Is it safe to breastfeed while taking Prozac (fluoxetine)?

From the Guidelines

Breastfeeding while taking Prozac (fluoxetine) is generally considered acceptable for most mothers, as the benefits of treating maternal depression often outweigh the minimal risks to the infant. The American Academy of Pediatrics classifies fluoxetine as usually compatible with breastfeeding 1. While small amounts of the medication do pass into breast milk, studies have shown that most infants receive less than 10% of the weight-adjusted maternal dose, and this exposure rarely causes noticeable side effects in babies. However, every situation is unique, and the decision should be made in consultation with both your obstetrician and psychiatrist. They will consider factors such as your specific dosage (typically 20-80 mg daily for adults), the age and health of your infant, and the importance of the medication for your mental health. Some infants, particularly premature babies or those with liver problems, may need closer monitoring. Watch for potential side effects in your baby such as irritability, poor feeding, or sleep disturbances, though these are uncommon. According to a study published in the American Family Physician, fluoxetine produces higher infant plasma concentrations compared to other antidepressants, but there is little evidence to support any causal link between antidepressant use in breastfeeding mothers and adverse effects in infants 1.

Key considerations for breastfeeding mothers taking Prozac include:

• Monitoring for potential side effects in the infant, such as irritability or poor feeding
• Considering the age and health of the infant, as well as the importance of the medication for the mother's mental health
• Consulting with both an obstetrician and psychiatrist to make an informed decision
• Being aware that the benefits of treating maternal depression often outweigh the minimal risks to the infant, as untreated depression can negatively impact both mother-infant bonding and child development.

From the FDA Drug Label

Nursing MothersBecause Prozac is excreted in human milk, nursing while on Prozac is not recommended.

• Breastfeeding is not recommended while taking Prozac, as the drug is excreted in human milk.
• There have been reports of adverse effects on infants nursed by mothers on Prozac, including crying, sleep disturbance, vomiting, and watery stools 2.

From the Research

Breastfeeding on Prozac

• The use of Prozac (fluoxetine) during breastfeeding has been studied in several research papers 3, 4, 5, 6, 7.
• According to a study published in 1998, fluoxetine and its metabolite norfluoxetine were detected in all samples of maternal plasma and breast milk, but the amounts in infants' plasma and urine were below the lower limit of detection 4.
• Another study published in 2008 found that fluoxetine concentrations are detectable in infants' sera, but the findings are not definitive due to the small sample size and uncontrolled nature of the studies 3.
• A 2011 review of antidepressant use during breastfeeding found that most newer antidepressants, including fluoxetine, produce low or undetectable plasma concentrations in nursing infants, but suspected adverse effects have been reported in a few infants 5.
• A study published in 2003 measured platelet serotonin levels in breastfeeding mother-infant pairs before and during maternal treatment with fluoxetine, and found that most infants experienced little to no change in platelet serotonin levels, but one infant had a substantial decline in platelet serotonin levels 6.
• A systematic review published in 2015 found that sertraline and paroxetine have a better neonatal safety profile during breastfeeding compared to other selective serotonin reuptake inhibitors (SSRIs), including fluoxetine 7.

Key Findings

• Fluoxetine is detectable in breast milk and infants' plasma, but the amounts are generally low 4, 5.
• The use of fluoxetine during breastfeeding may be associated with suspected adverse effects in some infants 5.
• Most infants do not experience significant changes in platelet serotonin levels while breastfeeding during maternal fluoxetine treatment 6.
• Sertraline and paroxetine are considered to be safer alternatives to fluoxetine during breastfeeding 7.