Summary of Use during Lactation

A safety scoring system finds ziprasidone possible to use cautiously during breastfeeding.[1] Because there is little published experience with ziprasidone during breastfeeding, other antipsychotic agents are preferred, especially while nursing a newborn or preterm infant.

Drug Levels

Maternal Levels. In one woman, ziprasidone was started at 9 days postpartum (dosage not stated, but presumably at a low dose and titrated upward). Serum and milk concentrations were obtained 10 minutes before the morning dose every day for 16 days. By day 7 of therapy, the patient was taking 80 mg of ziprasidone twice daily. Ziprasidone was not detectable in milk until day 10 of therapy when the milk concentration was 11 mcg/L; thereafter, the milk concentrations were not quantifiable (<10 mcg/L).[2]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A woman took ziprasidone 40 mg and citalopram 60 mg daily throughout pregnancy and postpartum. She breastfed extensively, except for occasional formula feedings by others. At 6 months of age, a pediatrician found the infant to be healthy with normal growth and development.[3]

Effects on Lactation and Breastmilk

Prolactin elevation has occurred during ziprasidone treatment,[4-9] and galactorrhea has been reported, often in adolescents.[6-11] However, prolactin elevation might be more transient and less severe than with phenothiazines.[12-14] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider

Haloperidol, Olanzapine, Quetiapine, Risperidone

References

1.

Uguz F. A new safety scoring system for the use of psychotropic drugs during lactation. Am J Ther. 2021;28:e118–e26. [PubMed: 30601177]

2.

Schlotterbeck P, Saur R, Hiemke C, et al. Low concentration of ziprasidone in human milk: A case report. Int J Neuropsychopharmacol. 2009;12:437–8. [PubMed: 19203410]

3.

Werremeyer A. Ziprasidone and citalopram use in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry 2009;166:1298. Letter. PMID: 19884241. [PubMed: 19884241]

4.

Ginsberg DL. Ziprasidone-induced galactorrhea. Prim Psychiatry. 2003;(April):22–3.

5.

Ginsberg DL. Ziprasidone-induced hyperprolactinemia. Prim Psychiatry. 2004;11:26–7.

6.

Jordan MP. Ziprasidone-associated galactorrhea in a female teenager. J Am Acad Child Adolesc Psychiatry 2003;42:4-5. Letter. PMID: 12500070. [PubMed: 12500070]

7.

Kopecek M, Bares M, Mohr P. Ziprasidone-induced galactorrhea: A case report. Neuro Endocrinol Lett. 2005;26:69–70. [PubMed: 15726024]

8.

Ramadan M, Khan A, Preskorn S. D2-blockade and possible ziprasidone-induced galactorrhea. Int Clin Psychopharmacol. 2005;20:113–4. [PubMed: 15729088]

9.

Saldaña SN, Delgado SV. Ziprasidone-associated galactorrhea in an adolescent female. J Child Adolesc Psychopharmacol. 2007;17:259–60. [PubMed: 17489723]

10.

Myers WT. A lacting adolescent on atypical antipsychotics: A case report of an emerging challenge. J Investig Med. 2014;62:485. Abstract.

11.

Raza S, Haq F. Ziprasidone-induced galactorrhea in an adolescent female: A case report. Prim Care Companion J Clin Psych 2010;12. PMID: 20944784. [PMC free article: PMC2947527] [PubMed: 20944784]

12.

Goodnick PJ, Rodríguez L, Santana O. Antipsychotics: Impact on prolactin levels. Expert Opin Pharmacother. 2002;3:1381–91. [PubMed: 12387684]

13.

Maguire GA. Prolactin elevation with antipsychotic medications: Mechanisms of action and clinical consequences. J Clin Psychiatry. 2002;63 Suppl 4:56–62. [PubMed: 11913677]

14.

Weiden PJ, Daniel DG, Simpson G, et al. Improvement in indices of health status in outpatients with schizophrenia switched to ziprasidone. J Clin Psychopharmacol. 2003;23:595–600. [PubMed: 14624190]

Substance Name

Ziprasidone

CAS Registry Number

146939-27-7

Drug Class

Breast Feeding

Lactation

Antipsychotic Agents