Is fetal exposure to clozapine harmful?/nA woman who is treated with clozapine is planning to becom

Fråga: Is fetal exposure to clozapine harmful?<br><br>A woman who is treated with clozapine is planning to become pregnant.

Sammanfattning: No information concerning fetal malformations during clozapine treatment could be located. However, the small number of successful pregnancies cannot be used to conclude that clozapine is safe for use during gestation. Fetal risks such as floppy infant syndrome, seizures and clozapine induced agranulocytosis cannot be excluded. Risks of fetal exposure to clozapine must be balanced against the mothers likelihood of psychotic relapse without clozapine treatment. In general, the minimal effective dose of clozapine and intensive psychiatric care is recommended for pregnant women.

Svar: Very limited literature, consisting mainly of case reports on clozapine treatment in pregnancy is available. This question has previously been dealt with in Drugline. Clinical follow-up studies on clozapine have not suggested any causal connection between clozapine and fetal malformations (1). Today, sixteen successful pregnancies have been reported concerning clozapine exposure during gestation (2,3). However, nine cases of adverse pregnancy outcomes involving the use of clozapine during pregnancy have been reported to the FDA, but a cause-effect relationship has not been documented (2). In addition, reproduction studies in rats and rabbits have found no evidence of fetal adverse effects (2).<br><br>One reference describes that clozapine may pose extra risks in pregnancy. These include the accumulation of clozapine in fetal serum which may increase the risk of perinatal morbidity, such as floppy infant syndrome and neonatal seizures. The lack of knowledge about neonatal risks for clozapine-induced agranulocytosis and the inability to monitor fetal haematology is also mentioned (4). A case report concerned a 28-year-old woman who developed increasing glucose intolerance during initial clozapine treatment and pregnancy. Insulin injections were initiated to manage her diabetes (4). A reduction of the dose throughout the third trimester, or in the days immediately preceding delivery has been recommended to avoid sedative effects on the newborn (3).<br><br>In conclusion, the risks and benefits of continuing clozapine treatment during pregnancy must be carefully analysed on a case-by-case basis. An exacerbation of psychosis is probably more dangerous to the mother and child than continuation of clozapine. Intensive psychosocial support is recommended for these patients (4,5).<div id="referenser" style="display:none;">1 Drugline no 14588 (year 1998)<br>2 Briggs GB, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 5th ed. Baltimore: Williams & Wilkins; 1998. p<br>3 Dabney BJ (Ed): Reprorisk(R) System. Micromedex, Inc, Englewood, Colorado<br>4 Dickson RA, Hogg L: Pregnancy of a patient treated with clozapine. Psychiatr Serv 1998; 49: 1081-1083<br>5 Pregnancy and clozapine. Psychiatr Serv 1998; 49: 997</div>