From the FDA Drug Label
Quetiapine was excreted into human milk. Because of the potential for serious adverse reactions in nursing infants from quetiapine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother’s health In published case reports, the level of quetiapine in breast milk ranged from undetectable to 170 μg/L. The estimated infant dose ranged from 0.09% to 0.43% of the weight-adjusted maternal dose.
Quetiapine use in breastfeeding is associated with a risk of serious adverse reactions in nursing infants. The drug is excreted into human milk, and the estimated infant dose can range from 0.09% to 0.43% of the weight-adjusted maternal dose.
- A decision should be made to either discontinue nursing or discontinue the drug, considering the importance of the drug to the mother's health 1.
- Due to the potential risks, a conservative approach would be to avoid quetiapine use in breastfeeding women, unless the benefits to the mother outweigh the potential risks to the infant.
From the Research
Quetiapine is generally considered compatible with breastfeeding for most mothers, with the amount of medication that passes into breast milk being relatively low, typically less than 1% of the maternal weight-adjusted dose, as supported by the most recent study 2. When considering the use of quetiapine during breastfeeding, it's essential to weigh the benefits of maternal treatment against the potential risks to the infant. The evidence suggests that quetiapine has a better safety profile in breastfeeding compared to some other antipsychotics due to its lower milk penetration and fewer reported adverse effects in infants 3. Key points to consider when using quetiapine during breastfeeding include:
- Monitoring the baby for excessive drowsiness, poor feeding, or developmental concerns
- Using the lowest effective dose, typically starting at 25-50mg and titrating as needed for symptom control
- Taking the medication just after breastfeeding and before the infant's longest sleep period to minimize exposure
- Recognizing that premature infants or those with medical conditions may require additional monitoring due to potentially reduced ability to metabolize the medication The most recent and highest quality study on this topic, published in 2018 2, found that the mean infant quetiapine dose via milk per body weight relative to weight-adjusted maternal dose was 0.16%, indicating a very small exposure level. Given the potential benefits of breastfeeding and the relatively low risk of quetiapine exposure, the benefits of maternal treatment with quetiapine often outweigh the minimal risks to the breastfed infant, especially for mothers with postpartum psychosis or severe bipolar disorder.