Ziprasidone use while Breastfeeding
Drugs containing Ziprasidone: Geodon
Ziprasidone Levels and Effects while Breastfeeding
Summary of Use during Lactation
Because there is little published experience with ziprasidone during breastfeeding, other antipsychotic agents are preferred, especially while nursing a newborn or preterm infant.
Maternal Levels. In one woman, ziprasidone was started at 9 days postpartum (dosage not stated, but presumably at a low dose and titrated upward). Serum and milk concentrations were obtained 10 minutes before the morning dose every day for 16 days. By day 7 of therapy, the patient was taking 80 mg of ziprasidone twice daily. Ziprasidone was not detectable in milk until day 10 of therapy when the milk concentration was 11 mcg/L; thereafter, the milk concentrations were not quantifiable (<10 mcg/L).
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
A woman took ziprasidone 40 mg and citalopram 60 mg daily throughout pregnancy and postpartum. She breastfed extensively, except for occasional formula feedings by others. At 6 months of age, a pediatrician found the infant to be healthy with normal growth and development.
Effects on Lactation and Breastmilk
Prolactin elevation has occurred during ziprasidone treatment, and galactorrhea has been reported, often in adolescents. However, prolactin elevation might be more transient and less severe than with phenothiazines. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Alternate Drugs to Consider
1. Uguz F. Second-generation antipsychotics during the lactation period: A comparative systematic review on infant safety. J Clin Psychopharmacol. 2016;36:244-52. PMID: 27028982
2. Schlotterbeck P, Saur R, Hiemke C et al. Low concentration of ziprasidone in human milk: a case report. Int J Neuropsychopharmacol. 2009;12:437-8. PMID: 19203410
3. Werremeyer A. Ziprasidone and citalopram use in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry. 2009;166:1298. Letter. PMID: 19884241
4. Jordan MP. Ziprasidone-associated galactorrhea in a female teenager. J Am Acad Child Adolesc Psychiatry. 2003;42(1):4-5. Letter. PMID: 12500070
5. Kopecek M, Bares M, Mohr P. Ziprasidone-induced galactorrhea: a case report. Neuro Endocrinol Lett. 2005;26:69-70. PMID: 15726024
6. Ramadan M, Khan A, Preskorn S. D2-blockade and possible ziprasidone-induced galactorrhea. Int Clin Psychopharmacol. 2005;20:113-4. PMID: 15729088
7. Saldana SN, Delgado SV. Ziprasidone-associated galactorrhea in an adolescent female. J Child Adolesc Psychopharmacol. 2007;17:259-60. PMID: 17489723
8. Ginsberg DL. Ziprasidone-induced galactorrhea. Prim Psychiatr. 2003;April:22-3.
9. Ginsberg DL. Ziprasidone-induced hyperprolactinemia. Prim Psychiatry. 2004;11:26-7.
10. Myers WT. A lacting adolescent on atypical antipsychotics: A case report of an emerging challenge. J Invest Med. 2014;62:485. Abstract.
11. Raza S, Haq F. Ziprasidone-Induced galactorrhea in an adolescent female: A case report. Prim Care Companion J Clin Psych. 2010;12.
12. Maguire GA. Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry. 2002;63(suppl 4):56-62. PMID: 11913677
13. Goodnick PJ, Rodriguez L, Santana O. Antipsychotics: impact on prolactin levels. Expert Opin Pharmacother. 2002;3:1381-91. PMID: 12387684
14. Weiden PJ, Daniel DG, Simpson G, Romano SJ. Improvement in indices of health status in outpatients with schizophrenia switched to ziprasidone. J Clin Psychopharmacol. 2003;23:595-600. PMID: 14624190
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Other brands: Geodon