Is Amoxapine safe while breastfeeding?

Summary of use during breastfeeding

Because there is no published experience with amoxapine during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.

Effects on the breastfed infant

Relevant published information was not found as of the revision date.

Effects on milk supply

Two cases of galactorrhea have been reported in nonbreastfeeding women who were taking amoxapine.[2,3] The clinical relevance of these findings in nursing mothers is not known. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[4] The antidepressants used by the mothers were not specified.

A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[5] None of the mothers were taking amoxapine.

In a study of 80,882 Norwegian mother-infant pairs from 1999 to 2008, new postpartum antidepressant use was reported by 392 women and 201 reported that they continued antidepressants from pregnancy. Compared with the unexposed comparison group, late pregnancy antidepressant use was associated with a 7% reduced likelihood of breastfeeding initiation, but with no effect on breastfeeding duration or exclusivity. Compared with the unexposed comparison group, new or restarted antidepressant use was associated with a 63% reduced likelihood of predominant, and a 51% reduced likelihood of any breastfeeding at 6 months, as well as a 2.6-fold increased risk of abrupt breastfeeding discontinuation. Specific antidepressants were not mentioned.[6]

Levels in milk

Maternal Levels. In one nonbreastfeeding woman who developed galactorrhea during use of amoxapine 250 mg daily, amoxapine was found to be qualitatively present at less than 20 mcg/L, but not quantifiable at 0.75 and 11.5 hours after the dose. Milk levels of 8-hydroxyamoxapine, an active metabolite of amoxapine, were 113 and 168 mcg/L at 0.75 and 11.5 hours after the dose, respectively.[1] No data are available on amoxapine in breastfeeding women.

Infant Levels. Relevant published information was not found as of the revision date.

Alternatives LactMed lists

• Nortriptyline
• Paroxetine
• Sertraline