Is Clozapinum Safe in Breastfeeding

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

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Because there is little published experience with Clozapinum during breastfeeding, and sedation and adverse hematologic effects have been reported in breastfed infants, other agents are preferred.[1] If breastfeeding is undertaken by a mother who is taking Clozapinum, close monitoring of the infant for excessive sedation and periodic monitoring of the infant's white blood cell count is advisable. Several authoritative sources recommend that women taking Clozapinum not breastfeed.[2][3][4]

Among 4 infants who were breastfed by mothers taking Clozapinum, 1 infant experienced drowsiness and 1 infant experienced agranulocytosis possibly caused by Clozapinum. Details of the cases are lacking.[7] A healthy female infant was born to a mother who took Clozapinum 100 mg daily throughout pregnancy and lactation. She was breastfed (extent not stated) up to 1 year of age. The infant developed normally except for speech which was delayed considerably. She did not achieve normal, fluent speech until the age of 5 years. The delayed speech development was possibly related to Clozapinum in breastmilk, but it could have been the result of exposure to the drug during gestation or could have been unrelated to Clozapinum.[8] One woman who took Clozapinum 100 mg daily in late pregnancy and postpartum partially breastfed her infant for 5 days. No neurodevelopmental disorders were detected in the infant after 32 months of follow-up.[6]

Unlike the phenothiazines, Clozapinum has a minimal effect on maternal serum prolactin levels.[9][10] However, a woman who had been taking Clozapinum plus high-dose haloperidol developed hyperprolactinemia and severe galactorrhea 2 weeks after stopping haloperidol and 4 days after starting valproic acid. A dose of cabergoline normalized her serum prolactin and galactorrhea ceased for the following 2 months of observation.[11] The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.