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.
- Yes, fluoxetine (Prozac) is present in breast milk, with a reported concentration of 70.4 ng/mL in one breast-milk sample 1.
- The presence of fluoxetine in breast milk may pose a risk to the infant, as evidenced by a case where an infant developed adverse effects, including crying, sleep disturbance, vomiting, and watery stools, while being nursed by a mother on Prozac 1.
From the Research
Prozac (fluoxetine) does pass into breast milk, with infants typically receiving about 10% of the mother's weight-adjusted dose. Despite this transfer, most experts consider Prozac compatible with breastfeeding for most women, as the benefits of treating the mother's depression or anxiety often outweigh the potential minimal risks to the breastfed infant 2, 3, 4, 5, 6. The American Academy of Pediatrics classifies it as usually compatible with breastfeeding.
Key Considerations
- Mothers taking Prozac while breastfeeding should monitor their infants for irritability, poor feeding, or sleep disturbances, though these effects are uncommon.
- Premature infants or those with liver problems may be more sensitive to the medication.
- For mothers concerned about medication exposure, taking the dose immediately after breastfeeding and waiting 4-6 hours before the next feeding can minimize the amount in milk, though this timing strategy isn't usually necessary for Prozac.
- The long half-life of fluoxetine and its active metabolite norfluoxetine, which ranges from 4-6 days and 4-16 days, respectively, allows for once-weekly dosing in some cases, but this does not directly impact the amount of medication transferred to the infant through breast milk 5.
Clinical Implications
- The decision to use Prozac during breastfeeding should be made on a case-by-case basis, considering the mother's mental health needs and the potential risks to the infant.
- Healthcare providers should counsel mothers on the potential risks and benefits of taking Prozac while breastfeeding and monitor the infant for any adverse effects.
- The majority of the evidence suggests that Prozac is safe for use during breastfeeding, but it is essential to prioritize the mother's mental health and the infant's well-being 2, 3, 4, 5, 6.