Is Nortriptyline Hydrochloride compatible with breastfeeding? Do we have alternatives for Nortriptyline Hydrochloride?

Nortriptyline Hydrochloride

August 5, 2017 (Very Low Risk)

It is an active metabolite of Amitriptyline.

Excreted into breast milk in a clinically non-significant amount (Wisner 1997,Matheson 1988, Brixen1982) with no problems observed in breastfed infants from treated mothers (Wisner 2002, 1997 y 1991,Brixen1982).

Levels found in the plasma of those infants were very low or undetectable Wisner 2006 y 1991).

It is considered one of the safest antidepressants during lactation (Gentile 2014, Nielsen 2012, Hübner 2012, Pringsheim 2012, Davanzo 2011, Lanza 2009, ABM 2008, Weissman 2004).

Alternatives

We do not have alternatives for Nortriptyline Hydrochloride since it is relatively safe.

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

  • Nortriptyline

Writings

  • νορτριπτυλίνη υδροχλωρική (Greek)
  • Нортриптилина Гидрохлорид (Cyrillic)
  • ノルトリプチリン塩酸塩 (Japanese)
  • C19H21N,HCl (Molecular formula)
  • 3-(10,11-Dihydro-5H-dibenzo[a,d]cyclohepten-5-ylidene)propyl(methyl)amine hydrochloride (Chemical name)
  • N06AA10 (ATC Code/s)

References

  1. 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)
  2. Gentile S. Tricyclic antidepressants in pregnancy and puerperium. Expert Opin Drug Saf. 2014Abstract
  3. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013Abstract Full text (link to original source) Full text (in our servers)
  4. 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)
  5. Nielsen RE, Damkier P. Pharmacological treatment of unipolar depression during pregnancy and breast-feeding--a clinical overview. Nord J Psychiatry. 2012Abstract
  6. 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)
  7. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011Abstract
  8. 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)
  9. 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)
  10. Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK, Findling RL, Moses-Kolko EL. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006Abstract
  11. 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)
  12. 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)
  13. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002Abstract
  14. Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics. 1999Abstract Full text (link to original source) Full text (in our servers)
  15. Håberg M, Matheson I. [Antidepressive agents and breast feeding]. Tidsskr Nor Laegeforen. 1997Abstract
  16. Mammen O, Perel JM, Wheeler S. Antidepressants and breast-feeding. Am J Psychiatry. 1997Abstract Full text (link to original source) Full text (in our servers)
  17. Wisner KL, Perel JM, Findling RL, Hinnes RL. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacol Bull. 1997Abstract
  18. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996Abstract
  19. Wisner KL, Perel JM. Nortriptyline treatment of breast-feeding women. Am J Psychiatry. 1996Abstract
  20. Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995Abstract
  21. Altshuler LL, Burt VK, McMullen M, Hendrick V. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995Abstract
  22. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991Abstract
  23. Wisner KL, Perel JM. Serum nortriptyline levels in nursing mothers and their infants. Am J Psychiatry. 1991Abstract
  24. Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988Abstract
  25. Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982Abstract
  26. Nielsen JL. Plasma prolactin during treatment with nortriptyline. Neuropsychobiology. 1980Abstract
  27. Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979Abstract