Iloperidone and Breastfeeding

Summary of use during lactation

Because no information is available on the use of iloperidone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Drug levels in milk and infant serum

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

Effects in breastfed infants

Patients enlisted in the National Pregnancy Registry for Atypical Antipsychotics who were taking a second-generation antipsychotic drug while breastfeeding (n = 576) were compared to control breastfeeding patients who were not treated with a second-generation antipsychotic (n = 818). Of the patients who were taking a second-generation antipsychotic drug, 60.4% were on more than one psychotropic. A review of the pediatric medical records, no adverse effects were noted among infants exposed or not exposed to second-generation antipsychotic monotherapy or to polytherapy.[1] The number of women taking iloperidone was not reported.

Effects on lactation and breastmilk

Iloperidone causes minimal increases in serum prolactin.[2,3] The prolactin level in a mother with established lactation may not affect her ability to breastfeed. Patients enlisted in the National Pregnancy Registry for Atypical Antipsychotics who were taking a second-generation antipsychotic drug while breastfeeding (n = 576) were compared to control breastfeeding patients who had primarily diagnoses of major depressive disorder and anxiety disorders, most often treated with SSRI or SNRI antidepressants, but not with a second-generation antipsychotic (n = 818). Among women on a second-generation antipsychotic, 60.4% were on more than one psychotropic compared with 24.4% among women in the control group. Of the women on a second-generation antipsychotic, 59.3% reported “ever breastfeeding” compared to 88.2% of women in the control group. At 3 months postpartum, 23% of women on a second-generation antipsychotic were exclusively breastfeeding compared to 47% of women in the control group.[1] The number of women taking iloperidone was not reported.

Alternative drugs to consider

Haloperidol, Olanzapine, Quetiapine, Risperidone

References

1. Viguera AC, Vanderkruik R, Gaccione P, et al. Breastfeeding practices among women taking second-generation antipsychotics: Findings from the National Pregnancy Registry for Atypical Antipsychotics. Arch Womens Ment Health 2022;25:511-6.34318375 PubMed
2. Cutler AJ. Iloperidone: A new option for the treatment of schizophrenia. Expert Rev Neurother 2009;9:1727-41.19951132 PubMed
3. Weiden PJ, Cutler AJ, Polymeropoulos MH, et al. Safety profile of iloperidone: A pooled analysis of 6-week acute-phase pivotal trials. J Clin Psychopharmacol 2008;28 (2 Suppl 1):S12-9.18334908 PubMed