Safety in Lactation: Antipsychotics

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

Oral and non-depot antipsychotics with less sedating properties and a short half-life are preferred for use during breast feeding.

There is very limited information available on the use of depot antipsychotic injections during breastfeeding; the majority of available information relates to oral antipsychotics. Depot antipsychotic injections will result in constant plasma, and therefore breast milk levels in the mother. If the infant experiences adverse effects breastfeeding must be withheld as therapeutic levels are maintained in the mother for up to several weeks following injection.

Choice of antipsychotic should be based primarily on suitability for the patient rather than safety in breastfeeding. There is limited data on the neurodevelopmental effects of long-term exposure to antipsychotics during breastfeeding. Combinations of antipsychotic agents can negatively affect development.

Infants should be monitored for sedation, poor feeding, behavioural effects, extrapyramidal symptoms, and developmental milestones, especially if other antipsychotics are used concurrently.

Haloperidol is the preferred choice first-generation antipsychotic because of its more favourable side effect profile in general use.

Quetiapine is the preferred choice second-generation antipsychotic.