Last update July 5, 2022

N06AB04

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

SSRI antidepressant with actions and uses similar to those of fluoxetine. Oral administration once daily.

It is excreted in breast milk in small amounts although occasionally with a relative dose greater than 10%. (Pogliani 2019, Schoretsanitis 2019, Weisskopf 2017, Rampono 2000, Schmidt 2000, Jensen 1997, Spigset 1997)

Serum levels of infants from breastfeeding mothers who were treated have been shown to be undetectable or very low. (Berle 2004, Heikkinen 2002, Nordeng 2001, Rampono 2000)

Although there are some isolated cases of transient sleep disturbances, irritability or colic (Kronenfeld 2018, Schmidt 2000, Lee 2004), no short-term or long-term problems have been observed in the majority of infants whose mothers took it. (Werremeyer 2009, Berle 2004, Hendrick 2003, Rampono 2000, Jensen 1997)

Transient troubles in the early neonatal period like drug withdrawal syndrome among newborn or premature infants with high serum levels as a result of treatment with citalopram to the mother during pregnancy have been observed. (Erol 2017, Kieviet 2015, Franssen 2006, Nordeng 2001)

Galactorrhea associated or not to hyperprolactinemia, may appear. (Türkoğlu 2016, Trenque 2011, Koch 2011, Wessels 2006, González 2001).

Several medical societies, experts and expert consensus, consider the use of this medication safe or probably safe during breastfeeding. (Hale, Lactmed, Uguz 2021, Rubin 2004, Wisner 2002)

Safer known alternatives are preferable, especially during the neonatal period and in cases of prematurity. (Weisskopf 2017, Sriraman 2015, Larsen 2015, Sachs 2013, Rowe 2013, Berle 2011, Patil 2011, Davanzo 2010, Lanza 2009, ABM 2008, Weissman 2004, Gjerdingen 2003, Nordeng 2001)

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, Gorman 2012)


See below the information of this related product:

  • Maternal Depression (Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)

Alternatives

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

N06AB04 is Citalopram in ATC Code/s.

Is written in other languages:

N06AB04 is also known as

Tradenames

Main tradenames from several countries containing N06AB04 in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 80 %
Molecular weight 324 daltons
Protein Binding 80 %
VD 12 l/Kg
pKa 9.8 -
Tmax 2 - 4 hours
35 hours
M/P ratio 1 - 3 -
Theoretical Dose 0.024 - 0.048 mg/Kg/d
Relative Dose 3.6 - 18.3 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. LactMed. Drugs and Lactation Database (LactMed). Internet. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/ 2006 - Consulted on March 15, 2022 Full text (link to original source)
  3. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  4. Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol. 2018 Jun;84(6):1373-1379. Abstract Full text (link to original source)
  5. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017 Nov;33(4):701-709. Abstract
  6. Venkatesh KK, Castro VM, Perlis RH, Kaimal AJ. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017 Sep;37(9):1003-1009. Abstract
  7. Weisskopf E, Panchaud A, Nguyen KA, Grosjean D, Hascoët JM, Csajka C, Eap CB, Ansermot N; collaborators of the SSRI-Breast Milk study.. Simultaneous determination of selective serotonin reuptake inhibitors and their main metabolites in human breast milk by liquid chromatography-electrospray mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci. 2017 Jul 1;1057:101-109. Abstract
  8. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  9. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep;132(3):e796-809. Abstract Full text (link to original source) Full text (in our servers)
  10. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  11. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Abstract
  12. Koch HJ, Zellmer H. Marked mydriasis and neuritis nervi optici associated with galactorrhea following citalopram treatment: a case report and discussion. Case Rep Med. 2011 Abstract Full text (link to original source) Full text (in our servers)
  13. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  14. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Abstract Full text (link to original source) Full text (in our servers)
  15. Patil AS, Kuller JA, Rhee EH. Antidepressants in pregnancy: a review of commonly prescribed medications. Obstet Gynecol Surv. 2011 Abstract
  16. Trenque T, Herlem E, Auriche P, Dramé M. Serotonin reuptake inhibitors and hyperprolactinaemia: a case/non-case study in the French pharmacovigilance database. Drug Saf. 2011 Abstract
  17. Werremeyer A. Ziprasidone and citalopram use in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry. 2009 Abstract Full text (link to original source) Full text (in our servers)
  18. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  19. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  20. Franssen EJ, Meijs V, Ettaher F, Valerio PG, Keessen M, Lameijer W. Citalopram serum and milk levels in mother and infant during lactation. Ther Drug Monit. 2006 Abstract
  21. Wessels-van Middendorp AM, Timmerman L. Galactorroe en het gebruik van selectieve serotonineheropnameremmers. [Galactorrhoea and the use of selective serotonin reuptake inhibitors]. Tijdschr Psychiatr. 2006 Abstract Full text (link to original source) Full text (in our servers)
  22. Rubin ET, Lee A, Ito S. When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8. Abstract
  23. Berle JØ, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Abstract
  24. Lee A, Woo J, Ito S. Frequency of infant adverse events that are associated with citalopram use during breast-feeding. Am J Obstet Gynecol. 2004 Abstract
  25. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Abstract Full text (link to original source) Full text (in our servers)
  26. Hendrick V, Smith LM, Hwang S, Altshuler LL, Haynes D. Weight gain in breastfed infants of mothers taking antidepressant medications. J Clin Psychiatry. 2003 Abstract
  27. Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Abstract Full text (link to original source) Full text (in our servers)
  28. Heikkinen T, Ekblad U, Kero P, Ekblad S, Laine K. Citalopram in pregnancy and lactation. Clin Pharmacol Ther. 2002 Abstract
  29. Wisner KL, Parry BL, Piontek CM. Clinical practice. Postpartum depression. N Engl J Med. 2002 Abstract
  30. Nordeng H, Lindemann R, Perminov KV, Reikvam A. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr. 2001 Abstract
  31. Nordeng H, Bergsholm YK, Bøhler E, Spigset O. Overgang av selektive serotoninreopptakshemmere til morsmelk \ [The transfer of selective serotonin reuptake inhibitors to human milk]. Tidsskr Nor Laegeforen. 2001 Abstract Full text (link to original source) Full text (in our servers)
  32. González Pablos E, Mínguez Martín L, Hernández Fernández M, Sanguina Andrés RM. [A clinical case of galactorrhoea after citalopram treatment]. Actas Esp Psiquiatr. 2001 Abstract
  33. Schmidt K, Olesen OV, Jensen PN. Citalopram and breast-feeding: serum concentration and side effects in the infant. Biol Psychiatry. 2000 Abstract
  34. Rampono J, Kristensen JH, Hackett LP, Paech M, Kohan R, Ilett KF. Citalopram and demethylcitalopram in human milk; distribution, excretion and effects in breast fed infants. Br J Clin Pharmacol. 2000 Abstract Full text (link to original source) Full text (in our servers)
  35. Jensen PN, Olesen OV, Bertelsen A, Linnet K. Citalopram and desmethylcitalopram concentrations in breast milk and in serum of mother and infant. Ther Drug Monit. 1997 Abstract
  36. Spigset O, Carieborg L, Ohman R, Norström A. Excretion of citalopram in breast milk. Br J Clin Pharmacol. 1997 Abstract Full text (link to original source) Full text (in our servers)

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