Summary
Flupenthixol (FP), nortriptyline (NT) and zuclopenthixol, (ZCP) were determined in breast milk and plasma from 2 puerperal, lactating women with psychiatric disorders. The milk concentrations were equal to, higher and lower than those in plasma for FP, NT and ZCP, respectively. Variation in milk triglyceride concentration, but not milk pH, could partly explain between-breast differences in the milk concentrations. The study demonstrates the need for appropriate and representative milk sampling procedures. The estimated daily infant exposure averaged 0.5, 2.3 and 0.3% of the corresponding maternal weight related doses of FP, NT and ZCP. FP was also detectable in infant plasma. These drugs are not known to be harmful in small doses to breast-fed infants. However, concern about the effect of dopamine blocking agents on neurobehavioral mechanisms in animals warrants caution. If neuroleptics are required for a long period this risk must be weighed against the benefits of breast-feeding, also considering the psychological effects of the latter.
This is a preview of subscription content, log in via an institution to check access.
References
American Academy of Pediatrics, Committee on Drugs (1982) Psychotropic drugs in pregnancy and lactation. Pediatrics 69: 241–243
Matheson I (1986) Psykofarmaka og amming (Psychoparmacological drugs and breast-feeding). Tidsskr Nor Lægeforen 106: 1721–1722
Jørgensen A (1978) A sensitive and specific radioimmunoassay for cis(Z)-flupentixol in human serum. Life Sci 23: 1533–1542
Aaes-Jørgensen T (1980) Specific high performance liquid chromatographic method for estimation of the cis(Z)- and trans(E)-isomers of clopenthixol and a N-dealkyl metabolite. J Chromatogr 183: 239–245
Brixen-Rasmussen L, Halgrener J, Jørgensen A (1982) Amitriptyline and nortriptyline. Excretion in human breast milk. Psychopharmacology 76: 94–95
Neville MC, Koller RP, Seacat J, Casey CE, Allen JC, Acher P (1984) Studies on human lactation. 1. Within feed and between-breast variation in selected compounds of human milk. Am J Clin Nutr 40: 635–646
Syversen G, Ratkje SK (1985) Drug distribution within human milk phases. J Pharm Sci 74: 1071–1074
Kemp J, Ilett KF, Booth J, Hackett LP (1985) Excretion of doxepin and N-desmethyldoxepin in human milk. Br J Clin Pharmacol 20: 497–499
Kirk L, Jørgensen A (1980) Concentrations of Cis(Z)-flupentixol in maternal serum, amniotic fluid, umbilical cord serum, and milk. Psychopharmacology 72: 107–108
Pittard WB, O'Neal Jr, W (1986) Amitriptyline excretion in human milk. J Clin Psychopharmacol 6: 383–384
Aaes-Jørgensen T, Bjørndal F, Bartels U (1986) Zuclopenthixol levels in serum and breast milk. Psychopharmacology 90: 417–418
Wiles DH, Orr MW, Kolakowska T (1978) Chlorpromazine levels in plasma and milk of nursing mothers (Letter). Br J Clin Pharmacol 5: 272–273
Matheson I, Pande H, Alertsen AR (1985) Respiratory depression caused by N-desmethyldoxepin in breast milk (Letter). Lancet 2: 1124
Lundborg P (1972) Abnormal ontogeny in young rabbits after chronic administration of haloperidol to the nursing mother. Brain Res 44: 684–687
Ahlenius S, Brown R, Engel J, Lundborg P (1973) Learning deficits in 4 weeks old offspring of the nursing mothers treated with the neuroleptic drug penfluridol. Arch Pharmacol (Berl) 279: 31–37
Nakanishi H, Toenjes R, Doerner G, Fujii T, Okinga S (1986) Effects of neuroleptics administered to lactating rats on the behavioral development of offspring. Exp Clin Endocrinol 88: 13–24
Cuomo V (1987) Perinatal neurotoxicology of psychotropic drugs. Trends Pharmacol Sci 8: 346–350
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Matheson, I., Skjaeraasen, J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol 35, 217–220 (1988). https://doi.org/10.1007/BF00609257
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00609257