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

Chlorpromazine

August 12, 2018 (Low Risk)

Tranquilizer of the central nervous system with antipsychotic, anxiolytic and antiemetic properties.
Oral or intramuscular administration 1 to 3 times a day.

It is excreted in breast milk in amounts from undetectable to very small (Zuppa 2010, Yoshida 1998, Ohkubo 1993, Wiles 1978, Uhlir 1973) even after maternal doses of 1200 mg (Blacker 1962).

Urine levels of two infants whose mothers were taking chlorpromazine were very low, in the order of 1 microgram / L (Yoshida 1998).

It has been described in infants of mothers taking chlorpromazine from no side effects (Wiles 1978, Ayd 1964, Kris 1957) with normal growth and neurological development (Lacey 1971, Kris 1962) to numbness and sedation (Lee 1993, Wiles 1978, Lacey 1971 ) with a decrease in developmental score at 12 and 18 months when they were taking other psychotropic drugs at the same time (Yoshida 1998)

Supervision of drowsiness and development in infants is required (Klinger 2013, WHO 2002) and prescribed at the lowest effective dose and, if possible, in monotherapy (Parikh 2014, Tényi 2000).
Dosage of 100 mg per day does not cause problems for the infant (Lawrence 2016 p394).

Because it is a dopamine inhibitor, it produces an increase in prolactin levels and can increase milk production, having been used as a galactogogue (Lawrence 2016 p670, Mannion 2012, Muresan 2011, Zuppa 2010, Gabay 2002).

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

  • كلوربرومازين (Arabic)
  • Хлорпромазин (Cyrillic)
  • 氯丙嗪 (Chinese)
  • クロルプロマジン (Japanese)
  • C17 H19 ClN2 S (Molecular formula)
  • 3-(2-Chlorophenothiazin-10-yl)propyldimethylamine (Chemical name)
  • N05AA01 (ATC Code/s)

References

  1. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  2. Lawrence RA, Lawrence RM. Breastfeeding. A guide for the medical profession. Eighth Edition. Philadelphia: Elsevier; 2016
  3. Parikh T, Goyal D, Scarff JR, Lippmann S. Antipsychotic drugs and safety concerns for breast-feeding infants. South Med J. 2014Abstract
  4. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013Abstract
  5. Mannion C, Mansell D. Breastfeeding self-efficacy and the use of prescription medication: a pilot study. Obstet Gynecol Int. 2012Abstract Full text (link to original source) Full text (in our servers)
  6. Muresan M. Successful relactation--a case history. Breastfeed Med. 2011Abstract
  7. Zuppa AA, Sindico P, Orchi C, Carducci C, Cardiello V, Romagnoli C. Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. J Pharm Pharm Sci. 2010Abstract Full text (link to original source) Full text (in our servers)
  8. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002Abstract
  9. 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)
  10. Tényi T, Csábi G, Trixler M. Antipsychotics and breast-feeding: a review of the literature. Paediatr Drugs. 2000Abstract
  11. Yoshida K, Smith B, Craggs M, Kumar R. Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants. Psychol Med. 1998Abstract
  12. Ohkubo T, Shimoyama R, Sugawara K. Determination of chlorpromazine in human breast milk and serum by high-performance liquid chromatography. J Chromatogr. 1993Abstract
  13. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993Abstract Full text (link to original source) Full text (in our servers)
  14. Wiles DH, Orr MW, Kolakowska T. Chlorpromazine levels in plasma and milk of nursing mothers. Br J Clin Pharmacol. 1978Abstract Full text (link to original source) Full text (in our servers)
  15. Uhlír F, Rýznar J. Appearance of chlorpromazine in the mother's milk. Act Nerv Super (Praha). 1973Abstract
  16. Lacey JH. Dichloralphenazone and breast milk. Br Med J. 1971Abstract Full text (link to original source) Full text (in our servers)
  17. Kris EB. Children of mothers maintained on pharmacotherapy during pregnancy and postpartum. Curr Ther Res Clin Exp. 1965Abstract
  18. Ayd FJ. Children born of mothers treated with chloropromazine during pregnancy. Clin Med. 1964;71:1758-63.(Cited in Hale 2017 p 192) 1964
  19. Blacker KH, Weinstein BJ, Ellman GL. Mothers milk and chlorpromazine. Am J Psychol 1962;114:178–9 (Cited in Hale 2017 p 192). 1962
  20. HOOPER JH Jr, WELCH VC, SHACKELFORD RT. Abnormal lactation associated with tranquilizing drug therapy. JAMA. 1961Abstract
  21. KRIS EB, CARMICHAEL DM. Chlorpromazine maintenance therapy during pregnancy and confinement. Psychiatr Q. 1957Abstract