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Am J Psychiatry 1997; 154:1255-1260
Copyright © 1997 by American Psychiatric Association
Sertraline and desmethylsertraline in human breast milk and nursing infants
ZN Stowe, MJ Owens, JC Landry, CD Kilts, T Ely, A Llewellyn and CB Nemeroff
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
OBJECTIVE: The purpose of this study was to determine the concentrations of
sertraline and desmethylsertraline in both human breast milk and infant
serum. METHOD: Breast milk samples from 12 women were collected at specific
time intervals after oral doses of sertraline (25-200 mg once daily). For
11 mother-infant pairs, maternal serum levels 24 hours after a dose and
their infants' serum levels 2-4 hours after nursing were ascertained by
high-performance liquid chromatography. RESULTS: Sertraline and
desmethylsertraline were present in all breast milk samples, with a
gradient from "fore" milk to "hind" milk. The highest concentrations of
sertraline were observed in hind milk 7-10 hours after maternal dose.
Increasing the maternal dose of sertraline resulted in increased breast
milk concentrations of both sertraline and desmethylsertraline. Detectable
concentrations of sertraline were found in three nursing infants and
desmethylsertraline in six. No adverse effects of exposure were observed in
any infant. CONCLUSIONS: Sertraline and desmethylsertraline were present in
the breast milk of nursing women treated with sertraline. Concentrations
were affected by aliquot of milk sampled, time after maternal dose, and
maternal daily dose. The infants' serum concentrations detected were below
the detection limit of most commercial laboratories. The presence of
desmethylsertraline in six infants' samples underscores the importance of
metabolite monitoring in determining infant exposure. Estimates of daily
infant exposure can be determined after analysis of sertraline and
desmethylsertraline concentrations from one full breast at maternal serum
steady state. Future studies of breast milk and infant serum samples should
address these issues.
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