The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review

Hum Psychopharmacol. 2015 May;30(3):143-51. doi: 10.1002/hup.2473. Epub 2015 Mar 18.


Objective: The present study provides a comprehensive review of the existing literature on the safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and lactation.

Methods: Studies published in English, reporting the use of SNRIs in pregnant and/or breastfeeding women, were identified by searching MEDLINE/Pubmed, PsycINFO, and EMBASE.

Results: Twenty-nine studies were included in the review. Altogether, the initial evidence coming from the reviewed studies suggests a lack of association between SNRIs and an increased risk of major congenital malformations. Conversely, exposure to SNRIs seems to be significantly associated with an increased risk of some perinatal complications. No neonatal adverse events emerged, so far, in the few studies concerning the safety of SNRIs during breastfeeding.

Conclusions: Available data suggest that venlafaxine is relatively safe during pregnancy, in particular as far as major malformations are concerned, whereas considering the small number of studies published, no definitive conclusions can be drawn on its safety during breastfeeding. Because of the few studies so far published, the safety of duloxetine during pregnancy and breastfeeding remains to be well established.

Keywords: SNRI; breastfeeding; major malformations; perinatal complications; pregnancy.

Publication types

  • Review

MeSH terms

  • Abnormalities, Drug-Induced / epidemiology
  • Abnormalities, Drug-Induced / etiology
  • Breast Feeding
  • Duloxetine Hydrochloride / administration & dosage
  • Duloxetine Hydrochloride / adverse effects*
  • Female
  • Humans
  • Infant, Newborn
  • Lactation
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Serotonin and Noradrenaline Reuptake Inhibitors / administration & dosage
  • Serotonin and Noradrenaline Reuptake Inhibitors / adverse effects*
  • Venlafaxine Hydrochloride / administration & dosage
  • Venlafaxine Hydrochloride / adverse effects*


  • Serotonin and Noradrenaline Reuptake Inhibitors
  • Venlafaxine Hydrochloride
  • Duloxetine Hydrochloride