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Quetiapine and Breast Feeding

Consultant Psychiatrist, Department of Psychological Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia

Judith H Kristensen, BPharm

Senior Pharmacist, Department of Pharmacy, King Edward Memorial Hospital for Women

Kenneth F Ilett, PhD

Emeritus Professor of Pharmacology, Pharmacology and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia

L Peter Hackett, MRSC

Research Scientist, Clinical Pharmacology and Toxicology Laboratory, PathWest Laboratory Medicine, Nedlands, Western Australia

Rolland Kohan, FRACP

Neonatologist, Department of Neonatal Services, King Edward Memorial Hospital for Women

Reprints: Dr. Ilett, Pharmacology and Anaesthesiology Unit, M510, School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy., Crawley, Western Australia 6009, fax 618 9346 3469, Ken.Ilett{at}uwa.edu.au

OBJECTIVE: To quantify the relative infant dose of quetiapine during breast feeding, describe the milk:plasma (M:P) ratio, and determine the well-being of the exposed infant.

CASE SUMMARY: A 26-year-old mother and her 3-month-old son were studied over a 24 hour quetiapine dose interval at steady-state. Quetiapine concentrations were quantified by high-performance liquid chromatography. Infant exposure was calculated as the concentration in milk multiplied by an estimated milk production of 0.15 L/kg/day and normalized to the weight-adjusted maternal dose. The average concentration in milk was 41 µg/L, the M:P ratio (measured using average concentrations in the elimination phase) was 0.29, and the relative infant dose was 0.09% of the maternal weight-adjusted dose (7273 µg/kg/day). The infant plasma concentration of 1.4 µg/L was some 6% of the corresponding maternal plasma concentration. No adverse effects were noted in the infant.

DISCUSSION: Our findings of an infant exposure to quetiapine of less than 0.1% of the maternal dose and a lack of adverse effects confirm and extend the findings of 2 previous studies.

CONCLUSIONS: Although limited, the data shown here support the prescription of quetiapine to a breast-feeding mother following a careful individual risk/benefit analysis. We suggest regular monitoring of infant progress and occasional measurement of quetiapine in the infant's plasma.

Key Words: breast feeding, human milk, infant dose, lactation, quetiapine

Published Online, March 20, 2007. www.theannals.com, DOI 10.1345/aph.1H555