1. Fluoxetine transfer into breast milk in sheep Author: Author: Groșan Alexandra Coauthor: Coauthor: Cucean Anda

2. - Postpartum depression usually occurs in the first four weeks after birth and is affecting 1 of 500 women. - Confusion, mood changes or paranoia are the most common symptoms that can make the mother to kill herself or her child; so the treatment is imperative. - The antidepressants can cross the blood-milk barrier and the child is exposed to the medication. - Postpartum depression usually occurs in the first four weeks after birth and is affecting 1 of 500 women. - Confusion, mood changes or paranoia are the most common symptoms that can make the mother to kill herself or her child; so the treatment is imperative. - The antidepressants can cross the blood-milk barrier and the child is exposed to the medication. Fluoxetine transfer into breast milk in sheep -When the treatment is initiated the doctor should take into account the potential adverse effects in the breastfed children. - If the medication is incompatible with breastfeeding the baby must be fed with a milk formula. -When the treatment is initiated the doctor should take into account the potential adverse effects in the breastfed children. - If the medication is incompatible with breastfeeding the baby must be fed with a milk formula.

3. IntroductionIntroduction -The average amount of drug in breastmilk is higher with fluoxetine than with most other SSRIs and the long-acting, active metabolite, norfluoxetine, is detectable in the serum of most breastfed infants during the first 2 months postpartum and in a few thereafter. -Adverse effects such as colic, fussiness, and drowsiness have been reported in some breastfed infants. -Decreased infant weight gain was found in one study, but not in others. -No adverse effects on development have been found in a few infants followed for up to a year. Aim of the study The aim of the study was to determine how fluoxetine is excreted into milk in sheep.

4. Experimental protocol Milk sample Blood sample 20 mg/day fluoxetine Blood sample 1 1 2 2 2 2 3 3 Biological samples HPLC/MS/MS method Final concentration

5. Experimental data - Fluoxetine mean concentration in sheep plasma: 22.46 ng/ml (ranged between 2.58 and 112.13 ng/ml) - Fluoxetine mean concentration in milk: 29.69 ng/ml (ranged between 1.5 and 143.33 ng/ml) - Fluoxetine mean concentration in lamb plasma: 3.31 ng/ml (ranged between 0.34 and 8.85 ng/ml) DI dose (mg/day)=C milk (mg/ml)xV milk (ml)Where : DI dose – infant daily dose; C milk – milk concentration; V milk – the milk volume (aprox.. 150ml) DI dose fluoxetine = 4453.5 ng /day DI dose (mg/kg/day) DM dose (mg/kg/zi) RD (%) = Where : RD (%) –infant relative dose; DI dose – infant daily dose; DM dose – mother daily dose. 44.565 x 10 -4 (mg/kg/day) 20 (mg/kg/day) RD(%) fluoxetine = RD (%) = 2.23 %

6. Fluoxetine is excreted into milk and can be ingested by the children therefore it is recommended that breastfeeding to be done before the next dose, when drug concentration in maternal blood is the lowest. ConclusionConclusion

7. Thank you!