Amitriptyline

Tricyclic antidepressant and analgesic with marked anticholinergic and sedative properties. Indicated in the treatment of depression, neuropathic pain and migraine prophylaxis. It is metabolized to nortriptyline ^{(Weissmann 2004)}. Oral administration in two daily doses.

It is excreted into breastmilk in a clinically non-significant amount. ^{(Bader 1980, Brixen 1982, Pittard 1986, Breyer 1995)}

Plasma levels in the infant have been found undetectable. ^{(Ericsson 1979, Bader 1980, Brixen 1982, Breyer 1995)} or very low. ^{(Yoshida 1997)}

No side effects being observed even at maternal doses as high as 150-175 mg / day ^{(Brixen 1982 , Misri 1991, Nulman 2002)}. However, one published case of sedation on a 15-day-old infant that occured within few days after taken just 10 mg daily of amitriptyline by her mother because of insomnia and anxiety ^{(Uguz 2017)}. Levels were not measured in either milk or plasma of the infant and the mother.

Amitriptyline may produce galactorrhoea with or without hyperprolatinemia. ^{(Suthar 2018, Coker 2010, Egberts 1997)}

Somnolence and adequate feeding of the infant should be monitored. Because it can cause sedation and drowsiness, it is not recommended to share a bed (co-sleeping, bed-sharing) with the baby if this medication is being taken, due to increased risk of asphyxia or sudden infant death. ^{(UNICEF 2018, 2017, 2014 and 2013, Landa 2012, ABM 2008, UNICEF 2006)}

Expert authors consider the use of this medication to be possible during lactation. ^{(Hale, Uguz 2021)}

Until more published data is known about this drug in relation to breastfeeding, known safer alternatives are preferable ^{(Sriraman 2015, Davanzo 2011, ABM 2008)}, especially during the neonatal period and in the event of prematurity.

Women suffering from depression during pregnancy need more breastfeeding support due to their increased risk of breastfeeding problems and early weaning. ^{(Grzeskowiak 2018, Leggett 2017, Venkatesh 2017, Gorman 2012)}

See below the information of this related product:

• Maternal Depression (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)