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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Shellye on August 23, 2001, at 3:54:03
Looking for others that have been on Effexor and gone through pregnancy and breastfeeding.
Would like to know how things went. Did you breastfeed?
Did you decrease your doseage while pregnant?
Posted by SalArmy4me on August 23, 2001, at 6:59:44
In reply to On Effexor -will stay on while pregnant. Looking., posted by Shellye on August 23, 2001, at 3:54:03
Journal of Clinical Psychopharmacology
Volume 20(5) October 2000 pp 587-589
Use During Breast-Feeding
[Letters to the Editors]"A number of reports of venlafaxine in mothers who breast-feed have been published in the past 4 years. Data on the use of venlafaxine during breast-feeding now exceeds that of any other single antidepressant; to date, no adverse effects have been observed in the nursing infants. In studies that have evaluated serum levels of venlafaxine in the infants, the levels have typically been undetectable. Paroxetine and fluoxetine, like venlafaxine, are widely used in women of reproductive age, but few data exist on the impact of these medications in infants of breast-feeding women. A single case report describing colic in an infant exposed to fluoxetine through breast milk 6 led to a revision of fluoxetine's labeling to include a recommendation against its use by breast-feeding women. However, a study of the infants of 11 women taking fluoxetine while breast-feeding found no adverse effects in the exposed infants.
A single case report of an infant whose mother took venlafaxine 20 mg/day from the third day after delivery found no adverse effects in the infant. A level of venlafaxine in breast milk was obtained 4 hours after the oral dose, but no serum levels of venlafaxine were obtained in the infant. We present a case of a breast-feeding mother taking 10 mg of venlafaxine and obtained breast milk levels across a 24-hour period so that the times of peak concentration could be identified. Also, a serum level was obtained in the infant to obtain more definitive information regarding infant medication exposure.
Case Report
V.G., a 34-year-old white woman, had a history of panic disorder with agoraphobia since 14 years of age. Before conception, the patient had been successfully treated with paroxetine 10 mg and occasional alprazolam. At 24 weeks of pregnancy, she sought a psychiatric evaluation because of a recurrence of panic attacks and agoraphobia. She chose not to resume paroxetine until after delivery to avoid fetal exposure. At term, she delivered a healthy baby girl and began venlafaxine daily the day after delivery. She exclusively breast-fed from birth until 6 weeks postpartum, at which point she decided to switch to bottle-feeding because she believed her daughter was not taking well to breast-feeding.The venlafaxine produced a full remission of her panic disorder symptoms within 3 weeks of the birth. At that time, V.G. obtained breast milk samples over a 24-hour period beginning immediately after ingestion of the medication. Breast milk samples were collected from the same breast in sterile polypropylene tubes using a manual breast pump via two different procedures: (1) fore-milk samples (the first 10%-15% of milk produced) were collected from a single breast at 3- to 5-hour intervals postdose over a 24-hour period; and (2) breast milk samples were collected in 10-mL aliquots from fore-milk to hindmilk (the last 50% of milk produced at a single feeding). The morning after breast milk collection, maternal and infant serum samples were obtained 12 hours after the oral dose of venlafaxine and approximately 1 hour after the infant's last breast-feeding. Breast milk and serum sample analyses were performed using the methods described by our team elsewhere.9 The mean recovery of milk was 85%. The milk volume used in the analysis was 1 mL. The intra-assay variability was 8%, and the interassay variability was 3%. The assays had a lower limit of sensitivity of 1 ng/mL for serum and 2.0 ng/mL for breast milk.
Results
Breast milk levels of venlafaxine were nondetectable over the entire 24-hour collection, including fore-milk and hindmilk samples, and the infant's serum level of venlafaxine was similarly nondetectable. The maternal serum level was 10 ng/mL. In pediatric examinations at 6 weeks, 3 months, and 6 months, the child was found to be thriving and achieving appropriate developmental milestones.Discussion
In this case report, no adverse effects were observed in an infant who was exclusively breast-fed for 6 weeks by a mother receiving a therapeutic dose of venlafaxine, and venlafaxine was not detectable in the infant's serum at a limit of detection of 1 ng/mL. Both the time course of excretion (sampled at 3-4 hour intervals) and the gradient determination (foremilk to hindmilk) failed to produce quantifiable concentrations of venlafaxine in any of the samples assayed. Because hindmilk is 2 to 3 times more lipophilic than foremilk, we expected that venlafaxine would be detectable in hindmilk if it were present. However, hindmilk collections also revealed no detectable concentrations of venlafaxine. Consistent with our findings, a previous report described a low milk-to-plasma ratio for venlafaxine. venlafaxine may cross into breast milk to a lesser extent than sertraline or fluoxetine, which have been found in detectable concentrations in breast milk. Factors that influence the diffusion of a medication into breast milk include protein-binding, pKa, volume of distribution, half-life, and molecular weight. Like sertraline and fluoxetine, venlafaxine is weakly basic (pKa for sertraline, fluoxetine, and venlafaxine: 8.9, 9.5, and 9.9, respectively) and therefore is likely to enter breast milk, which is acidic relative to plasma. Sertraline, fluoxetine, and venlafaxine also share high protein-binding and large volumes of distribution. However, venlafaxine's shorter half-life and slightly higher molecular weight may account for its apparent decreased diffusion into breast milk. Citalopram and fluvoxamine have also been detected in breast milk.13-15 Like venlafaxine, they are weak bases, and fluvoxamine has a half-life comparable to that of paroxetine. However, these medications have relatively lower proteinbinding and smaller volumes of distribution.Given the substantial benefits of breast milk, including its antibodies, growth factors, fatty acids, and other substances that are not matched in formula, many new mothers prefer to breastfeed if that option is available to them. However, this case suggests that venlafaxine may be an option with minimal risk of infant exposure for nursing mothers requiring antidepressant medication."
Victoria Hendrick, MD
Posted by Shellye on August 23, 2001, at 11:41:09
In reply to Re: On Effexor -will stay on while pregnant. Looking. » Shellye, posted by SalArmy4me on August 23, 2001, at 6:59:44
I have been looking for! You are terrific!
Have an awsome day, where ever you are!
Posted by SalArmy4me on August 23, 2001, at 12:16:08
In reply to SalArmy4me- Thank you, thank you! Exactly what, posted by Shellye on August 23, 2001, at 11:41:09
I remain your servant. Thank you for listening to me.
This is the end of the thread.
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