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

Olanzapine

June 4, 2016 (Very Low Risk)

It is excreted in breast milk in clinically non-significant amount without problems observed in infants whose mothers were receiving this treatment, whether on psychomotor development, speech improvement and weight gaining.
Drug plasma levels in these infants were undetectable or very low.

In the neonatal period, isolated cases of sedation and / or withdrawal symptoms have been reported, possibly by accumulative mechanism during pregnancy or added effect from another drug.

Some experts think that Olanzapine would be the one of choice during lactation among second-generation antipsychotic drugs (Uguz 2016).

May induce increased plasma levels of Prolactin but less frequently and lower than other antipsychotic drugs.

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

  • Olanzapine Embonate

Writings

  • ολανζαπίνη (Greek)
  • أولانزابين (Arabic)
  • Оланзапин (Cyrillic)
  • 奥氮平 (Chinese)
  • オランザピン (Japanese)
  • C17H20N4S (Molecular formula)

Drug trade names

References

  1. Uguz F. Second-Generation Antipsychotics During the Lactation Period: A Comparative Systematic Review on Infant Safety. J Clin Psychopharmacol. 2016Abstract
  2. Aydin B, Nayir T, Sahin S, Yildiz A. Olanzapine and quetiapine use during breastfeeding: excretion into breast milk and safe breastfeeding strategy. J Clin Psychopharmacol. 2015Abstract
  3. Uguz F. Breastfed Infants Exposed to Combined Antipsychotics: Two Case Reports. Am J Ther. 2015Abstract
  4. 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)
  5. Parikh T, Goyal D, Scarff JR, Lippmann S. Antipsychotic drugs and safety concerns for breast-feeding infants. South Med J. 2014Abstract
  6. Stiegler A, Schaletzky R, Walter G, Wüst R, Abele H, Goelz R, Farger G, Wiatr G, Fallgatter AJ, Batra A. Olanzapine treatment during pregnancy and breastfeeding: a chance for women with psychotic illness? Psychopharmacology (Berl). 2014Abstract
  7. Klinger G, Stahl B, Fusar-Poli P, Merlob P. Antipsychotic drugs and breastfeeding. Pediatr Endocrinol Rev. 2013Abstract
  8. Brunner E, Falk DM, Jones M, Dey DK, Shatapathy CC. Olanzapine in pregnancy and breastfeeding: a review of data from global safety surveillance. BMC Pharmacol Toxicol. 2013Abstract
  9. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. 2013Abstract
  10. 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)
  11. Gilad O, Merlob P, Stahl B, Klinger G. Outcome of infants exposed to olanzapine during breastfeeding. Breastfeed Med. 2011Abstract
  12. Juruena MF, de Sena EP, de Oliveira IR. Safety and tolerability of antipsychotics: focus on amisulpride. Drug Healthc Patient Saf. 2010Abstract Full text (link to original source) Full text (in our servers)
  13. Whitworth A, Stuppaeck C, Yazdi K, Kralovec K, Geretsegger C, Zernig G, Aichhorn W. Olanzapine and breast-feeding: changes of plasma concentrations of olanzapine in a breast-fed infant over a period of 5 months. J Psychopharmacol. 2010Abstract
  14. Gentile S. Infant safety with antipsychotic therapy in breast-feeding: a systematic review. J Clin Psychiatry. 2008Abstract
  15. Lutz UC, Wiatr G, Orlikowsky T, Gaertner HJ, Bartels M. Olanzapine treatment during breast feeding: a case report. Ther Drug Monit. 2008Abstract
  16. Schlotterbeck P, Leube D, Kircher T, Hiemke C, Gründer G. Aripiprazole in human milk. Int J Neuropsychopharmacol. 2007Abstract Full text (in our servers)
  17. Ambresin G, Berney P, Schulz P, Bryois C. Olanzapine excretion into breast milk: a case report. J Clin Psychopharmacol. 2004Abstract
  18. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004Abstract
  19. Gardiner SJ, Kristensen JH, Begg EJ, Hackett LP, Wilson DA, Ilett KF, Kohan R, Rampono J. Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry. 2003Abstract
  20. Friedman SH, Rosenthal MB. Treatment of perinatal delusional disorder: a case report. Int J Psychiatry Med. 2003Abstract
  21. Croke S, Buist A, Hackett LP, Ilett KF, Norman TR, Burrows GD. Olanzapine excretion in human breast milk: estimation of infant exposure. Int J Neuropsychopharmacol. 2002Abstract
  22. Kirchheiner J, Berghöfer A, Bolk-Weischedel D. Healthy outcome under olanzapine treatment in a pregnant woman. Pharmacopsychiatry. 2000Abstract
  23. Goldstein DJ, Corbin LA, Fung MC. Olanzapine-exposed pregnancies and lactation: early experience. J Clin Psychopharmacol. 2000Abstract
  24. David SR, Taylor CC, Kinon BJ, Breier A. The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Clin Ther. 2000Abstract
  25. Crawford AM, Beasley CM Jr, Tollefson GD. The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Schizophr Res. 1997Abstract