Neonatal seizures from in utero venlafaxine exposure

Venlafaxine (Efexor), a selective noradrenergic reuptake inhibitor, is an important therapeutic option in the treatment of perinatal depression, but its effects on the newborn are uncertain. We present a report of two infants with neonatal seizures attributed to maternal use of venlafaxine. The first infant was hypotonic and required resuscitation at birth. The second was born in a good condition but developed clinically apparent seizures after the second day of life. Both infants responded rapidly to treatment with phenobarbitone that was weaned uneventfully by the first and second week of life. Both remain well at 1 year of age. Other causes of neonatal seizures were excluded and neurological investigations on these two infants were unremarkable. We suggest that all infants exposed to maternal venlafaxine, no matter their condition at birth, be monitored in hospital for at least 3 to 4 days in order to preempt and treat adverse neurological events.