Flupenthixol is not approved for marketing in the United States by the US Food and Drug Administration, but is available in Canada and other countries. Limited information indicates that maternal oral doses of up to 4 mg daily or depot injections of 40 mg every 2 weeks produce low levels in milk and breastfed infants' serum, and cause no adverse developmental consequences. Until more data are available, flupenthixol should be used with careful monitoring during breastfeeding.
Three women received flupenthixol during pregnancy and nursing; 2 of the women were receiving a depot injection. Milk flupenthixol concentrations on days 4 and 41 postpartum from the woman receiving 40 mg every 2 weeks were 0.8 and 1.8 mcg/L, respectively. Milk flupenthixol concentrations on day 17 postpartum from the woman receiving 60 mg every 3 weeks was 1.8 mcg/L. In the mother taking 2 mg of flupenthixol orally every day, a milk concentration on day 30 postpartum was 1.8 mcg/L; however, the collection time was not stated.
One woman received flupenthixol during pregnancy and postpartum. She took a daily oral dose of 1 mg of flupenthixol during pregnancy and 4 mg daily starting on the first day postpartum. Milk samples were taken 7 times over 36 hours on days 6 and 7 postpartum. The highest milk flupenthixol level of 6.8 mcg/L occurred 4.5 hours after the dose, and the average of the milk levels was 2.8 mcg/L. Milk flupenthixol levels measured on day 20 postpartum at 2 hours after the dose averaged 2.2 mcg/L with a maternal dose of 3 mg daily. On day 48 postpartum, flupenthixol was undetectable (<2 mcg/L) in milk 3.5 hours after a maternal dosage of 2 mg daily. Milk levels taken after feeding were much higher than those taken before feeding, probably because of higher concentrations in the more fat-rich hindmilk. The authors estimated that an exclusively breastfed infant would receive 0.4 mcg/kg daily or 0.6% of the maternal weight-adjusted dosage.
A woman took flupenthixol 1 mg and nortriptyline 100 mg daily during pregnancy and flupenthixol 4 mg and nortriptyline 125 mg daily immediately postpartum. Her exclusively breastfed infant had flupenthixol serum concentrations of <0.2 mcg/l="" and="">0.2><0.3 mcg/l="" on="" days="" 6="" and="" 7="" postpartum,="">0.3>
Effects in Breastfed Infants:
A woman took flupenthixol 1 mg and nortriptyline 100 mg daily during pregnancy and flupenthixol 4 mg and nortriptyline 125 mg daily immediately postpartum. She exclusively breastfed her infant. Over a 4-month period, the infant showed no signs of adverse drug effects and had normal motor development with a maternal dosage of flupenthixol 2 mg daily and nortriptyline 75 mg daily.
Possible Effects on Lactation:
Flupenthixol can increase serum prolactin and has caused galactorrrhea. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
1. Kirk L, Jorgensen A. Concentrations of cis(Z)-flupentixol in maternal serum, amniotic fluid, umbilical cord serum, and milk. Psychopharmacology (Berl). 1980;72:107-8. PMID:6781000 2. Matheson I, Skjaeraasen J. Milk concentrations of flupenthixol, nortriptyline and zuclopenthixol and between-breast differences in two patients. Eur J Clin Pharmacol. 1988;35:217-20. PMID:3191943 3. Trimble MR, Robertson MM. Flupenthixol in depression. A study of serum levels and prolactin response. J Affect Disord. 1983;5:81-9. PMID:6220047 4. Bostwick JR, Guthrie SK, Ellingrod VL. Antipsychotic-induced hyperprolactinemia. Pharmacotherapy. 2009;29:64-73. PMID:19113797 5. Jorgensen A , Andersen J, Bjorndal N, Dencker SJ, Lundin L, Malm U. Serum concentrations of cis(Z)-flupentixol and prolactin in chronic schizophrenic patients treated with flupentixol and cis(Z)-flupentixol decanoate. Psychopharmacology (Berl). 1982;77:58-65. PMID:6812119 6. Kropp S, Ziegenbein M, Grohmann R et al. Galactorrhea due to psychotropic drugs. Pharmacopsychiatry. 2004;37 (Suppl 1):S84-8. PMID:15052519
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