Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Fluoxetin

Klassificering: 2

Preparat: Fluoxetin BMM Pharma, Fluoxetin Ebb, Fluoxetin Mylan, Fluoxetin Orifarm, Fluoxetin ratiopharm, Fluoxetin Sandoz, Fluoxetin STADA®, Fluoxetin Teva, Fluoxetine Accord, Fluoxetine Orion, Fluoxetine Vitabalans, Fontex, Fontex®, Prozac

ATC kod: N06AB03

Substanser: fluoxetin, fluoxetinhydroklorid

Råd till allmänheten

Kontakta läkare för diskussion innan behandling påbörjas.

För hälso- och sjukvården

Rekommendation

Risken för ett friskt fullgånget barn anses vara låg vid terapeutiska doser.

Bakgrund

Passerar över till bröstmjölk i hög grad. Baserat på data från >110 kvinnor kan den relativa barndosen beräknas till max 10,5 % (1-14,20-23). Koncentrationer upp till 84 ng/mL för fluoxetin och 265 ng/mL för norfluoxetin har uppmätts hos 78 barn (1-3, 6-10, 13-16) Vid behandling av vuxna ses vanligen koncentrationer på 200-530 ng/mL (580-1530 nM) för fluoxetin och 100-460 ng/mL (290-1330 nM) för norfluoxetin. Inga negativa effekter har rapporterats hos 84 ammade barn (1-3, 5, 9-11, 15-16,20). Minskad viktuppgång har rapporterats hos 26 ammade barn (17) vilket motsägs av att ingen påverkan på viktuppgång kunde ses hos 29 ammade barn (18). Enstaka fall av kolik, hyperaktivitet, okontaktbarhet, irritabilitet, somnolens, matningssvårigheter, hyperglykemi och minskade serotoninnivåer i trombocyter (3, 8,12-15) har rapporterats hos ammade barn.

Uppdaterat: 2019-08-22

Referenser

Dokumentationsgrad: 2
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  8. Hale TW, Shum S, Grossberg M. Fluoxetine toxicity in a breastfed infant. Clin Pediatr (Phila) 2001;40(12):681-684. PubMed
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  12. Isenberg KE. Excretion of fluoxetine in human breast milk. J Clin Psychiatry 1990;51(4):169. PubMed
  13. Lester BM, Cucca J, Andreozzi L, Flanagan P, Oh W. Possible association between fluoxetine hydrochloride and colic in an infant. J Am Acad Child Adolesc Psychiatry 1993;32(6):1253-1255. PubMed
  14. Brent NB, Wisner KL. Fluoxetine and carbamazepine concentrations in a nursing mother/infant pair. Clin Pediatr (Phila) 1998;37(1):41-4. PubMed
  15. Epperson CN, Jatlow PI, Czarkowski K, Anderson GM. Maternal fluoxetine treatment in the postpartum period: effects on platelet serotonin and plasma drug levels in breastfeeding mother-infant pairs. Pediatrics 2003;112(5):e425. PubMed
  16. Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 1999;104(1):e11 PubMed
  17. Chambers CD, Anderson PO, Thomas RG, Dick LM, Felix RJ, Johnson KA et al. Weight gain in infants breastfed by mothers who take fluoxetine. Pediatrics 1999;104(5):e61. PubMed
  18. Hendrick V, Smith LM, Hwang S, Altshuler LL, Haynes D. Weight gain in breastfed infants of mothers taking antidepressant medications. J Clin Psychiatry 2003;64(4):410-412. PubMed
  19. Rohan A. Drug distribution in human milk. Australian Prescriber 1997;20(4).
  20. Pogliani L, Baldelli S, Cattaneo D, Pileri P, Clementi E, Cetin I et al. Selective serotonin reuptake inhibitors' passage into human milk of lactating women. J Matern Fetal Neonatal Med. 2018;1-6. PubMed
  21. Lopes BR, Cassiano NM, Carvalho DM, Moisés ECD, Cass QB. Simultaneous quantification of fluoxetine and norfluoxetine in colostrum and mature human milk using a 2-dimensional liquid chromatography-tandem mass spectrometry system. J Pharm Biomed Anal. 2018;150(0):362-367. PubMed
  22. Weisskopf E, Panchaud A, Nguyen KA, Grosjean D, Hascoët JM, Csajka C et al. Simultaneous determination of selective serotonin reuptake inhibitors and their main metabolites in human breast milk by liquid chromatography-electrospray mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2017;1057:101-109. PubMed
  23. Salazar FR, D'Avila FB, de Oliveira MH, Ferreira PL, Bergold AM. Development and validation of a bioanalytical method for five antidepressants in human milk by LC-MS. J Pharm Biomed Anal. 2016;129:502-508. PubMed

- Författat av Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.