- Only limited data are available on the use of second-generation antipsychotics (SGAs) during lactation.
- Estimates of infant ingestion of SGAs via breast milk vary between 0.09% and 10.7% of the weight adjusted maternal dose.
- Mothers receiving therapy with clozapine should not breastfeed.
- Adverse reactions in breast fed infants have been reported after exposure to clozapine and olanzapine via breast milk. Sedation has been noted only when the mother was receiving co-therapy with benzodiazepines and some antidepressants.
- Infants exposed to SGAs via breast milk should be monitored for sedation, poor feeding, behavioural effects, extrapyramidal symptoms and achievement of developmental milestones.
- Combined use with other sedating agents is best avoided as this increases the risks of drowsiness and poor feeding in the infant.
- Premature infants should not be exposed to antipsychotic medication via breast milk.
Acting Co-Director, West Midlands Medicines Information Service & UK Drugs in Lactation Advisory Service