Trifluoperazine and Breastfeeding

Summary of use during lactation

Limited information indicates that maternal doses of trifluoperazine up to 10 mg daily do not affect the breastfed infant. Very limited long-term follow-up data indicate no adverse developmental effects when other phenothiazines are used alone. A safety scoring system finds trifluoperazine to be not recommended during breastfeeding.[1] Because there is little published experience with trifluoperazine during breastfeeding, other antipsychotic agents may be preferred, especially wile nursing an newborn or preterm infant.

Drug levels in milk and infant serum

Maternal Levels. Two mothers taking trifluoperazine 5 and 10 mg per day orally had undetectable milk levels (<1 mcg/L) of trifluoperazine.[2] Infant Levels. Trifluoperazine was undetectable (<2 mcg/L) in urine at 86 days of age in an infant whose mother was taking trifluoperazine 10 mg daily.[2] The infant of one mother who was taking trifluoperazine 10 mg per day orally while breastfeeding had a serum trifluoperazine level of 1 mcg/L. The infant was 1.9 weeks old when tested and the mother had been taking trifluoperazine during pregnancy which might have contributed to the infant's serum level.[3]

Effects in breastfed infants

Two mothers taking trifluoperazine 5 and 10 mg per day orally breastfed their infants from 1 week and 8 weeks of age, respectively. Mental and psychomotor development were normal at various times up to 30 months of age.[2] One infant was breastfed from birth during maternal trifluoperazine 10 mg daily in addition to clonazepam 0.25 mg daily and valproic acid 500 mg daily. No adverse effects in the infant were reported by the mother (follow-up time unspecified).[3] One mother began taking trifluoperazine (dosage unspecified) 2 months postpartum while breastfeeding her infant. She also started olanzapine 10 mg daily, paroxetine and procyclidine (dosages unspecified). The infant experiences no adverse reactions.[4]

Effects on lactation and breastmilk

Phenothiazines cause galactorrhea in 26 to 40% of female patients.[5,6] Hyperprolactinemia appears to be the cause of the galactorrhea.[7-10] The hyperprolactinemia is caused by the drug's dopamine-blocking action in the tuberoinfundibular pathway.[11]

Alternative drugs to consider

Haloperidol, Olanzapine, Quetiapine, Risperidone

References

1. Uguz F. A new safety scoring system for the use of psychotropic drugs during lactation. Am J Ther 2021;28:e118-e26.30601177 PubMed
2. Yoshida K, Smith B, Craggs M, et al. Neuroleptic drugs in breast-milk: A study of pharmacokinetics and of possible adverse effects in breast-fed infants. Psychol Med 1998;28:81-91.9483685 PubMed
3. Birnbaum CS, Cohen LS, Bailey JW, et al. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 1999;104:e11.10390297 PubMed
4. Goldstein DJ, Corbin LA, Fung MC. Olanzapine-exposed pregnancies and lactation: Early experience. J Clin Psychopharmacol 2000;20:399-403.10917399 PubMed
5. Polishuk WZ, Kulcsar S. Effects of chlorpromazine on pituitary function. J Clin Endocrinol Metab 1956;16:292-3.13286329 PubMed
6. Hooper JH, Jr, Welch VC, Shackelford RT. Abnormal lactation associated with tranquilizing drug therapy. JAMA 1961;178:506-7.14448766 PubMed
7. 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
8. Turkington RW. Serum prolactin levels in patients with gynecomastia. J Clin Endocrinol Metab 1972;34:62-6.5061776 PubMed
9. Beumont PJ, Gelder MG, Friesen HG, et al. The effects of phenothiazine on endrocrine function: I Patients with inappropriate lactation and amenorrhoea. Br J Psychiatry 1974;124:413-9.4151788 PubMed
10. Meltzer HY, Fang VS. The effect of neuroleptics on serum prolactin in schizophrenic patients. Arch Gen Psychiatry 1976;33:279-86.1259521 PubMed
11. Maguire GA. Prolactin elevation with antipsychotic medications: Mechanisms of action and clinical consequences. J Clin Psychiatry 2002;63 (Suppl 4):56-62.11913677 PubMed