Is Bupropion SR Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Bupropion SR? Is Bupropion SR safe for nursing mother and child? Does Bupropion SR extracts into breast milk? Does Bupropion SR has any long term or short term side effects on infants? Can Bupropion SR influence milk supply or can Bupropion SR decrease milk supply in lactating mothers?

Selective inhibitor of the neuronal reuptake of catecholamines (noradrenaline and dopamine). It is used as an antidepressant and to help stop smoking (Baraona 2017). Administered orally, one daily dose. Although the concentration in milk is much higher than the plasma concentration, it is excreted in breast milk in very small amounts (Neuman 2014, Davis 2009, Haas 2004, Briggs 1993). The plasma levels of infants whose mothers were taking it were undetectable or very low (Neuman 2014, Davis 2009, Baab 2002, Briggs 1993). Given the negligible excretion in milk, the absence of plasma levels in infants and the fact that no problems were observed in infants in several publications (Nonacs 2005, Baab 2002, Briggs 1993), two cases of seizures in infants whose mothers were taking Bupropion SR are difficult to explain, whether in monotherapy (Chaudron 2004) or associated with other antidepressants (Neuman 2014). Progress was satisfactory. Bupropion SR does not alter prolactin levels (Whiteman 1982). Avoid in mothers with a history of epilepsy since it decreases the seizure threshold. Until there is more published data on this drug in relation to breastfeeding, safer alternatives known may be preferable (Sriraman 2015, Carson 2013, Berle 2011, Davanzo 2011), especially during the neonatal period and in case of prematurity. See below the information of these related products:

Limited information indicates that maternal Bupropion SR doses of up to 300 mg daily produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants. However, there is little reported use in breastfed newborn infants and case reports of a possible seizure in partially breastfed 6-month-olds. If Bupropion SR is required by a nursing mother, it is not a reason to discontinue breastfeeding. However, another drug may be preferred, especially while nursing a newborn or preterm infant. Infants exposed to Bupropion SR and an SSRI through breastfeeding should be closely monitored for vomiting, diarrhea, jitteriness, or sedation and possibly measurement of serum levels to rule out toxicity if there is a concern.

Three partially to fully breastfed infants who were 15 weeks to 14 months of age had no clinically detectable adverse effects during maternal Bupropion SR therapy. Dosages were 100 mg 3 times daily of the immediate-release product in one mother, and 150 mg daily in the other two, one as the SR product and one as the immediate-release product.[2][6] Two women of 8 in an open-label clinical trial of Bupropion SR SR for postpartum depression breastfed their infants. The median dosage of Bupropion SR SR in the 8 women was 262.5 mg (range 37.5-300 mg). Seven women completed the 8-week study and 1 took the drug for 6 weeks. No specific details were given on the 2 women who breastfed their infants, but neither noted any adverse effects in their infants.[7]A woman who started taking sustained-release Bupropion SR 150 mg daily fed her 6-month-old infant by breastfeeding and stored breastmilk in addition to solid foods. After 3 days and 2 doses of the drug, the infant had symptoms consistent with a seizure, but no infant serum levels were obtained. The seizure was possibly related to the Bupropion SR in breastmilk.[8] An uncontrolled online survey compiled data on 930 mothers who nursed their infants while taking an antidepressant. Infant drug discontinuation symptoms (e.g., irritability, low body temperature, uncontrollable crying, eating and sleeping disorders) were reported in about 10% of infants. Mothers who took antidepressants only during breastfeeding were much less likely to notice symptoms of drug discontinuation in their infants than those who took the drug in pregnancy and lactation.[9] In a telephone follow-up study, 124 mothers who took a benzodiazepine while nursing reported whether their infants had any signs of sedation. One mother who was taking Bupropion SR 1 mg daily, flurazepam 15 mg daily, clonazepam 0.25 mg twice daily, and risperidone 0.75 mg daily reported sedation in her breastfed infant.[10] A 6.5-month-old infant developed severe vomiting and an apparent tonic seizure after being breastfed by her mother. The mother had been taking escitalopram 10 mg daily since birth and had begun extended-release Bupropion SR 150 mg daily 3 weeks earlier. The seizure occurred 8 hours after the mother's morning dose of Bupropion SR. The infant's mother had noted disturbances in sleep behavior, unusual movements, and unresponsiveness followed by sleep on several previous occasions. The baby was partially breastfed, also receiving pumped breastmilk, formula, and solid foods. Breastfeeding was discontinued and the baby was discharged after being asymptomatic for 48 hours. The seizure was probably drug-related, most likely caused by Bupropion SR and hydroxyBupropion SR in breastmilk, but a contribution by escitalopram cannot be ruled out.[5] A retrospective database study compared women who took Bupropion SR with no SSRI (n = 29) women who took an SSRI but no Bupropion SR (n = 54), and women who took a combination of Bupropion SR and a SSRI (n = 23) during breastfeeding. There were 5 (17%) adverse events reported by the mothers in their infants in the Bupropion SR group, 4 (7%) in the SSRI group and 7 (30%) in the combination group. The proportion of adverse events was significantly higher in the combination group compared to the SSRI group. The reported adverse events included vomiting, diarrhea, jitteriness, sleepiness, hypotony and a seizure (reported in the SSRI group). No seizures were reported in infants exposed to Bupropion SR (alone or with an SSRI) through breastfeeding There was no statistically significant difference among the groups with regards to average daily weight gain in the first 6 months after birth. therefore seizures are probably not a major concern in these infants.[11]

A 34-year-old non-pregnant woman diagnosed with depression was started on Bupropion SR 150 mg daily. During the second week of therapy, she presented with galactorrhea and an elevated serum prolactin level of 98 mcg/L. A cranial MRI found no abnormalities. Bupropion SR was discontinued and the galactorrhea disappeared in 2 days. One week later, her serum prolactin level was 3 mcg/L. Fluoxetine 20 mg daily was started and continued for 4 months with no signs of galactorrhea.[12] 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.[13] 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.[14] None of the mothers were taking Bupropion SR.