From the FDA Drug Label
Olanzapine is present in human milk. There are reports of excess sedation, irritability, poor feeding and extrapyramidal symptoms (tremors and abnormal muscle movements) in infants exposed to olanzapine through breast milk The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZYPREXA and any potential adverse effects on the breastfed child from ZYPREXA or from the mother’s underlying condition Infants exposed to ZYPREXA should be monitored for excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements)
Olanzapine and Breastfeeding: Olanzapine is present in human milk and may cause adverse effects in infants, including excess sedation, irritability, poor feeding, and extrapyramidal symptoms.
- Key Considerations:
- Monitor infants for adverse effects
- Weigh the benefits of breastfeeding against the potential risks to the infant
- Consider the mother's clinical need for olanzapine 1
From the Research
Olanzapine is generally considered compatible with breastfeeding, and mothers taking olanzapine can usually continue breastfeeding their infants, as only small amounts of the medication pass into breast milk. The relative infant dose is estimated to be about 1-4% of the mother's weight-adjusted dose, which is below the 10% level of concern 2. Most studies have not shown adverse effects in breastfed infants whose mothers were taking therapeutic doses of olanzapine 3, 4. However, mothers should monitor their infants for excessive drowsiness, poor feeding, or developmental delays. The benefits of breastfeeding typically outweigh the minimal risks associated with olanzapine exposure through breast milk. If a mother needs to take olanzapine for her mental health condition such as bipolar disorder or schizophrenia, maintaining her stability is important for both her wellbeing and her ability to care for her infant. For mothers on higher doses (above 10mg daily), additional monitoring of the infant may be warranted. It's always best to take olanzapine at bedtime after the last feeding of the day to minimize infant exposure.
Some key points to consider:
- The frequency of fetal outcomes in pregnancies exposed to olanzapine did not differ from rates of outcomes reported in the general population 3
- Olanzapine was not detected in the plasma of infants whose mothers were taking the medication 2
- A withdrawal syndrome was seen in 10% of infants exposed to olanzapine in utero 4
- Long-acting olanzapine injection during pregnancy and breastfeeding has been reported in a case study, with no adverse effects on the breast-fed infant 5
In terms of safety concerns, olanzapine is cited as safe for breastfeeding, although monitoring is recommended 6. Overall, the available evidence suggests that olanzapine can be used during breastfeeding, but mothers should be closely monitored and the decision to breastfeed should be made after individual risk-benefit analysis.