毒理性
◉ 母乳喂养期间的使用总结：每天服用最高400毫克的喹硫平的母亲，其乳汁中的剂量不到母亲体重调整剂量的1%。对长期接触喹硫平的婴儿有限的随访表明，婴儿通常发育正常。一个安全评分系统发现喹硫平在哺乳期间是可以使用的。对第二代抗精神病药物的系统性回顾得出结论，喹硫平在哺乳期间似乎是首选或次选药物。如果同时使用其他抗精神病药物，请监测婴儿的嗜睡和发育里程碑。
◉ 对哺乳婴儿的影响：一位母亲在怀孕期间每天口服25毫克喹硫平，并在哺乳期间继续每天口服50毫克喹硫平。6周时，婴儿状况良好。没有进一步的随访报告。
另一位母亲每天服用200毫克喹硫平，她的婴儿在8周大时开始完全母乳喂养。婴儿在4.5个月大时发育良好，没有报告不良影响。
一位患有产后精神病的哺乳母亲在产后6周开始服用喹硫平，剂量为每天25毫克，同时服用未指定的苯二氮卓类药物。在接下来的6周内，喹硫平的剂量逐渐增加到每天200毫克，在接下来的4周内增加到每天300毫克（产后16周）。她在产后8周开始每天服用15毫克的米氮平。哺乳（程度未指定）持续到产后16周，因为乳汁减少而停止。在此期间，婴儿过度嗜睡，直到苯二氮卓剂量减少，同时喹硫平剂量增加。在停止哺乳后至少跟踪了婴儿2个月，没有发现对婴儿的生长、运动或心理发展或婴儿戒断迹象的影响。
一位患有双相情感障碍的哺乳母亲在产后4个月开始服用20毫克的帕罗西汀，然后在产后6个月开始服用每天200毫克的喹硫平。她定期哺乳（程度未说明），婴儿没有明显的不良影响。
一位长期接受每天400毫克喹硫平和每天200毫克氟伏沙明治疗的女性的整个孕期和产后都服用这些药物。她部分哺乳了她的婴儿（程度未说明）3个月。没有观察到不良事件，婴儿发育正常。
六位哺乳母亲在产后患有重度抑郁症，每天服用25至400毫克喹硫平，并加用抗抑郁药（通常是帕罗西汀）。他们的哺乳婴儿在9至18个月大时使用贝利量表进行了发育测试。一项婴儿在心理和心理运动发育量表上的测量略低，另一项在心理发育量表上的测量略低。所有其他得分都在正常范围内。作者认为，这两个婴儿的低分可能不是由婴儿通过母乳摄入的药物引起的。
一位母亲每天服用400毫克喹硫平、40毫克氟西汀和每次20毫克、每天三次的奥昔康，她的婴儿每天哺乳6到7次，并每天三次口服120微克的吗啡以治疗阿片类药物戒断。3个月大时检查，婴儿的体重降至年龄的第25百分位，而出生时为第50百分位。作者将体重下降归因于阿片类药物戒断。婴儿的丹佛发育评分等于他的实际年龄。
一位60周大的婴儿在母亲每天服用75毫克喹硫平和225毫克文拉法辛治疗期间，50%的时间接受哺乳。母亲或医疗记录中没有报告不良反应。
一位患有双相情感障碍的母亲在分娩双胞胎并服用治疗剂量的钠伐普酸后，在产后20天开始每天晚上11点服用200毫克喹硫平和15毫克奥氮平。她在夜间停止哺乳，并在早上7点丢弃泵出的乳汁。然后她哺乳她的婴儿直到晚上11点。母亲按照这个时间表为婴儿喂食了15个月。对婴儿的每月随访表明正常生长，无论是儿科医生还是父母都没有注意到婴儿有任何不良影响。
一位每晚服用100毫克喹硫平治疗双相情感障碍的母亲哺乳了两个连续的早产儿。两个婴儿在最后的随访访问（具体时间未指定）时都被报告为发育正常。
一位患有双相情感障碍的母亲在两次怀孕期间每天服用25毫克喹硫平和100毫克拉莫三嗪治疗双相情感障碍。第一次分娩后，她没有哺乳，但在第二次分娩后哺乳了婴儿（程度未说明）。在2个月的婴儿健康检查中，婴儿达到了所有发育里程碑。
一位妇女在产后患有双相II型抑郁症，接受每天300毫克拉莫三嗪和300毫克喹硫平的联合治疗。作者报告她的哺乳婴儿（程度未说明）没有出现重大不良反应。
一位作者报告了一名在产后母亲治疗双相情感障碍期间接受哺乳的婴儿（程度未说明）。她的喹硫平剂量为每天200毫克。母亲报告婴儿没有不良影响。
在印度一家住院母婴精神科单位进行的一项前瞻性队列研究中，跟踪了2名接触喹硫平的哺乳婴儿；大多数接受了部分补充。没有一个
◉ Summary of Use during Lactation:Maternal quetiapine doses of up to 400 mg daily produce doses in milk that are less than 1% of the maternal weight-adjusted dosage. Limited long-term follow-up of infants exposed to quetiapine indicates that infants generally developed normally. A safety scoring system finds quetiapine to be possible to use during breastfeeding. Systematic reviews of second-generation antipsychotics concluded that quetiapine seemed to be the first- or second-choice agent during breastfeeding. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
◉ Effects in Breastfed Infants:One mother took quetiapine 25 mg daily orally during pregnancy and continued to take quetiapine 50 mg daily orally during lactation. At 6 weeks the infant was doing well. No further follow-up was reported.
