Management of depression in breastfeeding mothers – Are reboxetine, venlafaxine, duloxetine, mirtazapine, agomelatine and MAOIs safe?

· UKMi
  • Reboxetine, venlafaxine, duloxetine, mirtazapine, agomelatine and moclobemide are not considered first line antidepressants for use in breastfeeding mothers.
  • Because of the absence of data on use in lactation and their potential to cause serious interactions with some foods and drugs, first generation MAOIs should be avoided in lactation.
  • Limited data indicate that reboxetine, duloxetine and mirtazapine pass into milk in small amounts and estimated infant intake via milk has been calculated at values of up to 2% of the weight adjusted maternal dose. Values for venlafaxine are higher at 3.5 – 9.2%.
  • Venlafaxine via breast milk may attenuate neonatal withdrawal symptoms where the drug is used close to term.
  • Apart from two cases of reduced weight gain with venlafaxine, no adverse effects have been reported for infants exposed to reboxetine, duloxetine, mirtazapine,moclobemide or agomelatine.