Last update June 10, 2018
A melatonin receptor agonist and serotonin antagonist. It increases the release of norepinephrine and dopamine in the frontal cortex (EMA 2017).
Indicated in episodes of major depression.
Administered orally once a day at bedtime for at least 6 months. Stopping the drug does not require a progressive decrease in the dose.
Its pharmacokinetic data (low oral bioavailability, high protein binding and short life) explain the very small transfer to milk observed.
In a mother who took 25 mg daily, milk concentration reached 2 micrograms (mcg)/L 2 hours after taking it and was undetectable (<0.1 mcg/L) after 4 hours (Schmidt 2013).
You can minimize the risk even more, by waiting for at least 4 hours to breastfeed.
Side effects are usually mild or moderate, although hepatic damage has been reported in 4% of users, leading it to be withdrawn from sale in several countries (Carvalho 2016).
Its dopaminergic effect is anti-prolactin (dopamine inhibits prolactin secretion) and may decrease milk production during the first weeks after delivery. When breastfeeding is well established, prolactin levels are not correlated with milk production.
If you cannot use one of the proposed alternatives, milk production must be monitored.
Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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.
e-lactancia is a resource recommended by Confederación Nacional de Pediatría (CONAPEME) of Mexico
Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM