Neuropsychiatric Medications in Pregnancy

1. See Also
   1. Medications in Pregnancy
   2. Antepartum Depression
   3. Postpartum Depression
   4. Substance Abuse in Pregnancy
   5. Cocaine Abuse in Pregnancy
   6. Fetal Alcohol Syndrome
2. Indications: Neuropsychiatric Medications in Pregnancy
   1. Moderate-high risk Mood Disorder relapse in pregnancy
      1. Major Depression onset in Pregnancy
         1. See Depression in Pregnancy
      2. Bipolar Disorder (30-50% risk off mood stabilizers)
      3. Puerperal Psychosis
      4. Severe Major Depression
      5. History of Postpartum Depression
      6. Cyclothymia
   2. Disorder with high morbidity on relapse
      1. Schizophrenia
      2. Bipolar Disorder
      3. Severe chronic depression
      4. Panic Disorder with Agoraphobia
3. Class B: No risk in controlled animal studies
   1. Antidepressants
      1. Fluoxetine (Prozac) - best studied SSRI in pregnancy
      2. Sertraline (Zoloft) - some safety data available
      3. Bupropion (Wellbutrin) - based on little safety data
   2. Antipsychotics
      1. Clozapine (Clozaril)
   3. Sedatives
      1. Zolpidem (Ambien)
4. Class C: Small risk in controlled animal studies
   1. Anxiolytics (not recommended in pregnancy)
      1. See Class D for adverse effects in pregnancy
      2. Clonazepam (Klonopin)
   2. Anticonvulsants
      1. Carbamazepine (Tegretol, 1% Neural Tube Defect risk)
      2. Ethosuximide
   3. MAO inhibitors (not recommended in pregnancy)
      1. Isocarboxazid
      2. Phenelzine
      3. Tranylcypromine
   4. Other Antidepressants
      1. Trazodone (Desyrel)
      2. Venlafaxine (Effexor) - little data available
      3. Mirtazapine (Remeron)
      4. Desipramine
   5. Antipsychotics
      1. Haloperidol (Haldol)
         1. Best studied of all Antipsychotics
         2. No known Teratogenicity (preferred in pregnancy)
   6. Drugs of Abuse
      1. Amphetamine
      2. Lysergic Acid (LSD)
      3. Marijuana
   7. Chemical Dependency Medications
      1. Antabuse - not in Briggs (1998)
5. Class D: Strong evidence of risk to the human fetus
   1. Anxiolytics
      1. Wean off prior to conception (10% per week)
      2. Teratogenicity: Increased orofacial cleft risk
      3. Perinatal affects: Hypotonia, Apnea, Hypothermia
      4. If used, avoid first trimester and perinatal use
      5. Agents
         1. Chlordiazepoxide (Librium)
         2. Diazepam (Valium)
         3. Lorazepam (Ativan)
         4. Midazolam (Versed)
   2. Anticonvulsants
      1. Valproic Acid (Depakote, 5% Neural Tube Defect risk)
      2. Phenytoin (Dilantin)
      3. Phenobarbital
      4. Primidone (Mysoline)
   3. Miscellaneous
      1. Lithium
         1. Teratogenicity: Ebstein's Anomaly (0.1% risk)
         2. Perinatal: Cyanosis, Hypotonicity
   4. Selective Serotonin Reuptake Inhibitors
      1. Paroxetine (Paxil)
   5. Tricyclic Antidepressants
      1. Amitriptyline (Elavil)
      2. Imipramine
      3. Nortriptyline (Pamelor)
6. Class X: Very high risk to the human fetus
   1. Anxiolytics
      1. Alprazolam (Xanax)
      2. Triazolam (Halcion)
      3. Flurazepam (Dalmane)
   2. Drugs of abuse
      1. Phencyclidine
      2. Alcohol - not in Briggs (1998)
         1. See Fetal Alcohol Syndrome
7. References
   1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
   2. Larimore (2000) Prim Care 27(1):35-53
   3. Ward (2002) Am Fam Physician 66:629-39