毒理性
◉ 母乳喂养期间使用总结:尽管没有关于在母乳喂养期间使用帕利哌酮的数据,但它是一种活性代谢物。利培酮数据显示,帕利哌酮(9-羟基利培酮)在母乳中的浓度较低,婴儿摄入的量也较小。一个安全评分系统发现帕利哌酮在母乳喂养期间可以谨慎使用,尽管其他人并不推荐。由于没有发表的使用帕利哌酮在母乳喂养期间的经验和长期随访数据,其他药物可能更受欢迎,特别是在哺乳新生儿或早产儿时。由于帕利哌酮仅作为长效产品提供,与剂量有关的哺乳时间将不会有用。长效注射剂型可能会在数月内继续向母乳中输送少量药物。监测哺乳婴儿是否困倦、生长和体重增长是否充足、是否紧张不安、颤抖和异常运动。
◉ 对哺乳婴儿的影响:截至修订日期,没有找到关于帕利哌酮的已发布信息。然而,从其母药利培酮在哺乳期间使用的有限数据表明,对婴儿没有短期或长期的不良影响。
参加国家非典型抗精神病药物怀孕登记处的患者在哺乳期间使用第二代抗精神病药物(n = 576)与未使用第二代抗精神病药物的哺乳对照组(n = 818)进行比较。在服用第二代抗精神病药物的患者中,60.4%的患者正在使用一种以上的精神药物。在回顾儿科病历时,暴露或不暴露于第二代抗精神病药物单药治疗或多药治疗的新生儿中没有记录到不良影响。没有报告使用帕利哌酮的妇女人数。
◉ 对泌乳和母乳的影响:帕利哌酮已导致服用该药物的患者催乳素血清水平升高、男性乳房发育和乳汁分泌过多。在已建立泌乳的母亲中,催乳素水平可能不会影响她的哺乳能力。
参加国家非典型抗精神病药物怀孕登记处的患者在哺乳期间使用第二代抗精神病药物(n = 576)与主要诊断为重性抑郁障碍和焦虑障碍的对照组哺乳患者进行比较,这些患者通常使用SSRI或SNRI类抗抑郁药治疗,但不用第二代抗精神病药物(n = 818)。在服用第二代抗精神病药物的妇女中,60.4%的人正在使用一种以上的精神药物,而对照组的这一比例为24.4%。在服用第二代抗精神病药物的妇女中,59.3%的人报告“曾经哺乳”,而对照组的这一比例为88.2%。在产后3个月,服用第二代抗精神病药物的妇女中有23%的人专门哺乳,而对照组的这一比例为47%。没有报告使用帕利哌酮的妇女人数。
◉ Summary of Use during Lactation:Although no data are available for the use of paliperidone during breastfeeding, it is the active metabolite of risperidone. Risperidone data indicate that the concentrations of paliperidone (9-hydroxyrisperidone) in breastmilk are low, and amounts ingested by the infant are small. A safety scoring system finds paliperidone possible to use cautiously during breastfeeding, although others do not recommend it. Because there is no published experience with paliperidone during breastfeeding and little long-term follow-up data, other agents may be preferred, especially while nursing a newborn or preterm infant. Because paliperidone is available only as long-acting products, timing of nursing with respect to doses would not be useful. Long-acting injectable formulations may continue to deliver small amounts to breastmilk for many months. Monitor breastfed infants for drowsiness, adequate growth and weight gain, jitteriness, tremors, and abnormal movements.
◉ Effects in Breastfed Infants:No published information on paliperidone was found as of the revision date. However, limited data from the use of its parent drug, risperidone, during nursing indicate no short- or long-term adverse effects on the infant.
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. The number of women taking paliperidone was not reported.
◉ Effects on Lactation and Breastmilk:Paliperidone has caused elevated prolactin serum levels, gynecomastia, and galactorrhea in patients taking the drug. 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. The number of women taking paliperidone was not reported.
来源:Drugs and Lactation Database (LactMed)