Pregnancy is always a special situation where every action or side effect of the drug varies when compared to a situation of a non-pregnant patient. It is not only because the pregnant woman's metabolism differs due to the hormonal and other changes happened to her, but also because every medicine or its metabolite passes to the baby and shows its action there. The only thing is, be cautious, attentive and well supervised when you take any single drug in pregnancy. The interactions can vary in pregnancy, and the dosage may differ as well. Strict supervision of the Physician is mandatory.
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Loptar and its metabolites cross the human placenta (Heikkinen, Ekblad, Kero 2002). An increased risk of teratogenic effects, including cardiovascular defects, may be associated with maternal use of Loptar or other SSRIs; however, available information is conflicting. Nonteratogenic effects in the newborn following SSRI/SNRI exposure late in the third trimester include respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypo- or hypertonia, hyper-reflexia, jitteriness, irritability, constant crying, and tremor. Symptoms may be due to the toxicity of the SSRIs/SNRIs or a discontinuation syndrome and may be consistent with serotonin syndrome associated with SSRI treatment. Persistent pulmonary hypertension of the newborn (PPHN) has also been reported with SSRI exposure. The long-term effects of in utero SSRI exposure on infant development and behavior are not known.
Due to pregnancy-induced physiologic changes, women who are pregnant may require adjusted doses of Loptar to achieve euthymia (Heikkinen, Ekblad, Kero 2002). The ACOG recommends that therapy with SSRIs or SNRIs during pregnancy be individualized; treatment of depression during pregnancy should incorporate the clinical expertise of the mental health clinician, obstetrician, primary health care provider, and pediatrician. According to the American Psychiatric Association (APA), the risks of medication treatment should be weighed against other treatment options and untreated depression. For women who discontinue antidepressant medications during pregnancy and who may be at high risk for postpartum depression, the medications can be restarted following delivery. Treatment algorithms have been developed by the ACOG and the APA for the management of depression in women prior to conception and during pregnancy (ACOG 2008; APA 2010; Yonkers 2009).
Pregnant women exposed to antidepressants during pregnancy are encouraged to enroll in the National Pregnancy Registry for Antidepressants (NPRAD). Women 18 to 45 years of age or their health care providers may contact the registry by calling 844-405-6185. Enrollment should be done as early in pregnancy as possible.
Loptar breastfeeding
When a drug is taken when the patient is breast feeding, a part of the drug is secreted in her breast milk and is passed to the baby. The dosage of the medicine to mother and baby are different, and many drugs actions are side effects when you take them without a disease, and what if you the baby takes them without a disease? What if the drug is contraindicated in newborns, infants or children? So, breastfeeding is a very alarming situation when the mother is on medications. Ask your Physician or Pediatrician about the effect of the drug on the baby and how much is excreted in breast milk and if it harms the baby!
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A decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. Excreted into human milk: Yes Comments: -Breastfed infants should be monitored for drowsiness -Mothers taking an SSRI during pregnancy and postpartum may have difficulty breastfeeding and may require additional breastfeeding support.
Cases of minor behavioral side effects such as drowsiness or fussiness have been reported; however no adverse effects on development have been observed in infants followed for up to 1 year. It has been suggested that Loptar therapy may be continued during breastfeeding if it was used during pregnancy or if other antidepressants were ineffective. Escitalopram, the S-enantiomer of Loptar, may be preferred during breastfeeding as its usual dose is about 25% that of Loptar and has a lower infant exposure. One study has reported that the relative dose to a suckling infant is similar to that reported for fluoxetine, and higher than that reported for fluvoxamine, paroxetine, or sertraline. Two cases have been reported of infants experiencing excessive somnolence, decreased feeding, and weight loss in relation to breast-feeding from a mother receiving Loptar. Milk/serum concentration ratios based on single pairs of samples from the two patients ranged from 1.16 to 1.88. Based on this, the absolute dose a suckling infant may ingest would be in the range of 4.3 to 17.6 micrograms/kg. The relative dose would be 0.7% to 5.9% of the weight- adjusted maternal dose. In one case the infant was reported to have recovered completely once the infants mother discontinued the Loptar. According to another case report, the relative infant Loptar dose from breast milk is approximately 9% of the weight- adjusted maternal dose. A study of seven women taking Loptar and their infants has reported that the plasma concentrations of Loptar and demethylcitalopram in the infants were very low or absent and there were no adverse effects.
See references
References for pregnancy information
"Product Information. Celexa (Loptar)." Forest Pharmaceuticals, St. Louis, MO.
"Use of psychoactive medication during pregnancy and possible effects on the fetus and newborn. Committee on Drugs. American Academy of Pediatrics." Pediatrics 105(4 Pt 1) (2000): 880-7
Cerner Multum, Inc. "Australian Product Information." O 0
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
Sivojelezova A, Shuhaiber S, Sarkissian L, Einarson A, Koren G "Loptar use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome." Am J Obstet Gynecol 193 (2005): 2004-9
References for breastfeeding information
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
Franssen EJ, Meijs V, Ettaher F, Valerio PG, Keessen M, Lameijer W "Loptar Serum and Milk Levels in Mother and Infant During Lactation." Ther Drug Monit 28 (2006): 2-4
Rampono J, Kristensen JH, Hackett LP, Pech M, Kohan R, Ilett KF "Loptar and demethylcitalopram in human milk; distribution, excretion and effects in breast fed infants." Br J Clin Pharmacol 50 (2000): 263-8
Cerner Multum, Inc. "Australian Product Information." O 0
United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL: http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT." ([cited 2013 -]):
"Product Information. Celexa (Loptar)." Forest Pharmaceuticals, St. Louis, MO.
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References
PubMed Health. "Citalopram (By mouth): This section provide the link out information of drugs collectetd in PubMed Health. ". http://www.ncbi.nlm.nih.gov/pubmedhe... (accessed September 17, 2018).
Human Metabolome Database (HMDB). "Citalopram: The Human Metabolome Database (HMDB) is a freely available electronic database containing detailed information about small molecule metabolites found in the human body.". http://www.hmdb.ca/metabolites/HMDB0... (accessed September 17, 2018).
LiverTox. "Citalopram: LIVERTOX provides up-to-date, accurate, and easily accessed information on the diagnosis, cause, frequency, patterns, and management of liver injury attributable to prescription and nonprescription medications, herbals and dietary supplements. ". https://livertox.nlm.nih.gov//Citalo... (accessed September 17, 2018).
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