From the Guidelines
Prozac (fluoxetine) is generally considered safe during breastfeeding, though it should be used with appropriate caution. Most experts agree that the benefits of treating maternal depression often outweigh the potential risks to the breastfed infant. The amount of fluoxetine that passes into breast milk is relatively small, with infants typically receiving less than 10% of the maternal dose adjusted for weight, as indicated by the relative infant dose concept 1.
Key Considerations
- When used during breastfeeding, it's best to take Prozac immediately after nursing to minimize the concentration in milk at the next feeding.
- Mothers should monitor their infants for potential side effects such as irritability, poor feeding, or sleep disturbances, though these are uncommon, as reported in studies 1.
- Prozac has a long half-life and active metabolites, so it may accumulate in an infant's system over time.
- For this reason, some providers prefer shorter-acting SSRIs like sertraline (Zoloft) for breastfeeding mothers, especially with premature or newborn infants.
- However, if Prozac has worked well for the mother previously, continuing it during breastfeeding is often reasonable rather than switching medications, considering the marginally superior remission rate of SNRIs over SSRIs in patients with major depressive disorder 1.
Decision Making
As with any medication during breastfeeding, the decision should be made in consultation with healthcare providers who can assess the individual situation, taking into account the potential benefits and risks, including the adverse effects associated with antidepressant medications 1. The choice of medication should be based on the best available evidence, with consideration of the patient's specific needs and medical history.
From the FDA Drug Label
Nursing MothersBecause Prozac is excreted in human milk, nursing while on Prozac is not recommended. In one breast–milk sample, the concentration of fluoxetine plus norfluoxetine was 70.4 ng/mL. The concentration in the mother’s plasma was 295. 0 ng/mL. No adverse effects on the infant were reported. In another case, an infant nursed by a mother on Prozac developed crying, sleep disturbance, vomiting, and watery stools. The infant’s plasma drug levels were 340 ng/mL of fluoxetine and 208 ng/mL of norfluoxetine on the second day of feeding
- Key points:
- Prozac is excreted in human milk
- Nursing while on Prozac is not recommended due to potential adverse effects on the infant
- Adverse effects reported in an infant include crying, sleep disturbance, vomiting, and watery stools
- Clinical decision: Based on the information provided, it is not safe to use Prozac while breastfeeding due to the potential risk of adverse effects on the infant 2.
From the Research
Safety of Prozac in Breastfeeding
- The use of Prozac (fluoxetine) during breastfeeding has been studied, and the results suggest that it is generally considered safe, but with some precautions 3, 4, 5.
- Prozac is a selective serotonin reuptake inhibitor (SSRI) that is secreted in breast milk, but the levels are typically low to very low 3, 5.
- Some studies have reported suspected adverse effects in infants exposed to Prozac through breast milk, particularly when compared to other SSRIs like sertraline and paroxetine 3, 4.
- However, the benefits of breastfeeding are considered to outweigh the potential risks associated with Prozac use, and mothers should not be advised to discontinue breastfeeding solely due to Prozac use 3, 5.
- An individual risk-benefit assessment should always be performed, taking into account the specific properties of the medication, such as the relative infant dose and side effect profile 5.
Comparison to Other SSRIs
- Sertraline and paroxetine are considered preferred agents for use during breastfeeding due to their low levels in breast milk and relatively safe profiles 3, 5, 6.
- Fluoxetine (Prozac) and citalopram have been reported to have higher levels in breast milk, but are still considered relatively safe when used during breastfeeding 3, 4, 5.
- The choice of SSRI should be based on the individual patient's needs and medical history, as well as the potential risks and benefits associated with each medication 5, 6, 7.