SERTRALINE AND NORSERTRALINE LEVELS IN 3 BREAST-FED INFANTS

Background: In assessing the safety of medication use in breastfeeding , it is important to know whether the drug used by the mother will be present in the breastfed infant. Compared with data for tricyclic anti depressants (TCAs), which have generally not been found in the plasma of breastfed infants, there are few data on the use of serotonin selec tive reuptake inhibitors (SSRIs) in breastfeeding. This poses a dilemm a for breastfeeding women and their treating clinicians, because of th e enhanced tolerability of SSRIs compared with TCAs, and because some patients do not respond well to TCAs. Method: Sertraline and norsertra line plasma concentrations were measured in three breastfeeding mother -infant pairs. Maternal and infant plasma samples were drawn a few min utes apart. Two of the infants had an additional sample assayed withou t contemporaneous maternal samples examined. Drug assay was by high-pe rformance liquid chromatography. Limit of reproducible quantifiability was 2 ng/mL, and limit of detectability was 1 ng/mL. Results: Materna l sertraline dose ranged from 50 to 100 mg/day. All infant plasma samp les showed low levels (< 2 ng/mL) of either sertraline and norsertrali ne or norsertraline alone. Breastfeeding was continued, and the infant s have shown no adverse effects on short-term follow-up. Conclusion: T hese data suggest that sertraline and/or its almost inactive metabolit e may be present at very low concentrations in the plasma of breastfed infants. No adverse effects were noted in the infants. Limitations of the findings and possible implications for the use of sertraline duri ng breastfeeding are discussed.