Can you take vortioxetine while breastfeeding?

What LactMed would consider instead

LactMed ends this record by naming the drugs it would consider in place of vortioxetine. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.

• Nortriptyline
• Paroxetine
• Sertraline

How much vortioxetine gets into breastmilk

Maternal Levels. Three lactating mothers were taking vortioxetine for depression, two were taking 10 mg once daily and one was taking 20 mg once daily. Milk samples were taken 5 times over a 24-hour period before the dose and at 5, 7, 10, 12, and 24 hours after a dose at steady state. With the dose of 10 mg, the peak concentration of vortioxetine in milk was 13.9 mcg/L at 7 hours after the dose. With the dose of 20 mg, the peak milk concentration was 52.3 mcg/L at 5 hours after the dose. The weight-adjusted infant dosages were 1.1% for 10 mg dose and 1.7% for 20 mg dose.

A woman who was taking a vortioxetine dose of 76.1 mcg/kg daily collected 6 to 8 milk samples over a 24-hour period. The peak milk level was 8.2 mcg/L and the mean concentration was 6 mcg/L. Using the mean value, the absolute infant dose in a fully breastfed infant would be 0.9 mcg/kg daily and the relative infant dose would be 1.2% of the mother’s weight-adjusted dosage.

A Japanese woman with depression was taking vortioxetine 20 mg zolpidem 10 mg, duloxetine 20 mg, rebamipide 100 mg and the Asian herbal medicine Kami-kihi-tou 2.5 grams daily. On day 4 postpartum, she collected a sample of 5 mL of foremilk 2 hours after her vortioxetine dose. The milk sample contained 9.3 mcg/L which the authors used to calculate a relative infant dose of 0.32%. This may not represent the maximum value, because the peak milk level occurred at 7 hours after a dose in another study.

Infant Levels. Relevant published information was not found as of the revision date.

What has been seen in breastfed infants

Three lactating mothers were taking vortioxetine for depression, two were taking 10 mg once daily and one was taking 20 mg once daily. All mothers were exclusively breastfeeding their infants aged 1, 2 and 6 months of age. No mothers reported any unusual behavior in their infants.

A woman who was taking a vortioxetine dose of 76.1 mcg/kg daily partially breastfed her infant. She did not observe any adverse effects in her infant.

A postpartum Japanese woman with depression was taking vortioxetine 20 mg zolpidem 10 mg, duloxetine 20 mg, rebamipide 100 mg and the Asian herbal medicine Kami-kihi-tou 2.5 grams daily. She partially (over 50%) breastfed her infant for 3 months. The infant had no detectable drug-related adverse effects on routine follow-up at 1, 3, 5, 7 and 9-months postpartum.

Effects on milk supply

Vortioxetine has caused hyperprolactinemia and galactorrhea in some patients.

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 vortioxetine.

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.