Antipsychotic use while breastfeeding

Consider the advice for antipsychotic use while breastfeeding in accordance with the Principles of psychotropic use while breastfeeding.

Data on antipsychotic use while breastfeeding are limited to case reports and about half of these concern olanzapine. At the time of writing, brexpiprazole, lurasidone, asenapine and cariprazineNaughton 2023LactMed 2006 have not been adequately studied; alternative antipsychotics would be preferred. Except for clozapine, other antipsychotics appear safe in breastfeeding, but should be used with caution. Avoid breastfeeding with clozapine; it achieves a high concentration in breastmilk and there is a theoretical risk of infant agranulocytosis. Advise the patient to stop breastfeeding and continue clozapine.

Olanzapine, quetiapine and ziprasidone have low infant doses relative to maternal weight-adjusted dose (relative infant dose). Moderate relative infant doses are described for aripiprazole, risperidone and paliperidone. Amisulpride has been associated with high relative infant doses. Adverse events have rarely been reported in infants.

Haloperidol, chlorpromazine and periciazine, especially at high dose, have occasionally been associated with adverse reactions in breastfed infants (eg urinary retention, dystonic reactions). Using a low dose (ie less than 10 mg haloperidol daily or equivalent), may decrease the risk of adverse reactions.

Reserve long-acting injectable antipsychotics for when there are no other treatment options—if the infant has an adverse reaction, advise the patient to stop breastfeeding.

For advice on antipsychotic use in females of childbearing potential, see here.