Is Maprotiline Safe in Breastfeeding

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

If maprotiline is required by the mother, it is not a reason to discontinue breastfeeding. However, because there is little published experience with maprotiline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.

Although it is structurally a tetracyclic compound, maprotiline has pharmacologic actions similar to the tricyclic antidepressants. Follow-up for 1 to 3 years in a group of 20 breastfed infants whose mothers were taking a tricyclic antidepressant found no adverse effects on growth and development.[3] Two small controlled studies indicate that other tricyclic antidepressants have no adverse effect on infant development.[4][5] 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. One of the mothers was taking maprotiline.[6]

Maprotiline has caused increased serum prolactin levels and galactorrhea in nonpregnant, nonnursing patients.[6][7] 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.[8] 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.[9] None of the mothers were taking maprotiline.