Last update April 16, 2015

Mirtazapine

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Excreted into breast milk in a clinically non-significant amount.

Plasma level of breastfed infants from treated mothers with Mirtazapine are usually undetectable or very low.

Not significant clinically based side-effects in the infants both at short and long-term have been observed.

Isolated cases of galactorrhea have been reported.

The poor extrauterine adaptation that may appear in neonates just after birth when the pregnant woman has been treated with selective reuptake-inhibitors of Serotonin like Venlafaxine or Mirtazapine, is seen to be mild if the baby is breastfed.

Alternatives

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.

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.

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 50 %
Molecular weight 265 daltons
Protein Binding 85 %
Tmax 2 hours
T1/2 20 - 40 hours
M/P ratio 0.8 -
Theoretical Dose 0.005 - 0.02 mg/Kg/d
Relative Dose 0.6 - 5.3 %

References

  1. 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)
  2. Smit M, Wennink HJ, Heres MM, Dolman KK, Honig A. Mirtazapine in pregnancy and lactation: data from a case series. J Clin Psychopharmacol. 2015 Abstract
  3. Schroeder K, Huber CG, Jahn H. Mirtazapine-induced galactorrhea: a case report. J Neuropsychiatry Clin Neurosci. 2013 Abstract Full text (link to original source) Full text (in our servers)
  4. Kieviet N, Dolman KM, Honig A. The use of psychotropic medication during pregnancy: how about the newborn? Neuropsychiatr Dis Treat. 2013 Abstract Full text (link to original source) Full text (in our servers)
  5. AEMPS. Mirtazapina. Ficha técnica. 2013 Full text (in our servers)
  6. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  7. Pfizer. Mirtazapine. Product Monograph. 2012 Full text (in our servers)
  8. Patil AS, Kuller JA, Rhee EH. Antidepressants in pregnancy: a review of commonly prescribed medications. Obstet Gynecol Surv. 2011 Abstract
  9. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Abstract Full text (link to original source) Full text (in our servers)
  10. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  11. 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
  12. Tonn P, Reuter SC, Hiemke C, Dahmen N. High mirtazapine plasma levels in infant after breast feeding: case report and review of the literature. J Clin Psychopharmacol. 2009 Abstract
  13. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  14. 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)
  15. Kristensen JH, Ilett KF, Rampono J, Kohan R, Hackett LP. Transfer of the antidepressant mirtazapine into breast milk. Br J Clin Pharmacol. 2007 Abstract Full text (link to original source) Full text (in our servers)
  16. Klier CM, Mossaheb N, Lee A, Zernig G. Mirtazapine and breastfeeding: maternal and infant plasma levels. Am J Psychiatry. 2007 Abstract Full text (link to original source) Full text (in our servers)
  17. Gentile S. The safety of newer antidepressants in pregnancy and breastfeeding. Drug Saf. 2005 Abstract
  18. Aichhorn W, Whitworth AB, Weiss U, Stuppaeck C. Mirtazapine and breast-feeding. Am J Psychiatry. 2004 Abstract Full text (link to original source) Full text (in our servers)
  19. Schüle C, Baghai T, Bidlingmaier M, Strasburger C, Laakmann G. Endocrinological effects of mirtazapine in healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Abstract
  20. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Abstract

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