毒理性
◉ 母乳喂养期间使用总结：瑞波西汀未获得美国食品药品监督管理局在美国的上市批准，但在其他国家可用。有限的信息表明，母亲每日剂量高达10毫克的瑞波西汀在母乳中产生的水平较低，似乎不会对哺乳婴儿产生任何不良反应。在更多数据可用之前，瑞波西汀在母乳喂养期间应谨慎使用并进行监测。
◉ 对哺乳婴儿的影响：有四名患有产后抑郁症的母亲在服用平均每日6.5毫克（79微克/千克）瑞波西汀治疗期间，哺乳了1.3到2.1个月（具体程度未说明）。其中一名母亲还每日服用20毫克艾司西酞普兰，另一名每日服用300毫克舍曲林。这些婴儿中没有表现出任何不良反应。其中三名婴儿的丹佛发展评分正常；第四名母亲服用瑞波西汀的婴儿发展年龄仅为正常的71%，但这个问题在母亲服用瑞波西汀之前就已存在。
五名妇女在怀孕和哺乳期间服用了瑞波西汀（具体程度和剂量未说明）。他们的婴儿中没有出现不良反应，并且报告了正常的发展里程碑。
◉ 对泌乳和母乳的影响：瑞波西汀增加了男性受试者的血清催乳素水平。这一发现对哺乳母亲的意义尚不清楚。已建立泌乳的母亲催乳素水平可能不会影响她的哺乳能力。
一项观察性研究调查了2859名在怀孕前两年内服用抗抑郁药的妇女的结果。与怀孕期间未服用抗抑郁药的妇女相比，整个孕期（三个季度）都服用抗抑郁药的妇女在出院时哺乳的可能性降低了37%。仅在第三季度服用抗抑郁药的妇女在出院时哺乳的可能性降低了75%。仅在第一和第二季度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被开出抗抑郁药的妇女（n = 575）与患有精神疾病但未接受抗抑郁药治疗的妇女（n = 1552）以及没有精神疾病诊断的妇女（n = 30,535）。接受抗抑郁药治疗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瑞波西汀。
在一项涉及1999年至2008年的80,882对挪威母婴对的研究中，有392名妇女报告在产后新开始使用抗抑郁药，有201名报告从怀孕期间继续使用抗抑郁药。与未暴露的对照组相比，晚期妊娠使用抗抑郁药与哺乳开始的可能性降低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在6个月时主要哺乳的可能性降低63%，任何哺乳的可能性降低51%，以及突然停止哺乳的风险增加2.6倍有关。具体抗抑郁药未提及。
◉ Summary of Use during Lactation:Reboxetine is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal doses of up to 10 mg daily produce low levels in milk and appear to not result in any adverse effects in breastfed infants. Until more data are available, reboxetine should be used with careful monitoring during breastfeeding.
◉ Effects in Breastfed Infants:Four infants whose mothers had postpartum depression had been breastfed (extent not stated) for 1.3 to 2.1 months during maternal reboxetine therapy at an average dose of 6.5 mg (79 mcg/kg) daily. One of the mothers was also taking escitalopram 20 mg daily and another was taking sertraline 300 mg daily. None of the infants exhibited any adverse reactions. Three of the infants had normal Denver developmental scores; the fourth whose mother was taking reboxetine had a developmental age of only 71% of normal, but the problem predated maternal reboxetine therapy.
Five women used reboxetine during pregnancy and lactation (extent not stated) in unspecified doses. No adverse effects were noted in their infants and normal developmental milestones were reported.
◉ Effects on Lactation and Breastmilk:Reboxetine increased serum prolactin in male subjects. The relevance of this finding to nursing mothers is not clear. 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 reboxetine.
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)
