Are first-generation antipsychotics safe during breast feeding?

· West Midlands Medicines Information Service

  • Only limited data are available on the use of first-generation antipsychotic drugs (FGAs) during lactation.
  • Estimates of infant ingestion of FGAs via breast milk vary between 0.1% and 20.7% of the weight adjusted maternal dose.
  • When selecting a FGA for use in a breast feeding mother, a less sedating agent with a shorter half-life and data to support use in lactation is preferred.
  • Adverse reactions (drowsiness and sedation) in breast fed infants have been reported after exposure to chlorpromazine via breast milk.
  • Adverse effects on infant development have been seen only when chlorpromazine was used in combination with haloperidol
  • 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 FGAs via breast milk.
  • Infants exposed to FGAs via breast milk should be monitored for sedation, poor feeding, behavioural effects, extrapyramidal symptoms and achievement of developmental milestones
ChlorpromazineFlupentixolHaloperidolMental health and illnessObstetrics and gynaecologyPaediatric and neonatal medicinePerphenazineQ&ASafety in LactationSulpirideTrifluoperazineZuclopenthixol