Safety of Antipsychotics.

Women typically have been counseled to avoid using psychiatric medications during pregnancy because of known or unknown risks of prenatal exposure to these medications. But data suggest that pregnancy does not protect women from new onset or relapse of psychiatric disorders.

This is particularly true for women who have disorders such as schizophrenia or bipolar illness, which is also now treated with antipsychotics. Women with schizophrenia who stop their antipsychotics are at a great risk for relapse, at which point they frequently pursue behaviors that can be harmful to them and their fetuses.

The newer atypical antipsychotics are becoming first-line treatment for many people with schizophrenia because they do not have some of the side effects of the older medications and they appear to result in better acute and long-term responses. They are also increasingly being used for a range of other psychiatric disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, anxiety disorders, and depression.

Most of the available reproductive safety data come from literature on the typical antipsychotics and are several decades old. These data suggest that there is no increased risk of congenital malformations associated with first-trimester exposure to high-potency antipsychotics like haloperidol (Haldol) or midpotency antipsychotics like perphenazine (Trilafon). There also appear to be no safety issues when these drugs are used in labor and delivery or post partum, and there is literature suggesting that these agents are not problematic when used during lactation.

Therefore in our dinic, it is our standard approach to continue treatment in patients who are dependent on a typical high-potency antipsychotic, such as haloperidol, fluphenazine hydrochloride (Prolixin, Permitil), or trifluoperazine (Stelazine), or a midpotency antipsychotic.

We avoid using low-potency antipsychotics, such as chlorpromazine, because of side effects, such as hypotension, and a suggestion that they might be associated with a slightly increased risk for malformations. We have only sparse data on the reproductive safety of the ...