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Sertralin

Klassificering: 2

Preparat: Oralin, Sertralin Actavis, Sertralin Alpharma, Sertralin Alternova, Sertralin Amendia, Sertralin Bluefish, Sertralin Copyfarm, Sertralin Hexal, Sertralin IVAX, Sertralin Krka, Sertralin Mylan, Sertralin Orion, Sertralin Paranova, Sertralin Ranbaxy, Sertralin ratiopharm, Sertralin Sandoz, Sertralin STADA, Sertralin Teva, Sertralin Winthrop, Sertraline Accord, Sertrone, Setaloft, Zoloft, Zoloft®

ATC kod: N06AB06

Substanser: sertralin, sertralinhydroklorid

Råd till allmänheten

Kontakta läkare för diskussion innan behandling påbörjas.

För hälso- och sjukvården

Rekommendation

Risken för ett friskt fullgånget barn anses vara låg vid terapeutiska doser.

Bakgrund

Passerar över till bröstmjölk. Baserat på data från knappt 66 kvinnor kan den relativa barndosen beräknas till <4 % (1-4, 17-19, 22). Plasmakoncentrationer av sertralin och desmetylsertralin har varit icke-detekterbara eller mycket låga hos närmare 100 ammade barn (2,4-13). Hos två barn har höga plasmakoncentrationer av sertralin och desmetylsertralin uppmätts (50 % respektive >100 % av moderns plasmakoncentration) (2,9). Inga negativa effekter har rapporterats hos mer än 125 ammade barn (2,4-7,9-12,14, 20). För sammanlagt tio ammade barn har symptom rapporterats: minskad sugreflex, muskulär hypotoni, täta avföringar, agitation, somnolens, slöhet, insomnia, hörselproblem och utvecklingssvårigheter (1,15-16, 20-21).

Uppdaterat: 2019-08-22

Referenser

Dokumentationsgrad: 2
  1. Müller MJ, Preuß C, Paul T, Streit F, Brandhorst G, Seeliger S. Serotonergic overstimulation in a preterm infant after sertraline intake via breastmilk. Breastfeed Med. 2013;8(3):327-9. PubMed
  2. Stowe ZN, Hostetter AL, Owens MJ, Ritchie JC, Sternberg K, Cohen LS et al. The pharmacokinetics of sertraline excretion into human breast milk: determinants of infant serum concentrations. J Clin Psychiatry. 2003;64(1):73-80. PubMed
  3. Berle JO, 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;65(9):1228-1234. PubMed
  4. Dodd S, Stocky A, Buist A, Burrows GD, Norman TR. Sertraline analysis in the plasma of breast-fed infants. Aust N Z J Psychiatry. 2001;35(4):545-6. PubMed
  5. Hendrick V, Fukuchi A, Altshuler L et al. Use of sertraline, paroxetine and fluvoxamine by nursing women. Br J Psychiatry. 2001;179:163-6. PubMed
  6. Sunder KR, Wisner KL, Hanusa BH, Perel JM. Postpartum depression recurrence versus discontinuation syndrome: observations from a randomized controlled trial. J Clin Psychiatry. 2004;65(9):1266-8. PubMed
  7. Wisner KL, Hanusa BH, Perel JM, Peindl KS, Piontek CM, Sit DK et al. Postpartum depression: a randomized trial of sertraline versus nortriptyline. J Clin Psychopharmacol. 2006;26(4):353-60. PubMed
  8. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009;52(3):483-97. PubMed
  9. Wisner KL, Perel JM, Blumer J. Serum sertraline and N-desmethylsertraline levels in breast-feeding mother-infant pairs. Am J Psychiatry. 1998;155(5):690-2. PubMed
  10. Mammen OK, Perel JM, Rudolph G, Foglia JP, Wheeler SB. Sertraline and norsertraline levels in three breastfed infants. J Clin Psychiatry. 1997;58(3):100-3. PubMed
  11. Epperson N, Czarkowski KA, Ward-O'Brien D, Weiss E, Gueorguieva R, Jatlow P et al. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry. 2001;158(10):1631-7. PubMed
  12. Stowe ZN, Owens MJ, Landry JC, Kilts CD, Ely T, Llewellyn A et al. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry. 1997;154(9):1255-60. PubMed
  13. Dodd S, Stocky A, Buist A, Burrows GD, Maguire K, Norman TR. Sertraline in paired blood plasma and breast-milk samples from nursing mothers. Hum Psychopharmacol. 2000;15(4):161-264. PubMed
  14. 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;190(1):218-21. PubMed
  15. Rohan A. Drug distribution in human milk. Australian Prescriber 1997;20(4).
  16. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr. 2012;161(3):448-51. PubMed
  17. Pogliani L, Baldelli S, Cattaneo D, Pileri P, Clementi E, Cetin I et al. Selective serotonin reuptake inhibitors' passage into human milk of lactating women. J Matern Fetal Neonatal Med. 2018;1-6. PubMed
  18. Weisskopf E, Panchaud A, Nguyen KA, Grosjean D, Hascoët JM, Csajka C et al. 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;1057:101-109. PubMed
  19. Salazar FR, D'Avila FB, de Oliveira MH, Ferreira PL, Bergold AM. Development and validation of a bioanalytical method for five antidepressants in human milk by LC-MS. J Pharm Biomed Anal. 2016;129:502-508. PubMed
  20. Uguz F, Arpaci N. Short-Term Safety of Paroxetine and Sertraline in Breastfed Infants: A Retrospective Cohort Study from a University Hospital. Breastfeed Med. 2016;11:487-489. PubMed
  21. Uguz F. Better Tolerance of Citalopram in a Breastfed Infant Who Could Not Tolerate Sertraline and Paroxetine. Breastfeed Med. 2018;13(1):89-90. PubMed
  22. Schoretsanitis G, Augustin M, Saßmannshausen H, Franz C, Gründer G, Paulzen M. Antidepressants in breast milk; comparative analysis of excretion ratios. Arch Womens Ment Health. 2018. PubMed

- Författat av Klinisk farmakologi, Karolinska Universitetssjukhuset för Hälso- och sjukvårdsförvaltningen, Region Stockholm. Janusmed amning uppdateras kvartalsvis.