的病例中，在纯母乳喂养的婴儿中，没有注意到暴露于牛奶中的药物的不良反应。由于未对宫内或哺乳期间接触度洛西汀的婴儿进行长期随访，因此不能排除在生命后期出现功能/神经行为缺陷的可能性。结论：在妊娠后半期和出生后前32天的母乳喂养期间，未观察到度洛西汀对婴儿的发育毒性或其他毒性迹象。然而，不能排除在晚年出现功能/神经行为缺陷的可能性。
OBJECTIVE: To report a case of a woman who used duloxetine during pregnancy and breast-feeding.CASE SUMMARY: A 29-year-old woman was treated with duloxetine for depression during the second half of an uncomplicated gestation. She gave birth at term to a healthy female infant. A cord blood sample was obtained at birth. The mother continued the antidepressant while exclusively breast-feeding her infant. One month later, we collected blood and milk samples from the mother and a single blood sample from the infant. All samples were analyzed for the presence and concentrations of duloxetine.DISCUSSION: Duloxetine crosses the placenta at term and is excreted into breast milk. No evidence of developmental or other type of toxicity was observed in the infant at birth or during the first 32 days after birth. The published literature detailing human pregnancy experience with this antidepressant is limited to 11 cases in which women became pregnant while taking duloxetine. In 10 cases, the drug was discontinued when pregnancy was diagnosed and no outcome data were reported. In the eleventh case, an infant exposed to duloxetine 90 mg/day developed neonatal behavioral syndrome. One study examined the excretion of duloxetine into breast milk, but the mothers discontinued nursing for the study. In the present case, no adverse effects from exposure to the drug in milk were noted in the exclusively breast-fed infant. The possibility of functional/neurobehavioral deficits appearing later in life cannot be excluded because long-term follow-up has not been conducted in infants exposed to duloxetine in utero or during nursing.CONCLUSION: No developmental toxicity or other signs of toxicity were observed in an infant exposed to duloxetine during the second half of gestation and during breast-feeding in the first 32 days after birth. However, the possibility of functional/neurobehavioral deficits appearing later in life cannot be excluded.