Information on level of drugs into breastmilk
Wendy Jones in Breastfeeding and Medication, 2013
Atypical anti-psychotics Atypical anti-psychotics may be better tolerated with fewer extra-pyramidal side effects. However, they do produce weight gain and a risk of hyperglycaemia which may need to be monitored regularly. Antipsychotic of choice in a mother during breastfeeding based on evidence of benefit and safety for the baby: The drug which best controls symptoms in the mother, is the most important consideration Amisulpiride Brand names: Solian US brands: Australian brands: Solian Amisulpiride has fewer side effects than the typical anti-psychotics but agitation and insomnia are reported. It is 16% plasma protein bound and 48% orally bio-available. It also increases prolactin and may lead to galactorrhoea (Teoh et al. 2010). There is limited information on transfer into breastmilk. Ilett et al. (2010) studied one mother who was keen to undertake partial breastfeeding on 250 mg desvenlafaxine daily and 100 mg amilsulpiride twice daily. Measurements on levels in milk and the plasma of mother and baby over a 24-hour period, gave a relative infant dose of 6.1% for amisulpride. No abnormalities in development were noted in a paediatric assessment and the mother planned to continue partial breastfeeding. 173
Posttraumatic Stress Disorder
Stephen M. Stahl, Bret A. Moore in Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy, 2013
Both the VA/DoD (2010) and the APA Guideline Watch (Benedek et al., 2009) support the use of SNRIs for PTSD. There are currently four SNRIs available in the United States: venlafaxine, desvenlafaxine, duloxetine, and milnacipran. Of these, venlafaxine has the strongest evidence, based on two large-scale RCTs with civilian populations. Davidson et al. (2006a) studied venlafaxine extended-release versus placebo in 329 adult outpatients with a CAPS (Clinician-Administered PTSD Scale; Blake et al., 1995) score of 60 or greater and found a mean change in total CAPS score from baseline of —51.7 for venlafaxine compared to —43.9 for placebo. When the three symptom clusters of PTSD were analyzed, the re-experiencing and avoidance/numbing symptom clusters improved compared to placebo, but the hyperarousal symptom cluster did not. Remission rates (CAPS = 20 or below) were 50.9& for venlafaxine and 37.5& for placebo. In a separate 12-week multicenter double-blind trial, venlafaxine extended release was compared to sertraline and placebo. Only venlafaxine indicated significant improvements over placebo (Davidson et al., 2006b). Desvenlafaxine, a metabolite of venlafaxine, has not been studied in PTSD. An open-label preliminary study of duloxetine showed promising results, justifying the need for an RCT (Villarreal, Canive, Calaise, Toney, & Smith, 2010).
Inhibitors of Human CYP2D6
Shufeng Zhou in Cytochrome P450 2D6, 2018
Duloxetine coadministration increases the AUC and Cmax of desipramine 122% and 63% in humans, respectively (Skinner et al. 2003), while desvenlafaxine has only marginal effect on the exposure of desipramine (Patroneva et al. 2008). Sertraline results in an approximately 30%-44% elevation in plasma desipramine concentrations (Alderman et al. 1997b; Barros and Asnis 1993; Preskorn et al. 1994). Citalopram causes -50% increase in the AUC of desipramine (Gram et al. 1993).
Desvenlafaxine in the treatment of major depression: an updated overview
Published in Expert Opinion on Pharmacotherapy, 2021
Trevor R Norman, James S Olver
Desvenlafaxine is marketed for the treatment of major depression in a number of countries and there is considerable experience with its use in clinical practice. Its efficacy is based on multiple clinical trials, which have been extensively reviewed elsewhere [8,9]. The present article considers additional trials of desvenlafaxine in major depressive disorder.
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