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Neuropsychiatric Medications in Pregnancy
Aka: Neuropsychiatric Medications in Pregnancy, Sedative Medications in Pregnancy, Psychiatric Medications in Pregnancy, Neurologic Medications in Pregnancy
- See Also
- Medications in Pregnancy
- Antepartum Depression
- Postpartum Depression
- Substance Abuse in Pregnancy
- Cocaine Abuse in Pregnancy
- Fetal Alcohol Syndrome
- Background
- Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
- Although FDA Pregnancy Categories are no longer FDA designated, they are included here
- As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
- Precautions
- SSRIs have shown mixed or weak associations with Autism (as one of many contributing factors)
- Boukhris (2016) JAMA Pediatr 170(2):117-2 +PMID:26660917 [PubMed]
- Harrington (2014) Pediatrics 133:e1241-8 +PMID:24733881 [PubMed]
- Hviid A (2013) N Engl J Med 369:2406-15 [PubMed]
- Rai (2013) BMJ 346:f2059 [PubMed]
- SSRI association with Persistent Pulmonary Hypertension
- Increased risk by 6 fold if SSRIs used after 20 weeks
- Number needed to harm: 286-351
- Grigoriadis (2014) BMJ 348:f6932 [PubMed]
- Indications: Neuropsychiatric Medications in Pregnancy
- Moderate-high risk Mood Disorder relapse in pregnancy
- Major Depression onset in Pregnancy
- See Depression in Pregnancy
- Bipolar Disorder (30-50% risk off mood stabilizers)
- Puerperal Psychosis
- Severe Major Depression
- History of Postpartum Depression
- Cyclothymia
- Disorder with high morbidity on relapse
- Schizophrenia
- Bipolar Disorder
- Severe chronic depression
- Panic Disorder with Agoraphobia
- Class B: No risk in controlled animal studies
- Antidepressants
- Sertraline (Zoloft) - some safety data available
- Bupropion (Wellbutrin) - based on little safety data
- Antipsychotics
- Clozapine (Clozaril)
- Sedatives
- Zolpidem (Ambien)
- Class C: Small risk in controlled animal studies
- Anxiolytics (not recommended in pregnancy)
- See Class D for adverse effects in pregnancy
- Clonazepam (Klonopin)
- Anticonvulsants
- Carbamazepine (Tegretol, 1% Neural Tube Defect risk)
- Ethosuximide
- MAO inhibitors (not recommended in pregnancy)
- Isocarboxazid
- Phenelzine
- Tranylcypromine
- Other Antidepressants
- Trazodone (Desyrel)
- Venlafaxine (Effexor) - little data available
- Mirtazapine (Remeron)
- Desipramine
- Fluoxetine (Prozac)
- Well studied in pregnancy, but data in 2015 showed association with cardiac defects
- Berard (2015) Br J Clin Pharmacol +PMID:26613360 [PubMed]
- Antipsychotics
- Haloperidol (Haldol)
- Best studied of all Antipsychotics
- No known Teratogenicity (preferred in pregnancy)
- Drugs of Abuse
- Amphetamine
- Lysergic Acid (LSD)
- Marijuana
- Chemical Dependency Medications
- Antabuse - not in Briggs (1998)
- Class D: Strong evidence of risk to the human fetus
- Anxiolytics
- Wean off prior to conception (10% per week)
- Teratogenicity: Increased orofacial cleft risk
- Perinatal affects: Hypotonia, Apnea, Hypothermia
- If used, avoid first trimester and perinatal use
- Agents
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Midazolam (Versed)
- Anticonvulsants
- Valproic Acid (Depakote, 5% Neural Tube Defect risk)
- Phenytoin (Dilantin)
- Phenobarbital
- Primidone (Mysoline)
- Miscellaneous
- Lithium
- Teratogenicity: Ebstein's Anomaly (0.1% risk)
- Perinatal: Cyanosis, Hypotonicity
- Selective Serotonin Reuptake Inhibitors
- Paroxetine (Paxil)
- Tricyclic Antidepressants
- Amitriptyline (Elavil)
- Imipramine
- Nortriptyline (Pamelor)
- Class X: Very high risk to the human fetus
- Anxiolytics
- Alprazolam (Xanax)
- Triazolam (Halcion)
- Flurazepam (Dalmane)
- Drugs of Abuse
- Phencyclidine
- Alcohol - not in Briggs (1998)
- See Fetal Alcohol Syndrome
- Preparations: Other
- Pregabalin (Lyrica) in first trimester has been linked to possible birth defects
- Winterfeld (2016) Neurology 86(24): 2251-7 [PubMed]
- References
- Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
- Larimore (2000) Prim Care 27(1):35-53 [PubMed]
- Ward (2002) Am Fam Physician 66:629-39 [PubMed]