Is 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine? Is 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine safe for nursing mother and child? Does 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine extracts into breast milk? Does 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine has any long term or short term side effects on infants? Can 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine influence milk supply or can 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine decrease milk supply in lactating mothers?

Milk levels of 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Some experts consider 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine one of the antidepressants of choice for nursing mothers.[1][2] Other agents with may be preferred when large doses are required or while nursing a newborn or preterm infant.

No behavioral or physical changes were noted in a 6-week-old breastfed infant whose mother had been taking 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine 200 mg/day at bedtime for 15 days.[5] Follow-up for 1 to 3 years in 14 breastfed infants whose mothers were taking 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine in an average dosage of 161 mg daily (range 125 to 225 mg daily) found no adverse effects on growth and development.[8] Four infants were breastfed for 7 to 18 weeks during maternal use of 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine 75 to 150 mg daily starting at 2 weeks (3 infants) and 8 weeks (1 infant) postpartum. Formal testing indicated no adverse effects on infant development up to 30 months of age. The mother of 1 infant was taking haloperidol along with 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine 150 mg daily.[6] In another study, 25 infants whose mothers took a tricyclic antidepressant during pregnancy and lactation were tested formally between 15 to 71 months and found to have normal growth and development. Some of the mothers were taking 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine.[9] Six postpartum mothers diagnosed with panic disorder were successfully treated with 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine 25 to 35 mg (mean 28 mg) daily starting at a mean of 5.9 weeks postpartum. Mothers were treated for a mean of 9.3 weeks. All mothers reported that no adverse effects occurred in their infants.[10]

5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine has caused increased prolactin levels and gynecomastia in nonpregnant, nonnursing patients.[11][12] Galactorrhea has been reported rarely.[13][14] The clinical relevance of these findings in nursing mothers is not known. 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.[15] 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.[16] None of the mothers were taking 5-(3-(Dimethylamino)propyl)-10,11-dihydro-5H-dibenz(b,f)azepine.