毒理性
◉ 母乳喂养期间使用总结：去甲丙咪嗪及其代谢物在母乳中的水平较低，在哺乳婴儿的血清中尚未检测到。未报告立即的副作用，有限的随访也未发现对婴儿生长和发育产生不良影响。在母乳喂养期间通常不会预期去甲丙咪嗪的使用会对哺乳婴儿产生任何不良影响，尤其是婴儿年龄超过2个月时。一个安全评分系统认为在母乳喂养期间使用去甲丙咪嗪是可能的。
◉ 对哺乳婴儿的影响：对一名母亲在分娩后16周开始每天服用100毫克去甲丙咪嗪8周的婴儿进行了随访，直至36个月大。未发现对生长和发育产生不良影响。
◉ 对泌乳和母乳的影响：去甲丙咪嗪在一些患者中引起了血清催乳素水平的升高。这些发现在哺乳母亲中的临床相关性尚不清楚。已建立泌乳的母亲体内的催乳素水平可能不会影响她的哺乳能力。
一项观察性研究观察了在怀孕前两年内服用抗抑郁药的2859名妇女的结果。与怀孕期间未服用抗抑郁药的妇女相比，整个孕期（三个 trimesters）都服用抗抑郁药的妇女在出院时哺乳的可能性降低了37%。仅在第三孕期服用抗抑郁药的妇女在出院时哺乳的可能性降低了75%。仅在第一和第二孕期服用抗抑郁药的妇女在出院时哺乳的可能性没有降低。研究中未具体说明母亲使用的抗抑郁药种类。
一项回顾性队列研究比较了2001年至2008年的医院电子医疗记录，研究对象是晚期妊娠期间分发抗抑郁药的妇女（n = 575），有精神疾病但未接受抗抑郁药的妇女（n = 1552），以及没有精神疾病诊断的妇女（n = 30,535）。接受抗抑郁药的妇女在出院时哺乳的可能性比没有精神疾病诊断的妇女低37%，但与未接受治疗的精神疾病母亲相比，哺乳的可能性没有降低。这些母亲中没有人在服用去甲丙咪嗪。
在一项针对1999年至2008年的80,882对挪威母婴对的研究中，有392名妇女报告了产后新开始使用抗抑郁药，201名妇女报告她们从怀孕期间继续使用抗抑郁药。与未暴露的对照组相比，晚期妊娠期间使用抗抑郁药与哺乳开始的几率降低7%有关，但对哺乳持续时间和专一性没有影响。与未暴露的对照组相比，新开始或重新开始使用抗抑郁药与6个月时主要哺乳的几率降低63%和任何哺乳的几率降低51%有关，以及突然停止哺乳的风险增加2.6倍。具体抗抑郁药未提及。
◉ Summary of Use during Lactation:Milk levels of desipramine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Desipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. A safety scoring system finds desipramine use to be possible during breastfeeding.
◉ Effects in Breastfed Infants:One infant whose mother took desipramine 100 mg daily for 8 weeks starting at 16 weeks postpartum was followed up at 36 months of age. No adverse effects on growth and development were found.
◉ Effects on Lactation and Breastmilk:Desipramine has caused increased serum prolactin levels in some patients. 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. 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. None of the mothers were taking desipramine.
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.
来源:Drugs and Lactation Database (LactMed)
