Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Drugline nr 19295

Publicerat 2002-09-26

Question

Is imipramine compatible with breast-feeding?

Answer

Imipramine and its pharmacologically active metabolite desipramine are excreted into breast milk at low concentrations (1-2). In two reports, including a total of 5 women treated with imipramine (75-200 mg/day) during breast-feeding, the infant daily dose (imipramine and desipramine) has been calculated to be 0.3-7% of the maternal weight-related dosage (1-2). In four of these five cases, the amount of active drug in breast milk ingested by the infant did correspond to 0.3-2% of the maternal weight-related daily dosage, while the concentration of imipramine in the breast milk was higher in the fifth woman. Drug concentrations in plasma of three infants corresponded to about 2% of the concentration in maternal plasma (1-2). No drug-related effects were noted in the breast-fed infants. In a case report on desipramine (300 mg/day) and breast-feeding, desipramine and its metabolite 2-hydroxydesipramine were measured in the milk of a nursing mother and in the plasma of the mother and infant (3). The infant daily dose (desipramine and 2-hydroxydesipramine) was calculated to be 2.4% of the maternal weight-related dosage. Neither parent compound nor metabolite could be detected in the infant's serum even though the measurements were made shortly after peak ingestion by the infant. No drug-related effects were noted in the breast-fed infant after 3 weeks of on-going treatment of the mother with desipramine.

Since the infant's dose of imipramine and its metabolites in breast milk is low and the drug has a large apparent volume of distribution (21 L/kg) and undergoes extensive first pass metabolism after oral administration (4), the amount of drug entering the systemic circulation of the infant would be very low. This is confirmed by the very low levels of drug detected in the plasma of infants to nursing mothers treated with imipramine.

Conclusion

Imipramine and its pharmacologically active metabolite desipramine are excreted into breast milk at low concentrations. No negative drug-related effects were noted in five infants breast-fed by mothers treated with imipramine. Based on present data, the advantages of breast-feeding seem to outweigh any putative adverse drug effects in infants to nursing mothers treated with imipramine at recommended dosages.

Annas A
Elwin CE

References

  1. Sovner R, Orsulak PJ. Excretion of imipramine and desipramine in human breast milk. Am J Psychiatry 1979;136:451-2.
  2. Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics and of possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. J Affect Disord 1997;43:225-37.
  3. Stancer HC, Reed KL. Desipramine and 2-hydroxydesipramine in human breast milk and the nursing infant's serum. Am J Psychiatry 1986;143:1597-1600.
  4. Dollery C Sir, editor. Therapeutic drugs. 2nd ed. Edinburgh: Churchill Livingstone; 1999

Senast ändrad 2018-09-20