Is it safe to use Inderal (propranolol) or Cipramil (citalopram) during pregnancy?/nA woman, in wee

Fråga: Is it safe to use Inderal (propranolol) or Cipramil (citalopram) during pregnancy? A woman, in week 7 of pregnancy (since last menstrual period) is being treated with Inderal (propranolol) 10-20mg (sometimes up to 40mg) when required for tachycardia. She has also been treated with Cipramil (citalopram) until week 7 of pregnancy for depression.

Sammanfattning: No general increase in the teratogenic risk was observed for citalopram. There were, however more cases of hypospadia and opticus hypoplasia in exposed fetuses than expected. An increased number of spina bifida in fetuses exposed to propranolol was seen. No causal relationship has been established for either drug. Twenty-three cases of intrauterine growth retardation have been associated with propranol treatment. Propranolol has direct pharmacological effect on the fetus and its use during late pregnancy should be restricted.

Svar: Available data on citalopram and other selective serotonin reuptake inhibitors do not suggest an association with teratogenicity (1,2). Data from the Swedish Medical Birth Registry regarding the use of citalopram by 817 pregnant women do not show an overall increased risk for malformations compared to the population, 1.71 and 2.48 percent respectively. There were, however more cases of hypospadia and opticus hypoplasia in citalopram treated women than expected (3). The same pattern of malformations is found for all the selective serotonin reuptake inhibitors (3). Further investigations are needed to draw any conclusion about a cause relationship.

As regards propranolol, the drug is not generally considered a teratogen (4,5). However, data from Medical Birth Registry based on (330 propranolol-exposed pregnancies ) has shown an increased number of spina bifida (two cases) in fetuses exposed to propranolol (3) compared to the expected frequency in the general unexposed population (0.04%). Whether this is related to drug exposure or some underlying maternal heart disease is unclear (3). Totally 23 cases of intrauterine growth retardation have been associated with propranolol treatment of the mother (5). Direct pharmacological effects such as bradycardia, hypoglycemia, polycythemia, apnoea and other symptoms of beta-blockade have been seen in newborns. The use of beta-receptor antagonists should be restricted during late pregnancy (5).