Distribution and excretion of venlafaxine and O-desmethylvenlafaxine in human milk

Br J Clin Pharmacol. 1998 May;45(5):459-62. doi: 10.1046/j.1365-2125.1998.00710.x.


Aims: To characterise the transfer of venlafaxine (V) and its O-desmethyl metabolite (ODV) into human milk by measuring milk/plasma (M/P) ratio, and to estimate the likely dose received by a breast-fed infant.

Methods: Milk and plasma samples were collected from three lactating women who were taking venlafaxine for depression, and were at steady-state. In two of the patients, venous blood and milk samples were collected 0, 1, 2, 3, 4, 6, 8 and 12 h post dose, while in the third patient a single pair of blood and milk samples was obtained 0.83 h post dose. A plasma sample was obtained from each of their infants. V and ODV were measured in plasma and milk by high performance liquid chromatography. M/P was calculated and infant dose estimated as drug concentration in milk x a milk intake of 0.15 l kg(-1) day(-1), relative to the weight-adjusted maternal dose.

Results: Mean M/P for V was 4.1 (range 2.8-4.8) and 3.1 for ODV (range 2.8-3.8). The mean total infant dose (as V equivalents) was 7.6% (range 4.7-9.2%) of the maternal weight-adjusted dose, with approximately equal amounts of V (3.5%) and ODV (4.1%) in the dose. ODV (median 100 microg I(-1)) was detected in the plasma of all three infants. The infants were healthy and showed no acute adverse effects.

Conclusions: These preliminary data show that the total dose of V and ODV ingested by breast-fed infants can be as high as 9.2% of maternal intake. Moreover there were measurable concentrations of ODV in the infants' plasma. We recommend that exposed infants should be observed closely.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antidepressive Agents / analysis
  • Antidepressive Agents / pharmacokinetics*
  • Area Under Curve
  • Breast Feeding*
  • Chromatography, High Pressure Liquid
  • Cyclohexanols / analysis
  • Cyclohexanols / pharmacokinetics*
  • Desvenlafaxine Succinate
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Milk, Human / chemistry*
  • Milk, Human / metabolism
  • Tissue Distribution
  • Venlafaxine Hydrochloride


  • Antidepressive Agents
  • Cyclohexanols
  • Venlafaxine Hydrochloride
  • Desvenlafaxine Succinate