Antipsychotic medications are commonly categorized by their mechanism of action into first generation (typical) and second generation (atypical) medications. No information is available regarding the use of many antipsychotic medications during lactation and alternative medications should be considered due to the lack of information with these medications. For further details regarding specific medications see below.

For more detailed information and references on specific medications, please refer to LactMed, e-lactancia, Infant Risk, or Mother to Baby.

A safety scoring system determined that it is possible to use this medication during lactation with caution.¹ There is a risk of infant drowsiness  when used during lactation. When this medication has been used in combination with haloperidol, a possible negative effect on child development has been observed.² Chlorpromazine, as a dopamine antagonist, can increase prolactin and increase milk production. This medication should be used with caution in lactating parents with close monitoring of the infant for signs of excessive drowsiness or suboptimal development, especially when it is used in combination with other antipsychotics. While there is no absolute indication to pump and dump, the lactating parent should be engaged in shared decision making regarding the use of their milk while taking this medication.

Limited data shows that haloperidol up to 10mg daily yields low levels in breastmilk. No adverse child effects have been found. A safety scoring system determined that it is possible to use this medication with caution during lactation.¹ While this medication should be used with caution with close monitoring of the infant, there is no absolute indication to pump and dump and the lactating parent should be engaged in shared decision making when prescribed this medication.

No information is available regarding the use of this medication during lactation. Because lumateperone is known to be 97.5% bound to plasma proteins, the amount in the breastmilk would be expected to be low and would not be expected to adversely affect the infant. The manufacturer, however, does not recommend the use of this medication during lactation. Due to the lack of data, an alternative medication should be considered. While there is no absolute indication to pump and dump, this medication should be used with caution and lactating individuals should be engaged in shared decision making  when prescribed this medication.

Limited data shows that a daily dose up to 24mg of perphenazine yields low levels in breastmilk. No adverse child effects have been found.  Perphenazine, as a dopamine antagonist, can increase serum prolactin, causing increased milk production.  While an alternative is preferred due to the lack of data and this medication should be used with caution in lactating individuals, there is no absolute indication to pump and dump. Lactating parents should be engaged in shared decision when prescribed this medication.

Limited data shows that up to 10mg daily of trifluoperazine is not associated with  adverse child effects. A safety scoring system determined that this medication should not be used during lactation.¹ Trifluoperazine, as a dopamine antagonist, can increase serum prolactin, causing increased milk production. An alternative medication is preferred. This medication should be used with caution and providers should engage lactating parents in shared decision making when prescribing this medication.

Brexipiprazole is a dopamine receptor partial agonist, and is hypothesized to act as a functional agonist, partial agonist, or functional antagonist at the  dopamine D2 receptor; which may be dose dependent.^3,4 This medication can impact prolactin levels and contribute to low milk production that may be improved with discontinuation of the medication, which has been demonstrated in a single case report. This case report involved a parent who started brexipiprazole in her 3^rd trimester, experienced a decrease in milk production postnatally which then increased after cessation of the medication. Later she restarted the medication and experienced a similar decrease in milk production with a subsequent increase following cessation a second time.⁵ While parents should be counseled on the risk of insufficient milk production and that there is a lack of data on the safety of this medication in lactation, there is no absolute indication to pump and dump. Lactating and parents should be engaged in shared decision making when prescribed this medication.

There is no information available regarding the use of these medications during lactation and therefore it is recommended to prescribe alternative medications during lactation.

Aripiprazole is a dopamine receptor partial agonist, and is hypothesized to act as a functional agonist, partial agonist, or functional antagonist at the dopamine D2 receptor; which may be dose dependent.^3,4 Limited data shows that up to 15mg/day of aripiprazole yields low levels in breastmilk. This medication can impact prolactin levels and result in difficulty initiating lactation or contribute to low milk production that may be improved with discontinuation of the medication, which has been demonstrated in case reports.^6–12  While parents should be counseled on the high risk of insufficient milk production and that there is a lack of data on the safety of this medication in lactation, there is not an absolute indication to pump and dump. Lactating and parents should be engaged in shared decision making when prescribed this medication.

