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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK501170_"><span class="title" itemprop="name">Protriptyline</span></h1><p class="small">Last Revision: <span itemprop="dateModified">April 18, 2022</span>.</p><p><em>Estimated reading time: 2 minutes</em></p></div><div class="body-content whole_rhythm" itemprop="text"><p>CASRN: 438-60-8</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/134974679" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=134974679" alt="image 134974679 in the ncbi pubchem database" /></a><div id="LM309.Drug_Levels_and_Effects"><h2 id="_LM309_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM309.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Because there is no published experience with protriptyline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.</p></div><div id="LM309.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Relevant published information was not found as of the revision date.</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM309.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>Published information on protriptyline was not found as of the revision date. Follow-up for 1 to 3 years in a group of 20 breastfed infants whose mothers were taking a tricyclic antidepressant found no adverse effects on growth and development.[<a class="bk_pop" href="#LM309.REF.1">1</a>] Two small controlled studies indicate that other tricyclic antidepressants have no adverse effect on infant development.[<a class="bk_pop" href="#LM309.REF.2">2</a>,<a class="bk_pop" href="#LM309.REF.3">3</a>] In another study, 25 infants whose mothers took a tricyclic antidepressant during pregnancy and lactation were tested formally between 15 to 71 months and found to have normal growth and development.[<a class="bk_pop" href="#LM309.REF.4">4</a>]</p></div><div id="LM309.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[<a class="bk_pop" href="#LM309.REF.5">5</a>] The antidepressants used by the mothers were not specified.</p><p>A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[<a class="bk_pop" href="#LM309.REF.6">6</a>] None of the mothers were taking protriptyline.</p><p>In a study of 80,882 Norwegian mother-infant pairs from 1999 to 2008, new postpartum antidepressant use was reported by 392 women and 201 reported that they continued antidepressants from pregnancy. Compared with the unexposed comparison group, late pregnancy antidepressant use was associated with a 7% reduced likelihood of breastfeeding initiation, but with no effect on breastfeeding duration or exclusivity. Compared with the unexposed comparison group, new or restarted antidepressant use was associated with a 63% reduced likelihood of predominant, and a 51% reduced likelihood of any breastfeeding at 6 months, as well as a 2.6-fold increased risk of abrupt breastfeeding discontinuation. Specific antidepressants were not mentioned.[<a class="bk_pop" href="#LM309.REF.7">7</a>]</p></div><div id="LM309.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM314/">Nortriptyline</a>, <a href="/books/n/lactmed/LM327/">Paroxetine</a>, <a href="/books/n/lactmed/LM328/">Sertraline</a></p></div><div id="LM309.References"><h3>References</h3><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="LM309.REF.1">Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: A preliminary report. <span><span class="ref-journal">Int J Psychiatry Med. </span>1991;<span class="ref-vol">21</span>:157–71.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1894455" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1894455</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="LM309.REF.2">Buist A, Janson H. Effect of exposure to dothiepin and northiaden in breast milk on child development. <span><span class="ref-journal">Br J Psychiatry. </span>1995;<span class="ref-vol">167</span>:370–3.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7496646" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7496646</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="LM309.REF.3">Yoshida K, Smith B, Craggs M, et al. Investigation of pharmacokinetics and possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. <span><span class="ref-journal">J Affect Disord. </span>1997;<span class="ref-vol">43</span>:225–37.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9186793" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9186793</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="LM309.REF.4">Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: A prospective, controlled study. <span><span class="ref-journal">Am J Psychiatry. </span>2002;<span class="ref-vol">159</span>:1889–95.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12411224" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12411224</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="LM309.REF.5">Venkatesh KK, Castro VM, Perlis RH, et al. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: An observational cohort study. <span><span class="ref-journal">J Perinatol. </span>2017;<span class="ref-vol">37</span>:1003–9.</span> [<a href="/pmc/articles/PMC10034861/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10034861</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28682318" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28682318</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="LM309.REF.6">Leggett C, Costi L, Morrison JL, et al. Antidepressant use in late gestation and breastfeeding rates at discharge from hospital. <span><span class="ref-journal">J Hum Lact. </span>2017;<span class="ref-vol">33</span>:701–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28984528" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28984528</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="LM309.REF.7">Grzeskowiak LE, Saha MR, Nordeng H, et al. Perinatal antidepressant use and breastfeeding outcomes: Findings from the Norwegian Mother, Father and Child Cohort Study. <span><span class="ref-journal">Acta Obstet Gynecol Scand. </span>2022;<span class="ref-vol">101</span>:344–54.</span> [<a href="/pmc/articles/PMC9564556/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9564556</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35170756" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35170756</span></a>]</div></dd></dl></div></div><div id="LM309.Substance_Identification"><h2 id="_LM309_Substance_Identification_">Substance Identification</h2><div id="LM309.Substance_Name"><h3>Substance Name</h3><p>Protriptyline</p></div><div id="LM309.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>438-60-8</p></div><div id="LM309.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Antidepressive Agents</p><p>Antidepressive Agents, Tricyclic</p></div></div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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