Updates in Psychotropic Medication for Lactating Women / 대한정신약물학회지

ABSTRACT

The use of psychotropic medications in lactating women is controversial. Despite widely accepted advantages of human milk, patients and professionals hesitate to use medications during breastfeeding. Package inserts written by manufacturers routinely discourage breastfeeding to prevent law suits. Here we conducted a review to help professionals to decide medication for lactating women on an evidence-based risk-benefit analysis. First, we reviewed lactational pharmacology. The relative infant dose (RID) was defined to give an objective measure for infant exposure to medication, and drugs with RID lesser than 10% were considered quite safe. Subsequently, we reviewed each category of psychotropic medications which were commonly used in mental illness. We provided information for each drug such as Dr. Hale's lactation risk category, RID, half-life, and time to peak plasma level as references for the risk analysis. There was no contraindicated psychotropic medication during breastfeeding, but for lithium, close monitoring of infant serum levels is warranted. In conclusion, most of medications used to treat mental illness in lactating women were usually safe. Nevertheless, medication use in lactating women should always be considered on an individualized risk-benefit analysis, and untoward adverse effects on the infant should be monitored.