Is Aripiprazole compatible with breastfeeding? Do we have alternatives for Aripiprazole?

Aripiprazole

May 16, 2018 (Low Risk)

Its pharmacokinetic data (low oral bioavailability, large volume of distribution, moderately elevated molecular weight and high plasma protein binding) explains the negligible or zero passage into milk observed (Grover 2015, Nordeng 2014, Watanabe 2011, Lutz 2010, Schlotterbeck 2007).

No problems were observed in infants whose mothers were taking it (Nordeng 2014, Tarikh 2014, Lutz 2010). The plasma levels of these infants were undetectable or very low (Watanabe 2011).

Its relationship with prolactin is controversial because it lowers prolactin levels and has been used to treat prolactinomas and hyperprolactinemia induced by the use of other antipsychotics (Bakker 2016, Ranjbar 2015, Raghuthaman 2015, Safer 2013, Byerly 2009, Lorenz 2007, Goodnick 2002), but cases of decreased milk production have been reported (Frew 2015, Mendhekar 2006) and hyperprolactinemia/galactorrhea triggered by aripiprazole has been reported (Gunes 2018, Sogawa 2016, Prost 2016, Saraf 2014, Mendhekar 2005, Ruffatti 2005).

Due to its slow elimination, it may be worthwhile using other compatible antipsychotics with a shorter half-life, especially during the neonatal period and in case of prematurity (Uguz 2016).

Monitor for possible drowsiness in the infant (Hale 2017 p.74).

Alternatives

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.

Writings

  • أريبيبرازول (Arabic)
  • Арипипразол (Cyrillic)
  • 阿立哌唑 (Chinese)
  • アリピプラゾール (Japanese)
  • C23H27Cl2N3O2 (Molecular formula)

Drug trade names

References

  1. Gunes S. Hyperprolactinemic Galactorrhea as a Side Effect of Aripiprazole: An Adolescent Case (Aripiprazole-Related Hyperprolactinemic Galactorrhea). J Clin Psychopharmacol. 2018Abstract
  2. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  3. Sogawa R, Shimomura Y, Minami C, Maruo J, Kunitake Y, Mizoguchi Y, Kawashima T, Monji A, Hara H. Aripiprazole-Associated Hypoprolactinemia in the Clinical Setting. J Clin Psychopharmacol. 2016Abstract
  4. Propst AJ, Jarvis GE, Margolese HC. Aripiprazole-Induced Hypoprolactinemia in an Adult Male with First-Episode Psychosis. Clin Schizophr Relat Psychoses. 2016Abstract
  5. Uguz F. Second-Generation Antipsychotics During the Lactation Period: A Comparative Systematic Review on Infant Safety. J Clin Psychopharmacol. 2016Abstract
  6. Bakker IC, Schubart CD, Zelissen PM. Successful treatment of a prolactinoma with the antipsychotic drug aripiprazole. Endocrinol Diabetes Metab Case Rep. 2016Abstract
  7. Grover S, Avasthi A. Mood stabilizers in pregnancy and lactation. Indian J Psychiatry. 2015Abstract Full text (link to original source) Full text (in our servers)
  8. Frew JR. Psychopharmacology of bipolar I disorder during lactation: a case report of the use of lithium and aripiprazole in a nursing mother. Arch Womens Ment Health. 2015Abstract
  9. Ranjbar F, Sadeghi-Bazargani H, Niari Khams P, Arfaie A, Salari A, Farahbakhsh M. Adjunctive treatment with aripiprazole for risperidone-induced hyperprolactinemia. Neuropsychiatr Dis Treat. 2015Abstract
  10. Raghuthaman G, Venkateswaran R, Krishnadas R. Adjunctive aripiprazole in risperidone-induced hyperprolactinaemia: double-blind, randomised, placebo-controlled trial. BJPsych Open. 2015Abstract
  11. Nordeng H, Gjerdalen G, Brede WR, Michelsen LS, Spigset O. Transfer of aripiprazole to breast milk: a case report. J Clin Psychopharmacol. 2014Abstract
  12. Parikh T, Goyal D, Scarff JR, Lippmann S. Antipsychotic drugs and safety concerns for breast-feeding infants. South Med J. 2014Abstract
  13. Saraf G, Behere RV, Venkatasubramanian G, Rao NP, Varambally S, Gangadhar BN. Hyperprolactinemia with aripiprazole: understanding the paradox. Am J Ther. 2014Abstract
  14. Nordeng H, Gjerdalen G, Brede WR, Michelsen LS, Spigset O. Transfer of Aripiprazole to Breast Milk: A Case Report. J Clin Psychopharmacol. 2014Abstract
  15. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013Abstract
  16. Safer DJ, Calarge CA, Safer AM. Prolactin serum concentrations during aripiprazole treatment in youth. J Child Adolesc Psychopharmacol. 2013Abstract
  17. Watanabe N, Kasahara M, Sugibayashi R, Nakamura T, Nakajima K, Watanabe O, Murashima A. Perinatal use of aripiprazole: a case report. J Clin Psychopharmacol. 2011Abstract
  18. Lutz UC, Hiemke C, Wiatr G, Farger G, Arand J, Wildgruber D. Aripiprazole in pregnancy and lactation: a case report. J Clin Psychopharmacol. 2010Abstract
  19. Byerly MJ, Marcus RN, Tran QV, Eudicone JM, Whitehead R, Baker RA. Effects of aripiprazole on prolactin levels in subjects with schizophrenia during cross-titration with risperidone or olanzapine: analysis of a randomized, open-label study. Schizophr Res. 2009Abstract
  20. Schlotterbeck P, Leube D, Kircher T, Hiemke C, Gründer G. Aripiprazole in human milk. Int J Neuropsychopharmacol. 2007Abstract Full text (in our servers)
  21. Wolf J, Fiedler U. Hyperprolactinemia and amenorrhea associated with olanzapine normalized after addition of aripiprazole. J Clin Pharm Ther. 2007Abstract
  22. Lorenz RA, Weinstein B. Resolution of haloperidol-induced hyperprolactinemia with aripiprazole. J Clin Psychopharmacol. 2007Abstract
  23. Mendhekar DN, Sunder KR, Andrade C. Aripiprazole use in a pregnant schizoaffective woman. Bipolar Disord. 2006Abstract
  24. Mendhekar DN, Andrade C. Galactorrhea with aripiprazole. Can J Psychiatry. 2005Abstract
  25. Ruffatti A, Minervini L, Romano M, Sonino N. Galactorrhea with aripiprazole. Psychother Psychosom. 2005Abstract
  26. Goodnick PJ, Rodriguez L, Santana O. Antipsychotics: impact on prolactin levels. Expert Opin Pharmacother. 2002Abstract