olanzapine and Depression--Postpartum

Newer antipsychotic drugs offer significant clinical advantages for the treatment of psychosis. In particular for the treatment of postpartum disorders newer agents may be suited due to their favourable side-effect profiles. Of concern is the passage of the drugs into breast milk and what potential risks this poses for an infant who is breastfed. The excretion of olanzapine into the breast milk of five lactating women with postpartum psychosis was examined in this study. Nine pairs of plasma and breast-milk samples were collected and the concentration of olanzapine determined by high-performance liquid chromatography. Single-point milk-to-plasma ratios were calculated and ranged from 0.2 to 0.84 with a mean of 0.46. The median relative infant dose was 1.6% (range 0-2.5%) of the weight-adjusted maternal dose. During the study period, there were no apparent ill effects on the infant as a consequence of exposure to these doses of olanzapine. As with other antipsychotic drugs this study demonstrates that olanzapine passes into breast milk. The long-term effects of exposure in infants exposed to olanzapine requires further investigation.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Depression, Postpartum; Female; Humans; Infant; Infant, Newborn; Milk, Human; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales

We here report on a psychotic mother and her breast-fed infant who was treated with olanzapine. Consecutively olanzapine concentrations in the milk and plasma of the mother and in the infant were measured with tandem mass spectroscopy over a period of five month. The results show a relatively high plasma level in the infant aged four month, probably referring to an immature hepatic transformation system, especially CYP1A2. In the following four months plasma levels of olanzapine decreased to very low, even undetectable concentrations in the infant. The infant developed normally and showed no side effects during the treatment period.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Breast Feeding; Cytochrome P-450 CYP1A2; Depression, Postpartum; Female; Humans; Infant; Male; Milk, Human; Olanzapine; Psychotic Disorders; Tandem Mass Spectrometry

Although atypical antipsychotics are widely used during pregnancy, their safety is not well established. This case highlights the possible teratogenic effect of olanzapine, in which the baby was born with meningocele and ankyloblepharon. It is suggested that olanzapine may interfere with embryonic development at different stages of pregnancy.

Topics: Adult; Affective Disorders, Psychotic; Antipsychotic Agents; Benzodiazepines; Depression, Postpartum; Eyelids; Female; Humans; Infant, Newborn; Male; Meningocele; Olanzapine; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy Trimester, Third; Prenatal Exposure Delayed Effects; Recurrence