Clozapine pregnancy

Antipsychotic drug s are classified as Pregnancy Category C dm (except for clozapine which is Pregnancy Category B). Safe use of these dragp during... 

DiMichele, V., Ramenghi, L.A., and Sabatino, G. (1996) Clozapine and lotazepam administration in pregnancy [letter]. Eur Psychiatry 11 214. 

Tenyi, T., Trixler, M., Vereczkey, G., and Dorka, A. (1994) [Use of clozapine during pregnancy] Clozapine alkalmazasarol terhesseg-soran. Orv Hetil 135 1967—1969. 

Amenorrhea and infertility were consequences of the effects of typical neuroleptic drugs and of risperidone. Clinicians should be aware that patients changed from these agents to drugs like olanzapine, quetiapine, or clozapine are therefore at risk of pregnancy (6). 

Stoner SC, Sommi RW Jr, Marken PA, Anya I, Vaughn J. Clozapine use in two full-term pregnancies. J Clin Psychiatry 1997 58(8) 364-5. 

All antipsychotic drugs cross the placenta and reach the fetus in potentially significant amounts however, clozapine caused no serious complications or developmental abnormalities during pregnancy in two cases (218). 

Although it is not clear whether clozapine, the disease process, poor nutrition, lack of antenatal care, or a combination of all these factors, contributed to the outcome of this pregnancy. The authors suggested that one should be cautious about using clozapine during pregnancy. 

Clozapine caused no serious complications or developmental abnormalities during pregnancy in two cases... 

For patients who experience a breakthrough episode, the medication dose should first be optimized. When first-line medications at optimal dose fail to control symptoms, recommended treatment options include the addition of another first-line medication. Alternative treatment options include adding carbamazepine or oxcarbazepine in lieu of an additional first-line medication, adding an antipsychotic if not already prescribed, or changing from one antipsychotic to another. Of the antipsychotics, clozapine may be particularly effective for treatment of refractory illness. Electroconvulsive therapy (ECT) may also be considered for patients with severe or treatment-resistant illness. In addition, ECT is a potential treatment for patients with mixed episodes or for severe mania experienced during pregnancy. 

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