Another infant whose mother was taking 200 mg daily of quetiapine began to exclusively breastfeed at 8 weeks of age. The infant was developing well at 4.5 months of age and no adverse effects were reported.
A nursing mother with postpartum psychosis was started on quetiapine at 6 weeks postpartum at a dose of 25 mg daily along with unspecified benzodiazepines. The quetiapine dosage was increased gradually to 200 mg daily over the next 6 weeks and up to 300 mg daily over the ensuing 4 weeks (16 weeks postpartum). She was also started on mirtazapine 15 mg daily at 8 weeks postpartum. Breastfeeding (extent not specified) was continued until 16 weeks postpartum when it was stopped because of reduced milk production. During this time the infant was excessively drowsy until the benzodiazepine dosage was deceased at the same time as the quetiapine dosage was increased. The infant was followed for at least 2 months after breastfeeding ended and no effects on the infant's growth, motor or psychological development or signs of infant withdrawal were noted.
A nursing mother with bipolar disorder began taking 20 mg of paroxetine at 4 months postpartum and was then started on quetiapine 200 mg twice daily at 6 months postpartum. She breastfed regularly (extent not stated) and no obvious adverse effects were noted in the infant.
A woman who was treated chronically with quetiapine 400 mg and fluvoxamine 200 mg daily took the drugs throughout pregnancy and postpartum. She partially breastfed her infant (extent not stated) for 3 months from birth. No adverse events were seen and the infant developed normally.
Six nursing mothers took quetiapine in doses of 25 to 400 mg daily in addition to an antidepressant (usually paroxetine) for major depression postpartum. Their breastfed infants' development were tested at 9 to 18 months of age with the Bayley scales. Measurements were slightly low on the mental and psychomotor development scale in one infant and on the mental development scale in another. All other scores were within normal limits. The authors concluded that the low scores of the 2 infants were probably not caused by the drugs received by the infants in breastmilk.
An infant was born to a mother taking quetiapine 400 mg daily, fluoxetine 40 mg daily and oxycodone 20 mg 3 times daily. The infant was breastfed 6 to 7 times daily and was receiving 120 mcg of oral morphine 3 times daily for opiate withdrawal. Upon examination at 3 months of age, the infant's weight was at the 25th percentile for age, having been at the 50th percentile at birth. The authors attributed the weight loss to opiate withdrawal. The infant's Denver developmental score was equal to his chronological age.
One 60-week-old infant who was 50% breastfed was breastfed during maternal therapy with quetiapine 75 mg daily mg daily and venlafaxine 225 mg daily. No adverse reactions were reported by the mother or in the medical records.
A woman with bipolar disorder who delivered twins and was taking sodium valproate in a therapeutic dosage was started on quetiapine 200 mg and olanzapine 15 mg at 11 pm daily after 20 days postpartum. She withheld breastfeeding during the night and discarded milk pumped at 7 am. She then breastfed her infants until 11 pm. The mother continued feeding the infants on this schedule for 15 months. Monthly follow-up of the infants indicated normal growth and neither the pediatricians nor the parents noted any adverse effects in the infants.
A mother taking quetiapine 100 mg each night for bipolar disorder breastfed 2 successive preterm infants. Both infants were reported to be developing normally at their last follow-up visits (exact times not specified).
A woman with bipolar disorder took quetiapine 25 mg and lamotrigine 100 mg daily for the treatment of bipolar disorder during two pregnancies. After the first birth, she did not breastfeed, but she breastfed (extent not stated) the second infant. At the 2-month well baby checkup, the infant was meeting all developmental milestones.
A woman received a combination of 300 mg lamotrigine and 300 of quetiapine daily for postpartum bipolar II postpartum depression. The authors reported no major adverse reactions in her breastfed (extent not stated). infant.
An author reported 1 infant who was breastfed (extent not stated) during postpartum maternal treatment for bipolar disorder. Her quetiapine dosage was 200 mg daily. The mother reported no adverse effects in the infants.
A prospective cohort study of infants breastfed by mothers in an inpatient mother-baby psychiatric unit in India followed 2 infants who were exposed to quetiapine in breastmilk; most received partial supplementation. Neither had any short-term adverse effects. Infants were followed for 1 to 3 months after discharge and one of the infants who was also exposed to quetiapine in utero had motor and mental delay.
A woman was taking oral extended-release quetiapine 300 mg daily during the last 3 months of pregnancy and postpartum. At 3 months postpartum, her breastfed (extent not stated) infant had no apparent adverse effects and was developing normally.
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 quetiapine was not reported.
◉ Effects on Lactation and Breastmilk:Unlike the phenothiazines, quetiapine has a minimal effect on serum prolactin levels. However, galactorrhea has been reported. The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Galactorrhea occurred in a woman who was not breastfeeding while she was taking venlafaxine 112.5 mg daily and quetiapine. Galactorrhea occurred 10 days after her quetiapine dose was increased to 50 mg daily a few days after starting the drug at 12.5 mg daily. Her serum prolactin level was 27.3 mcg/L (normal 2 to 30 mcg/L) and decreased to 8.5 mcg/L 2 weeks after discontinuing the drug. Galactorrhea ceased 1 week later.
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 quetiapine was not reported.
来源:Drugs and Lactation Database (LactMed)
