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