Bupropion and Escitalopram During Lactation

Area of Science:

• Neonatal Neurology
• Pharmacology
• Maternal-Fetal Medicine

Background:

• Maternal depression treatment often involves antidepressants like bupropion and escitalopram.
• Increasing numbers of reproductive-aged women use polytherapy for depression.
• Infant exposure to these medications can occur via breastfeeding.

Purpose of the Study:

• To report a case of seizure-like symptoms in an infant exposed to bupropion and escitalopram through breast milk.
• To investigate the potential link between maternal antidepressant use and infant adverse events.

Main Methods:

• Case report of a 6.5-month-old infant presenting with emesis and seizure-like symptoms.
• Urine toxicology screen on infant positive for bupropion and escitalopram.
• Serum and breast milk analysis for bupropion and its metabolite, hydroxybupropion.

Main Results:

• Infant symptoms resolved with supportive care.
• Bupropion and hydroxybupropion were detected in infant serum and breast milk.
• Naranjo assessment indicated probable adverse drug events related to bupropion and escitalopram exposure.

Conclusions:

• Infants may exhibit increased susceptibility to the epileptogenic effects of bupropion and hydroxybupropion.
• Potential drug interactions between bupropion and escitalopram may contribute to adverse events.
• Further research is crucial to establish the safety of combined antidepressants during lactation.