ABSTRACT
We here report on a psychotic mother and her breast-fed infant who was treated with olanzapine. Consecutively olanzapine concentrations in the milk and plasma of the mother and in the infant were measured with tandem mass spectroscopy over a period of five month. The results show a relatively high plasma level in the infant aged four month, probably referring to an immature hepatic transformation system, especially CYP1A2. In the following four months plasma levels of olanzapine decreased to very low, even undetectable concentrations in the infant. The infant developed normally and showed no side effects during the treatment period.
Subject(s)
Antipsychotic Agents/pharmacokinetics , Benzodiazepines/pharmacokinetics , Breast Feeding , Adult , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Benzodiazepines/adverse effects , Benzodiazepines/therapeutic use , Cytochrome P-450 CYP1A2/metabolism , Depression, Postpartum/drug therapy , Female , Humans , Infant , Male , Milk, Human/chemistry , Olanzapine , Psychotic Disorders/drug therapy , Psychotic Disorders/etiology , Tandem Mass SpectrometryABSTRACT
Little is known about the use of antipsychotics in pregnancy and the corresponding plasma levels in the newborn child. We report on a woman with schizophrenia treated with olanzapine during pregnancy. Plasma levels of olanzapine were assessed both from the mother and from umbilical cord. The plasma level of the newborn (11 ng/mL) was about one third compared to the mother (range 25-34 ng/mL).The development of the fetus, delivery and the development of the child during the first six months were normal.
Subject(s)
Antipsychotic Agents/blood , Benzodiazepines/blood , Fetal Blood/chemistry , Pregnancy Complications/drug therapy , Schizophrenia/drug therapy , Adult , Female , Fetus/drug effects , Humans , Infant, Newborn , Olanzapine , Pregnancy , Pregnancy Complications/metabolism , Schizophrenia/metabolismABSTRACT
In this review we investigate whether sex differences exist for side effects of second-generation antipsychotics. Results are based on a MEDLINE search for the years 1974 through 2005. Even if pharmacokinetics differ between females and males, significantly higher plasma levels for women have been demonstrated only for olanzapine and clozapine. Hyperprolactinaemia is mainly induced by treatment with risperidone and amisulpride, and there is evidence for more pronounced prolactin levels in females. Most studies reviewed indicate that clozapine and olanzapine are associated with more body weight gain, once more especially in female patients. Furthermore, the few published studies indicate that metabolic syndrome is more frequent in females and there are likely no gender-specific differences between the new antipsychotic medications concerning frequency and degree of acute or chronic movement disturbance. The risk of QT prolongation with torsades de pointes arrhythmia is again higher in females. In conclusion, there is some evidence of sex differences in the side effects of second-generation antipsychotics. For better understanding of the basic mechanisms in sex differences, future studies with a primary focus on this topic are required. More specific data will help to determine how these differences shall affect clinical management.
Subject(s)
Antidepressive Agents, Second-Generation/adverse effects , Antipsychotic Agents/adverse effects , Arrhythmias, Cardiac/epidemiology , Drug-Related Side Effects and Adverse Reactions/epidemiology , MEDLINE , Metabolic Syndrome/epidemiology , Obesity/epidemiology , Antidepressive Agents, Second-Generation/blood , Antipsychotic Agents/blood , Arrhythmias, Cardiac/chemically induced , Causality , Comorbidity , Female , Humans , Incidence , Male , Metabolic Syndrome/chemically induced , Obesity/chemically induced , Risk Assessment , Risk Factors , Sex Distribution , Sex FactorsABSTRACT
We describe a patient suffering from dilative cardiomyopathy after 16 years of treatment with lithium carbonate. The literature concerning lithium and cardiac adverse reactions is briefly reviewed. There is good evidence for acute cardiac reactions, especially cardiac arrhythmia but a rather speculative association with long-term reactions such as cardiomyopathy. Nevertheless clinicians should be aware of this rare but life threatening conjunction of cardiac disease and lithium treatment.
Subject(s)
Antimanic Agents/adverse effects , Cardiomyopathy, Dilated/chemically induced , Lithium/adverse effects , Antimanic Agents/therapeutic use , Bipolar Disorder/complications , Bipolar Disorder/drug therapy , Bipolar Disorder/psychology , Electrocardiography/drug effects , Humans , Lithium/therapeutic use , Male , Middle Aged , RiskABSTRACT
We present the case of a breast-feeding woman with acute psychotic symptoms after delivery, which were treated with the antipsychotic agent risperidone. Serum levels of risperidone and 9-hydroxyrisperidone could be detected in both the mother and her infant. Drug-levels in breast milk were ten-fold lower compared to maternal serum. The patient responded well to antipsychotic treatment. Her infant did not display any adverse effects and psychomotor development was normal. In this case, risperidone was a safe treatment option for the breast-feeding mother and her infant. We also provide a brief overview of the clinically relevant data concerning antipsychotics and breast-feeding.
