Infant safety with antipsychotic therapy in breast-feeding: A systematic review
Infant safety with antipsychotic therapy in breast-feeding: A systematic review
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DOI：
10.4088/jcp.v69n0421
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发表时间：
2008-04-01
影响因子：
5.3
通讯作者：
Gentile, Salvatore
中科院分区：
文献类型：
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作者：
Gentile, Salvatore
背景：相对较多的女性可能在产后出现精神病症状。这些症状可能不仅对母亲而且对以后婴儿的健康产生毁灭性影响。患有精神病的母亲所生的孩子出现生理、心理和人格发育障碍的风险增加，而患有双相情感障碍的母亲所生的孩子患早发性精神疾病的风险增加。因此，临床医生应考虑有效预防或管理新妈妈精神病和情感复发的必要性。 目的：分析有关第一代和第二代抗精神病药对母乳喂养婴儿的安全性信息的文献，以便为产褥期需要此类药物的女性提供最安全的治疗选择。 数据来源：在 MEDLINE/PubMed/TOXNET（1950 年 - 1 月）上进行了计算机搜索2008）。使用的关键词如下：母乳喂养、哺乳期、产褥期、精神药物、非典型抗精神病药、典型抗精神病药和精神安定药。结论：对于大多数抗精神病药物在母乳喂养中的风险/获益情况，无法得出结论。因此，当临床医生被迫对未曾用药的患者开始抗精神病治疗时，最安全的选择应基于每种药物的总体疗效情况，但有两种可能的例外：氯氮平（该药物在母乳喂养期间应被视为禁忌，因为它可能诱发婴儿潜在的危及生命的事件）和奥氮平（该药物似乎与母乳喂养的婴儿诱发锥体外系反应的风险增加有关）。相反，对于在母乳喂养期间需要继续抗精神病治疗的患者，如果已知有效，则适合维持先前的药物治疗方案。
Background: A relatively high number of women may suffer from psychotic symptoms at postpartum onset. Such symptoms may have devastating effects not only on the mothers but also on the later infant's well being. Children born to mothers with psychosis are at increased risk of physiologic, psychological, and personality development disturbance, whereas children born to mothers with bipolar disorder are at increased risk of early-onset psychiatric disorders. Hence, clinicians should consider it imperative to prevent or manage effectively psychotic and affective relapses in new mothers.Objectives: To analyze the literature for information about the safety of first- and second-generation antipsychotics for breast-fed infants in order to individuate the safest treatment option for women who need such medications during puerperium.Data Sources: A computerized search was carried out on MEDLINE/PubMed/TOXNET (1950-January 2008). The following key words were used: breast-feeding, lactation, puerperium, psychotropic drugs, atypical antipsychotics, typical antipsychotics, and neuroleptics.Conclusions: No conclusions can be drawn about the risk/benefit profile of the majority of antipsychotic medications in breast-feeding. Hence, when clinicians are forced to start antipsychotic treatment in drug-naive patients, the choice of the safest option should be based on the general effectiveness profile of each agent, with 2 possible exceptions: clozapine (the drug should be considered contraindicated during breast-feeding because of its liability of inducing potential life-threatening events in the infant), and olanzapine (the drug seems to be associated with an increased risk of inducing extrapyramidal reactions in the breast-fed babies). Conversely, in patients who need to continue antipsychotic therapy during breast-feeding, it is suitable to maintain the previous pharmacologic regimen, if known as effective.