Last update: Jan. 29, 2017

Amitriptyline

Very Low Risk for breastfeeding


Safe. Compatible.
Not risky for breastfeeding or infant.

It is excreted into breastmilk in a clinically non-significant amount (Bader 1980, Brixen 1982, Pittard 1986, Breyer 1995, Yoshida 1999).

Plasma levels in the infant have been found undetectable (Ericsson 1979, Bader 1980, Brixen 1982, Breyer 1995) or very low (Yoshida 1997) and no side effects being observed even at maternal doses as high as 150-175 mg / day (Brixen 1982 , Misri 1991, Yoshida 1999, Nulman 2002).
However, one published case of sedation on a 15-day-old infant that occured within few days after taken just 10 mg daily of amitriptyline by her mother because of insomnia and anxiety (Oguz 2016). Levels were not measured in either milk or plasma of the infant and the mother.

Amitriptyline may produce galactorrhoea by prolactin stimulation.

Alternatives

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Amitriptyline is also known as


Amitriptyline in other languages or writings:

Group

Amitriptyline belongs to this group or family:

Tradenames

Main tradenames from several countries containing Amitriptyline in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 100 %
Molecular weight 314 daltons
Protein Binding 95 %
VD 6 - 10 l/Kg
Tmax 4 hours
T1/2 31 - 46 hours
M/P ratio 1 - 1,7 -
Theoretical Dose 0,02 mg/Kg/d
Relative Dose 4 %
Relat.Ped.Dose 1,3 - 2 %

References

  1. Uguz F. Poor Feeding and Severe Sedation in a Newborn Nursed by a Mother on a Low Dose of Amitriptyline. Breastfeed Med. 2016 Abstract
  2. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  3. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  4. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract Full text (in our servers)
  5. Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012 Abstract Full text (link to original source) Full text (in our servers)
  6. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group.. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract
  7. Nielsen RE, Damkier P. Pharmacological treatment of unipolar depression during pregnancy and breast-feeding--a clinical overview. Nord J Psychiatry. 2012 Abstract
  8. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  9. Hale TW, Kendall-Tackett K, Cong Z, Votta R, McCurdy F. Discontinuation syndrome in newborns whose mothers took antidepressants while pregnant or breastfeeding. Breastfeed Med. 2010 Abstract
  10. Acedo-Valenzuela MI, Mora-Díez N, Galeano-Díaz T, Silva-Rodríguez A. Determination of tricyclic antidepressants in human breast milk by capillary electrophoresis. Anal Sci. 2010 Abstract Full text (in our servers)
  11. Cassina M, Di Gianantonio E, Toldo I, Battistella PA, Clementi M. Migraine therapy during pregnancy and lactation. Expert Opin Drug Saf. 2010 Nov;9(6):937-48. Abstract
  12. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  13. Mahadevan U, Kane S. American gastroenterological association institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006 Jul;131(1):283-311. Review. Abstract Full text (link to original source) Full text (in our servers)
  14. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Abstract Full text (link to original source) Full text (in our servers)
  15. Hostetter AL, Stowe ZN, Cox M, Ritchie JC. A novel system for the determination of antidepressant concentrations in human breast milk. Ther Drug Monit. 2004 Abstract
  16. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8. Abstract
  17. Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Abstract Full text (link to original source) Full text (in our servers)
  18. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  19. Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002 Abstract
  20. Egberts AC, Meyboom RH, De Koning FH, Bakker A, Leufkens HG. Non-puerperal lactation associated with antidepressant drug use. Br J Clin Pharmacol. 1997 Abstract Full text (link to original source) Full text (in our servers)
  21. Håberg M, Matheson I. [Antidepressive agents and breast feeding]. Tidsskr Nor Laegeforen. 1997 Abstract
  22. Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics and of possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. J Affect Disord. 1997 Abstract
  23. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7. Review. Abstract
  24. Breyer-Pfaff U, Nill K, Entenmann KN, Gaertner HJ. Secretion of amitriptyline and metabolites into breast milk. Am J Psychiatry. 1995 Abstract
  25. Pons G, Rey E, Matheson I. Excretion of psychoactive drugs into breast milk. Pharmacokinetic principles and recommendations. Clin Pharmacokinet. 1994 Abstract
  26. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991 Abstract
  27. Pittard WB 3rd, O'Neal W Jr. Amitriptyline excretion in human milk. J Clin Psychopharmacol. 1986 Abstract
  28. Brixen-Rasmussen L, Halgrener J, Jørgensen A. Amitriptyline and nortriptyline excretion in human breast milk. Psychopharmacology (Berl). 1982 Abstract
  29. Bader TF, Newman K. Amitriptyline in human breast milk and the nursing infant's serum. Am J Psychiatry. 1980 Abstract
  30. Erickson SH, Smith GH, Heidrich F. Tricyclics and breast feeding. Am J Psychiatry. 1979 Abstract
  31. Turkington RW. Prolactin secretion in patients treated with various drugs: phenothiazines, tricyclic antidepressants, reserpine, and methyldopa. Arch Intern Med. 1972 Abstract

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