Is Nortriptyline Safe in Breastfeeding

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

It is an active metabolite of Amitriptyline. Excreted into breast milk in a clinically non-significant amount (Wisner 1997,Matheson 1988, Brixen1982) with no problems observed in breastfed infants from treated mothers (Wisner 2002, 1997 y 1991,Brixen1982). Levels found in the plasma of those infants were very low or undetectable Wisner 2006 y 1991). It is considered one of the safest antidepressants during lactation (Gentile 2014, Nielsen 2012, Hübner 2012, Pringsheim 2012, Davanzo 2011, Lanza 2009, ABM 2008, Weissman 2004).

Because of the low levels of nortriptyline in breastmilk, amounts ingested by the infant are small and usually not been detected in the serum of the infant, although the less active metabolites are often detectable in low levels in infant serum. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Most authoritative reviewers consider nortriptyline one of the preferred antidepressants during breastfeeding.[1][2][3]

At least 44 infants have been reported to have been exposed to nortriptyline in breastmilk with no reports of adverse reactions with maternal dosages from 25 to 175 mg daily.[4][5][7][9][10][11][12] The time of initial exposure ranged from the immediate newborn period to 3.5 months. The follow-up ranged from observation of the infants to full developmental testing.Twenty-seven of the above infants were tested formally between 15 to 71 months and found to have normal growth and development.[10][12] Two small controlled studies found that other tricyclic antidepressants in breastmilk also had no adverse effect on infant development.[13][14]

Nortriptlyine usually increases serum prolactin only slightly, but has caused galactorrhea in nonpregnant, nonnursing patients rarely.[15][16] 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.[17] 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.[18] None of the mothers were taking nortriptyline.