Risk for Psychotropica Drug Use in Pregnancy

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Practice Guidelines
ACOG Guidelines on Psychiatric Medication Use During
Pregnancy and Lactation
Table 1
Safety of Psychiatric Medications During Pregnancy and Lactation
DRUG
FDA PREGNANCY
CATEGORY*
AAP RATING LACTATION RISK CATEGORY†
Anxiolytics and hypnotics
Benzodiazepines
Alprazolam (Xanax) D Unknown, of
concern
L3
Chlordiazepoxide
(Librium)
D NA L3
Clonazepam
(Klonopin)
D NA L3
Clorazepate
(Tranxene)
D NA L3
Diazepam (Valium) D Unknown, of
concern
L3; L4 if used chronically
Estazolam (Prosom)‡ X NA L3
Flurazepam (Dalmane) X NA L3
Lorazepam (Ativan) D Unknown, of
concern
L3
Oxazepam (Serax)‡ D NA L3
Oxazepam (Serax)‡ D NA L3
Quazepam (Doral) X Unknown, of
concern
L2
Temazepam (Restoril) X Unknown, of
concern
L3
Triazolam (Halcion) X NA L3
Nonbenzodiazepine anxiolytics and hypnotics
Buspirone (Buspar) B NA L3
Chloral hydrate C Compatible L3
Eszopiclone (Lunesta) C NA NA
Zaleplon (Sonata) C Unknown, of
concern
L2
Zolpidem (Ambien) B NA L3
Antiepileptics and mood stabilizers
Carbamazepine
(Tegretol)
D Compatible L2
Lamotrigine (Lamictal) C Unknown L3
Lithium D Contraindicated L4
Valproic acid (Depakene) D Compatible L2
Antidepressants
Tricyclics and heterocyclics
Amitriptyline C Unknown, of
concern
L2
Amoxapine (Asendin)‡ C Unknown, of
concern
L2
Clomipramine
(Anafranil)
C Unknown, of
concern
L2
Desipramine
(Norpramin)
C Unknown, of
concern
L2
Doxepin (Sinequan)‡ C Unknown, of
concern
L5
Imipramine (Tofranil) C Unknown, of
concern
L2
Maprotiline
(Ludiomil)‡
B NA L3
Nortriptyline (Pamelor) C Unknown, of
concern
L2
Protriptyline (Vivactil) C NA NA
Selective serotonin reuptake inhibitors
Citalopram (Celexa) C NA L3
Escitalopram
(Lexapro)
C NA L3 in older infants
Fluoxetine (Prozac) C Unknown, of
concern
L2 in older infants; L3 in
neonates
Fluvoxamine (Luvox)‡ C Unknown, of
concern
L2
Paroxetine (Paxil) D Unknown, of
concern
L2
Sertraline (Zoloft) C
Unknown, of
concern
L2
Other antidepressants
Bupropion (Wellbutrin) B Unknown, of
concern
L3
Duloxetine (Cymbalta) C NA NA
Mirtazapine (Remeron) C NA L3
Nefazodone
(Serzone)‡
C NA L4
Trazodone (Desyrel)‡ C Unknown, of
concern
L2
Venlafaxine (Effexor) C NA L3
Antipsychotics
Aripiprazole (Abilify) C NA L3
Chlorpromazine
(Thorazine)‡
C Unknown, of
concern
L3
Clozapine (Clozaril) B Unknown, of
concern
L3
Fluphenazine (Prolixin)‡ C NA L3
Haloperidol (Haldol) C Unknown, of
concern
L2
Loxapine (Loxitane) C NA L4
Olanzapine (Zyprexa) C NA L2
Perphenazine (Trilafon)‡ C
Unknown, of
concern
NA
Pimozide (Orap) C NA L4
Quetiapine (Seroquel) C Unknown, of
concern
L4
Risperidone (Risperdal) C NA L3
Thioridazine (Mellaril)‡ C NA L4
Thiothixene (Navane) C NA L4
Trifluoperazine
(Stelazine)‡
C Unknown, of
concern
NA
Ziprasidone (Geodon) C Unknown, of
concern
L4
AAP = American Academy of Pediatrics; FDA = U.S. Food and Drug Administration; NA = not applicable.
*—The FDA classifies drug safety using the following categories: A = controlled studies show no risk; B = no
evidence of risk in humans; C = risk cannot be ruled out; D = positive evidence of risk; X = contraindicated in
pregnancy.
†— Lactation risk categories are as follows: L1 = safest; L2 = safer; L3 = moderately safe; L4 = possibly hazardous;
L5 = contraindicated.
‡— Brand name no longer available in the United States.
Adapted with permission from the American College of Obstetricians and Gynecologists. ACOG practice bulletin no.
87. Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2007;110(5):1180–1182.
Copyright © 2008 by the American Academy of Family Physicians.
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