Amitriptyline
It is excreted into breastmilk in a clinically non-significant amount (Bader 1980, Brixen 1982, Pittard 1986, Breyer 1995, Yoshida 1999).
Plasma levels in the infant have been found undetectable (Ericsson 1979, Bader 1980, Brixen 1982, Breyer 1995) or very low (Yoshida 1997) and no side effects being observed even at maternal doses as high as 150-175 mg / day (Brixen 1982 , Misri 1991, Yoshida 1999, Nulman 2002).
However, one published case of sedation on a 15-day-old infant that occured within few days after taken just 10 mg daily of amitriptyline by her mother because of insomnia and anxiety (Oguz 2016). Levels were not measured in either milk or plasma of the infant and the mother.
Amitriptyline may produce galactorrhoea by prolactin stimulation.
Alternatives
- Amoxapine (Very Low Risk)
- Imipramine-Hcl (Very Low Risk)
Very Low Risk
Compatible. Not risky for breastfeeding or infant.
Low Risk
Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.
High Risk
Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.
Very High Risk
Not recommended. Cessation of breastfeeding or alternative.
Synonyms
- Amitriptyline Embonate
- Amitriptyline Hydrochloride
Writings
- أميتريبتيلين (Arabic)
- Амитриптилин (Cyrillic)
- 阿米替林 (Chinese)
- アミトリプチリン (Japanese)
- C20H23N (Molecular formula)
Drug trade names
- Adepril™
- ADT™
- Amineurin™
- Amitrip™
- Amitrol™
- Amytril™
- Amyzol™
- Anapsique™
- Deprelio™
- Domical™
- Elavil™
- Eliwel™
- Endep™
- Laroxyl™
- Lentizol™
- Noriline™
- Novoprotect™
- Polytanol™
- Protanol™
- Redomex™
- Sarotena™
- Saroten™
- Sarotex™
- Stelminal™
- Syneudon™
- Teperin™
- Trepiline™
- Tripsol™
- Tripsyline™
- Tripta™
- Triptizol™
- Triptyline™
- Triptyl™
- Tryptanol™
- Tryptizol™
- Tryptomer™
- Uxen™
- АМІТРИПТИЛІН
- АМІТРИПТИЛІНУ ГІДРОХЛОРИД
- АМІТРИПТИЛІНУ ГІДРОХЛОРИД-ЗН
- АМІТРИПТИЛІНУ ГІДРОХЛОРИД-ОЗ
- САРОТЕН
References
- Uguz F. Poor Feeding and Severe Sedation in a Newborn Nursed by a Mother on a Low Dose of Amitriptyline. Breastfeed Med. 2016Abstract
- Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015Abstract Full text (link to original source) Full text (in our servers)
- Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014Abstract
- Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012Abstract Full text (link to original source) Full text (in our servers)
- Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012Abstract Full text (in our servers)
- Nielsen RE, Damkier P. Pharmacological treatment of unipolar depression during pregnancy and breast-feeding--a clinical overview. Nord J Psychiatry. 2012Abstract
- Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group.. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012Abstract
- Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011Abstract
- Hale TW, Kendall-Tackett K, Cong Z, Votta R, McCurdy F. Discontinuation syndrome in newborns whose mothers took antidepressants while pregnant or breastfeeding. Breastfeed Med. 2010Abstract
- Acedo-Valenzuela MI, Mora-Díez N, Galeano-Díaz T, Silva-Rodríguez A. Determination of tricyclic antidepressants in human breast milk by capillary electrophoresis. Anal Sci. 2010Abstract Full text (in our servers)
- Cassina M, Di Gianantonio E, Toldo I, Battistella PA, Clementi M. Migraine therapy during pregnancy and lactation. Expert Opin Drug Saf. 2010Abstract
- Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008Abstract Full text (link to original source) Full text (in our servers)
- Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006Abstract Full text (link to original source) Full text (in our servers)
- Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004Abstract
- Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004Abstract Full text (link to original source) Full text (in our servers)
- Hostetter AL, Stowe ZN, Cox M, Ritchie JC. A novel system for the determination of antidepressant concentrations in human breast milk. Ther Drug Monit. 2004Abstract
- Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003Abstract Full text (link to original source) Full text (in our servers)
- Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002Abstract
- WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
- Egberts AC, Meyboom RH, De Koning FH, Bakker A, Leufkens HG. Non-puerperal lactation associated with antidepressant drug use. Br J Clin Pharmacol. 1997Abstract Full text (link to original source) Full text (in our servers)
- Håberg M, Matheson I. [Antidepressive agents and breast feeding]. Tidsskr Nor Laegeforen. 1997Abstract
- Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics and of possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. J Affect Disord. 1997Abstract
- Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996Abstract
- Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995Abstract
- Pons G, Rey E, Matheson I. Excretion of psychoactive drugs into breast milk. Pharmacokinetic principles and recommendations. Clin Pharmacokinet. 1994Abstract
- Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991Abstract
- Pittard WB 3rd, O'Neal W Jr. Amitriptyline excretion in human milk. J Clin Psychopharmacol. 1986Abstract
- Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982Abstract
- Bader TF, Newman K. Amitriptyline in human breast milk and the nursing infant's serum. Am J Psychiatry. 1980Abstract
- Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979Abstract
- Turkington RW. Prolactin secretion in patients treated with various drugs: phenothiazines, tricyclic antidepressants, reserpine, and methyldopa. Arch Intern Med. 1972Abstract