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

Duloxetine

April 18, 2018 (Very Low Risk)

It is a reuptake-inhibitor of Serotonin and Norepinephrine.
Oral administration once a day.

Excreted into breast milk in clinically non-significant amount (Collin 2018, Andrade 2014, Rowe 2013, Boyce 2011, Berle 2011, Briggs 2009, EMA 2009, Lanza 2009, Lobo 2008) with no side-effects being observed in breastfed infants from treated mothers (Briggs 2009). Plasma level in those infants was very low or undetectable (Boyce 2011, Briggs 2009).

Because there is less experience published than with other antidepressants of the same pharmacological group, it should be preferred the use of an alternative drug that is known to be safer in the neonatal period or prematurity.

Galactorrhea has been observed with or without an increase in prolactin (Demirci 2015, Belli 2013, Korkmaz 2011), but less frequently than with other antidepressants (Trenque 2011).

Women who use antidepressant medication during pregnancy are in need of more support for breastfeeding since they are at risk for early weaning (Leggett 2017).

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.

Synonyms

  • Duloxetine Hydrochloride

Writings

  • Дулоксетина Гидрохлорид (Cyrillic)
  • 塩酸デュロキセチン (Japanese)
  • C18 H19 NOS, HCl (Molecular formula)
  • (+)-(S)-N-Methyl-γ-(1-naphthyloxy)-2-thiophenepropylamine hydrochloride (Chemical name)
  • LY-248686 (Experimental code/s)
  • N06AX21 (ATC Code/s)

Drug trade names

References

  1. Collin-Lévesque L, El-Ghaddaf Y, Genest M, Jutras M, Leclair G, Weisskopf E, Panchaud A, Ferreira E. Infant Exposure to Methylphenidate and Duloxetine During Lactation. Breastfeed Med. 2018Abstract
  2. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017Abstract
  3. Demirci S, Unubol M, Demirci K. Galactorrhea With Normal Prolactin Levels Associated With Duloxetine. J Clin Psychopharmacol. 2015Abstract
  4. Andrade C. The safety of duloxetine during pregnancy and lactation. J Clin Psychiatry. 2014Abstract Full text (link to original source) Full text (in our servers)
  5. Belli H, Akbudak M, Ural C. Duloxetine-related galactorrhea and restless legs syndrome: a case report. Psychiatr Danub. 2013Abstract Full text (link to original source) Full text (in our servers)
  6. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  7. Boyce PM, Hackett LP, Ilett KF. Duloxetine transfer across the placenta during pregnancy and into milk during lactation. Arch Womens Ment Health. 2011Abstract
  8. Trenque T, Herlem E, Auriche P, Dramé M. Serotonin reuptake inhibitors and hyperprolactinaemia: a case/non-case study in the French pharmacovigilance database. Drug Saf. 2011Abstract
  9. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011Abstract Full text (link to original source) Full text (in our servers)
  10. Korkmaz S, Kuloğlu M, Işık U, Sağlam S, Atmaca M. Galactorrhea during duloxetine treatment: a case report. Turk Psikiyatri Derg. 2011Abstract
  11. Briggs GG, Ambrose PJ, Ilett KF, Hackett LP, Nageotte MP, Padilla G. Use of duloxetine in pregnancy and lactation. Ann Pharmacother. 2009Abstract
  12. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009Abstract Full text (link to original source) Full text (in our servers)
  13. EMA. Duloxetine. Drug Summary. 2009 Full text (in our servers)
  14. EMA. Duloxetina. Ficha técnica. 2009 Full text (in our servers)
  15. Lobo ED, Loghin C, Knadler MP, Quinlan T, Zhang L, Chappell J, Lucas R, Bergstrom RF. Pharmacokinetics of duloxetine in breast milk and plasma of healthy postpartum women. Clin Pharmacokinet. 2008Abstract