In limited studies, there have been cases of infant sedation and agranulocytosis, an adverse hematologic effect, with parental use of this medication during lactation.^1,13,14 Many expert sources do not recommend the use of this medication during lactation.^15–17 Alternative medications should be considered.

No information is available regarding the use of this medication during lactation. Because this medication is known to be over 99% bound to plasma proteins, the amount in the breastmilk would be expected to be low and would not be expected to adversely affect the child. The manufacturer, however, does not recommend using this medication during lactation. Alternatives are preferred due to lack of data on the use of this medication in lactating individuals. While this medication should be used with caution in lactating parents, there is no absolute indication to pump and dump and lactating individuals should be engaged in shared decision making when prescribed this medication.

Limited data shows that up to 20mg/day of olanzapine yields low levels of this medication in breastmilk, and undetectable levels in the serum of breastfed infants. Although there are reports of infant sedation and developmental delays in a small case series, a safety scoring system determined that it is possible to use this medication during lactation.¹ Olanzapine is less likely to increase serum prolactin, as compared to phenothiazines. While infants should be closely monitored for sedation, growth delays, and developmental delays, there is not an absolute indication to pump and dump with this medication and lactating individuals should be engaged in shared decision making when prescribed this medication.

No information is available regarding the use of this medication during lactation. Paliperidone is an active metabolite of risperidone, please see the section on risperidone below for further details during lactation. A safety scoring system determined that it is possible to use this medication with caution in lactation.¹ Paliperidone is a long-acting injectable medication, therefore there may be small amounts delivered to the breastmilk for many months. Paliperidone, as a dopamine antagonist, can increase serum prolactin, causing increased milk production. While an alternative is preferred due to the lack of data and this medication should be used with caution, there is no absolute indication to pump and dump Lactating parents should be engaged in shared decision making when prescribed this medication.

Limited data shows that up to 6mg daily of risperidone yields low levels of this medication in breastmilk. Breastfed infants exposed to risperidone have been reported to be drowsy. When this medication was used in combination with other antipsychotic medications, there was a possible negative effect on child development or motor skills.^18–20 Risperidone, as a dopamine antagonist, can increase serum prolactin, causing increased milk production. While breastfed infants should be closely monitored for sedation and developmental delay especially when this medication is used in combination with other antipsychotics, there is not an absolute indication to pump and dump and the lactating parent should be engaged in shared decision making  when prescribed this medication.

Limited data shows that up to 400mg daily of Seroquel yields low levels in breastmilk with less than 1% of the maternal weight-adjusted dosage present in milk. No adverse child effects have been found. A safety scoring system determined that it is possible to use this medication during lactation.¹ There is no absolute indication to pump and dump with this medication.

This medication is not approved for market in the United States. It is used as a psychiatric medication and galactagogue in some countries outside the USA, as it can raise the parental prolactin level. This medication is found in high concentrations in breastmilk, greater than the accepted 10% of maternal weight-adjusted dosage in some cases. However, the serum level in infants has not been evaluated. No adverse child effects have been found. While alternatives are preferred, there is not an absolute indication to pump and dump with this medication and the lactating parent should be engaged in shared decision making when prescribed this medication.

Limited information is available regarding the use of this medication during lactation. A safety scoring system determined that it is possible to use this medication with caution in lactation.¹ Ziprasidone may increase the parental prolactin level and increase milk production although to a lesser degree than phenothiazines. Due to the lack of safety data, an alternative medication is preferred. While this medication should be used with caution and the infant should be monitored for extrapyramidal sympt¹oms (such as tremors and abnormal muscle movements), there is not an absolute indication to pump and dump. The lactating parent should be engaged in shared decision making when prescribed this medication.

There is no information available regarding the use of these medications during lactation and alternatives are  recommended.