Stowe Z N, Owens M J, Landry J C, Kilts C D, Ely T, Llewellyn A, Nemeroff C B
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
Am J Psychiatry. 1997 Sep;154(9):1255-60. doi: 10.1176/ajp.154.9.1255.
The purpose of this study was to determine the concentrations of sertraline and desmethylsertraline in both human breast milk and infant serum.
Breast milk samples from 12 women were collected at specific time intervals after oral doses of sertraline (25-200 mg once daily). For 11 mother-infant pairs, maternal serum levels 24 hours after a dose and their infants' serum levels 2-4 hours after nursing were ascertained by high-performance liquid chromatography.
Sertraline and desmethylsertraline were present in all breast milk samples, with a gradient from "fore" milk to "hind" milk. The highest concentrations of sertraline were observed in hind milk 7-10 hours after maternal dose. Increasing the maternal dose of sertraline resulted in increased breast milk concentrations of both sertraline and desmethylsertraline. Detectable concentrations of sertraline were found in three nursing infants and desmethylsertraline in six. No adverse effects of exposure were observed in any infant.
Sertraline and desmethylsertraline were present in the breast milk of nursing women treated with sertraline. Concentrations were affected by aliquot of milk sampled, time after maternal dose, and maternal daily dose. The infants' serum concentrations detected were below the detection limit of most commercial laboratories. The presence of desmethylsertraline in six infants' samples underscores the importance of metabolite monitoring in determining infant exposure. Estimates of daily infant exposure can be determined after analysis of sertraline and desmethylsertraline concentrations from one full breast at maternal serum steady state. Future studies of breast milk and infant serum samples should address these issues.
本研究旨在测定人母乳和婴儿血清中舍曲林及去甲基舍曲林的浓度。
对12名女性口服舍曲林（每日一次，25 - 200毫克）后，在特定时间间隔采集母乳样本。对于11对母婴，通过高效液相色谱法测定母亲服药24小时后的血清水平以及婴儿哺乳后2 - 4小时的血清水平。
所有母乳样本中均存在舍曲林和去甲基舍曲林，从“前奶”到“后奶”呈梯度变化。母亲服药后7 - 10小时，后奶中舍曲林浓度最高。增加母亲舍曲林剂量会导致母乳中舍曲林和去甲基舍曲林浓度均升高。在三名哺乳婴儿的血清中检测到了可检测浓度的舍曲林，六名婴儿中检测到了去甲基舍曲林。未观察到任何婴儿有暴露的不良反应。
接受舍曲林治疗的哺乳期妇女的母乳中存在舍曲林和去甲基舍曲林。浓度受所采母乳样本部分、母亲服药后时间以及母亲每日剂量的影响。检测到的婴儿血清浓度低于大多数商业实验室的检测限。六名婴儿样本中存在去甲基舍曲林凸显了代谢物监测在确定婴儿暴露情况方面的重要性。在母亲血清达到稳态时，分析一侧乳房完整乳汁中的舍曲林和去甲基舍曲林浓度后，可确定婴儿每日暴露量的估计值。未来关于母乳和婴儿血清样本的研究应解决这些问题。
