Perphenazine and Breastfeeding

Summary of use during lactation

Limited information indicates that maternal doses of perphenazine up to 24 mg daily produce low levels in milk. Very limited long-term follow-up data indicate no adverse developmental effects when other phenothiazines are used alone. Monitor the infant for excessive drowsiness during breastfeeding and for developmental milestones, especially if other antipsychotics are used concurrently.

Drug levels in milk and infant serum

Maternal Levels. Steady-state perphenazine milk levels were measured in one woman while she was taking perphenazine at two different dosages. At a dose of 12 mg every 12 hours (480 mcg/kg daily) the drug concentration in a 24-hour milk collection was 3.2 mcg/L. At a dose of 8 mg every 12 hours, the average milk concentration in each of two 12-hour collection periods was 2.1 mcg/L. Milk was collected at this dosage in three 4-hour collection periods. Levels in fractionated 4-hour periods were as follows: 0 to 4 hours: 1.8 mcg/L; 4 to 8 hours: 3.1 mcg/L; and 8 to 12 hours: 2 mcg/L. The authors calculated that the breastfed infant would receive 0.1% of the maternal weight-adjusted dosage.[1] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

One infant was breastfed from 1 month to 4.5 months of age during maternal intake of perphenazine 16 mg daily. The infant grew normally and no adverse drug effects were seen.[1]

Effects on lactation and breastmilk

Galactorrhea has been reported with perphenazine.[2,3] Hyperprolactinemia appears to be the cause of the galactorrhea.[4-6] The hyperprolactinemia is caused by the drug's dopamine-blocking action in the tuberoinfundibular pathway. [7] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternative drugs to consider

Haloperidol, Olanzapine, Quetiapine, Risperidone

References

1. Olesen OV, Bartels U, Poulsen JH. Perphenazine in breast milk and serum. Am J Psychiatry 1990;147:1378-9.2400007 PubMed
2. Basler RS, Lynch PJ. Black galactorrhea as a consequence of minocycline and phenothiazine therapy. Arch Dermatol 1985;121:417-8.4038862 PubMed
3. Hooper JH, Jr, Welch VC, Shackelford RT. Abnormal lactation associated with tranquilizing drug therapy. JAMA 1961;178:506-7.14448766 PubMed
4. Turkington RW. Prolactin secretion in patients treated with various drugs: Phenothiazines, tricyclic antidepressants, reserpine, and methyldopa. Arch Intern Med 1972;130:349-54.4560178 PubMed
5. Turkington RW. Serum prolactin levels in patients with gynecomastia. J Clin Endocrinol Metab 1972;34:62-6.5061776 PubMed
6. Meltzer HY, Fang VS. The effect of neuroleptics on serum prolactin in schizophrenic patients. Arch Gen Psychiatry 1976;33:279-86.1259521 PubMed
7. Maguire GA. Prolactin elevation with antipsychotic medications: Mechanisms of action and clinical consequences. J Clin Psychiatry 2002;63 (Suppl 4):56-62.11913677 PubMed