A recent analysis of all the published data on antidepressants used in breastfeeding mothers suggests that the transfer of fluoxetine is the highest and citalopram is next highest of this family. Fluoxetine produces the highest proportion (22%) of infant levels that are elevated above 10% of the average maternal level. Based on smaller numbers, the data on citalopram indicate that it produces elevated levels in 17% of infants.

They concluded that Nortriptyline, paroxetine, and sertraline may be preferred choices in breast-feeding women. Minimizing the maternal dose may be helpful with citalopram.(1)

A new case of fluoxetine toxicity has been reported in a preterm infant. They describe a preterm infant with marked motor automatism and skin manifestations after being exposed to fluoxetine in utero. The fluoxetine level drawn at 96 hours of age was 92 ng/ml, which was in adult therapeutic range. The neurologic symptoms resolved by 7 days and follow-up at 4 months revealed normal neurodevelopmental examination.(2)

I've received a number of queries around the world about Ultravist (iopromide) Its just another of the hundreds of ?iodinated? radiocontrast agents used from CT scans. Its initial phase half-life is 0.24 hours, and its terminal phase half-life is about 2 hours. As with all the other radiocontrast agents, Ultravist levels in milk are unknown, but are likely to be extremely low and virtually non-bioavailable orally in the infant.

I've recently come across some old data on prostaglandin E2 suggesting that in some patients it could suppress milk production. In two papers, it was suggested that prostaglandin E2 given orally for several days significantly suppressed milk production. One other paper found no change. At this time, some caution is recommended in exposing breastfeeding mothers to prolonged oral ingestion of prostaglandin E2. The acute use for cervical ripening used in thousands of deliveries, is unlikely to be a problem.(3-5)

Neonatal Withdrawal Syndrome: For a good review of neonatal withdrawal syndrome from Selective Serotonin Reuptake inhibitors used in pregnant women, see the review by Nordeng et.al. They conclude: Neonatal withdrawal syndrome can occur after third trimester in utero SSRI exposure. Further research should focus on whether it is safe to use SSRIs during the last trimester. All neonates exposed to SSRIs during the last trimester should be followed-up closely for withdrawal symptoms after birth.(6)