QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Google Scholar Articles by Briggs, G. G Articles by Padilla, G. PubMed PubMed Citation Articles by Briggs, G. G Articles by Padilla, G.

Use of Duloxetine in Pregnancy and Lactation

Pharmacist Clinical Specialist, Perinatal Support Service, MemorialCare Center for Women, Miller Children's Hospital, Long Beach Memorial Medical Center, Long Beach, CA

Peter J Ambrose, PharmD

Professor of Clinical Pharmacy, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco

Kenneth F Ilett, BPharm PhD

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

L Peter Hackett, MRSC

Scientist in Charge, Research, Clinical Pharmacology and Toxicology Laboratory, Path West Laboratory Medicine, Queen Elizabeth Medical Centre, Nedlands, Australia

Michael P Nageotte, MD

Perinatologist, Associate Chief Medical Officer, MemorialCare Center for Women, Miller Children's Hospital, Long Beach Memorial Medical Center

Guadalupe Padilla, MD

Neonatologist, Miller Children's Hospital, Long Beach Memorial Medical Center

Reprints: Mr. Briggs, MemorialCare Center for Women, Miller Children's Hospital, Long Beach Memorial Medical Center, 2801 Atlantic Ave., Long Beach, CA 90806, fax 562/933-2759, jbriggs{at}memorialcare.org

OBJECTIVE: To report a case of a woman who used duloxetine during pregnancy and breast-feeding.

CASE SUMMARY: A 29-year-old woman was treated with duloxetine for depression during the second half of an uncomplicated gestation. She gave birth at term to a healthy female infant. A cord blood sample was obtained at birth. The mother continued the antidepressant while exclusively breast-feeding her infant. One month later, we collected blood and milk samples from the mother and a single blood sample from the infant. All samples were analyzed for the presence and concentrations of duloxetine.

DISCUSSION: Duloxetine crosses the placenta at term and is excreted into breast milk. No evidence of developmental or other type of toxicity was observed in the infant at birth or during the first 32 days after birth. The published literature detailing human pregnancy experience with this antidepressant is limited to 11 cases in which women became pregnant while taking duloxetine. In 10 cases, the drug was discontinued when pregnancy was diagnosed and no outcome data were reported. In the eleventh case, an infant exposed to duloxetine 90 mg/day developed neonatal behavioral syndrome. One study examined the excretion of duloxetine into breast milk, but the mothers discontinued nursing for the study. In the present case, no adverse effects from exposure to the drug in milk were noted in the exclusively breast-fed infant. The possibility of functional/neurobehavioral deficits appearing later in life cannot be excluded because long-term follow-up has not been conducted in infants exposed to duloxetine in utero or during nursing.

CONCLUSIONS: No developmental toxicity or other signs of toxicity were observed in an infant exposed to duloxetine during the second half of gestation and during breast-feeding in the first 32 days after birth. However, the possibility of functional/neurobehavioral deficits appearing later in life cannot be excluded.

Key Words: breast-feeding, duloxetine, lactation, milk, pregnancy

Published Online, October 6, 2009. www.theannals.com, DOI 10.1345/aph.1M317