Mammen O K, Perel J M, Rudolph G, Foglia J P, Wheeler S B
Department of Psychiatry, University of Pittsburgh, Pa., USA.
J Clin Psychiatry. 1997 Mar;58(3):100-3. doi: 10.4088/jcp.v58n0302.
In assessing the safety of medication use in breastfeeding, it is important to know whether the drug used by the mother will be present in the breastfed infant. Compared with data for tricyclic antidepressants (TCAs), which have generally not been found in the plasma of breastfed infants, there are few data on the use of serotonin selective reuptake inhibitors (SSRIs) in breastfeeding. This poses a dilemma for breastfeeding women and their treating clinicians, because of the enhanced tolerability of SSRIs compared with TCAs, and because some patients do not respond well to TCAs.
Sertraline and norsertraline plasma concentrations were measured in three breastfeeding mother-infant pairs. Maternal and infant plasma samples were drawn a few minutes apart. Two of the infants had an additional sample assayed without contemporaneous maternal samples examined. Drug assay was by high-performance liquid chromatography. Limit of reproducible quantifiability was 2 ng/mL, and limit of detectability was 1 ng/mL.
Maternal sertraline dose ranged from 50 to 100 mg/day. All infant plasma samples showed low levels (< 2 ng/mL) of either sertraline and norsertraline or norsertraline alone. Breastfeeding was continued, and the infants have shown no adverse effects on short-term follow-up.
These data suggest that sertraline and/or its almost inactive metabolite may be present at very low concentrations in the plasma of breastfed infants. No adverse effects were noted in the infants. Limitations of the findings and possible implications for the use of sertraline during breastfeeding are discussed.
在评估母乳喂养期间用药的安全性时，了解母亲所使用的药物是否会出现在母乳喂养的婴儿体内至关重要。与三环类抗抑郁药（TCA）的数据相比，母乳喂养婴儿的血浆中一般未发现此类药物，而关于5-羟色胺再摄取抑制剂（SSRI）在母乳喂养中的使用数据较少。这给母乳喂养的女性及其治疗临床医生带来了两难境地，因为与TCA相比，SSRI的耐受性更强，且一些患者对TCA反应不佳。
测量了三对母乳喂养的母婴对中舍曲林和去甲舍曲林的血浆浓度。母婴血浆样本相隔几分钟采集。其中两名婴儿的另一份样本进行了检测，未同时检测母亲样本。药物检测采用高效液相色谱法。可重复定量的限度为2 ng/mL，可检测限度为1 ng/mL。
母亲舍曲林剂量范围为50至100 mg/天。所有婴儿血浆样本中舍曲林和去甲舍曲林或单独去甲舍曲林的水平均较低（<2 ng/mL）。继续进行母乳喂养，婴儿在短期随访中未出现不良反应。
这些数据表明，舍曲林和/或其几乎无活性的代谢产物可能以极低浓度存在于母乳喂养婴儿的血浆中。婴儿未出现不良反应。讨论了研究结果的局限性以及母乳喂养期间使用舍曲林的可能影响。
