One of my colleagues and I had a PUN/DEN moment today. A PUN is a Patient Unmet Need while a DEN is a Doctor’s Educational Need. This are rather fancy abbreviations for questions that come to us in daily clinical practice. A quick discussion with colleagues or a search on websites will bring a resolution to the problem in most cases. These questions if compiled somewhere are a good source of directed learning and education.

The answer to our question was not quite as clear as we initially expected. According to Epocrates online it is safe in lactation. According to rxlist.comIt is not known whether, and if so in what amount, sertraline or its metabolites are excreted in human milk“. And finally to confuse matters according to drugs.comSertraline passes into breast milk. Side effects have been reported in a baby exposed during nursing. Before taking this medicine, make sure your doctor knows if you are nursing your baby.” For a final clinically weightted answer rather than an ‘avoid being sued legal answer’ we went to emedicine.com which said the following:

  • Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into breast milk. Concentrations in breast milk vary widely.
  • Data on the use of tricyclic antidepressants, fluoxetine, sertraline, and paroxetine during breastfeeding are encouraging, and serum antidepressant levels in the breastfed infant are either low or undetectable. Reports of toxicity in breastfed infants are rare, although the long-term effects of exposure to trace amounts of medication are not known.
  • We discussed the case and it transpired the mother had only fed her child once as she was afraid of the package insert. We felt it was in the patiet’s best interests and her child’s that she continue breast feeding and consider the likelihood of any adverse outcome due to the sertraline as very low.

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