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Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition.
Andreas A Westin1, Malin Brekke2, Espen Molden2,3
1Department of Clinical Pharmacology, St Olav University Hospital, Trondheim, Norway.
Clinical Pharmacology and Therapeutics
|June 24, 2017
Summary
Pregnancy significantly lowers serum levels of quetiapine and aripiprazole antipsychotics. Close clinical monitoring and therapeutic drug monitoring are recommended during pregnancy for managing these medications.
Area of Science:
- Pharmacology
- Psychiatry
- Obstetrics
Background:
- Pregnancy alters drug pharmacokinetics, but its effect on antipsychotic serum levels is poorly understood.
- Antipsychotic medications are frequently used in women of childbearing age.
Purpose of the Study:
- To investigate the impact of pregnancy on serum concentrations of various antipsychotic medications.
- To assess changes in antipsychotic drug levels during the third trimester of pregnancy compared to pre- and post-pregnancy baseline levels.
Main Methods:
- Retrospective analysis of 201 serum antipsychotic therapeutic drug monitoring measurements from 110 pregnancies.
- Comparison of third-trimester concentrations with 512 measurements from the same women before and after pregnancy.
Main Results:
- Serum concentrations of quetiapine and aripiprazole were significantly lower in the third trimester (-76% and -52%, respectively; P < 0.001).
- Olanzapine levels showed no significant change (-9%; P = 0.40).
- Limited data suggest potential declines for perphenazine and haloperidol.
Conclusions:
- Pregnancy is associated with reduced serum concentrations of certain antipsychotics, notably quetiapine and aripiprazole.
- Clinical vigilance and therapeutic drug monitoring are crucial for pregnant individuals on antipsychotic therapy.
- Further research is needed to clarify the clinical implications of these concentration changes.
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