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Drug Cat Comments
Tricyclic antidepressants:
amitriptyline, clomipramine, C Withdrawal symptoms in newborn infants have
desipramine, dothiepin (dosulepin), been reported with prolonged maternal use of this
doxepin, imipramine, nortriptyline, class of drugs.
protriptyline, trimipramin
Other antidepressants:
mirtazapine, moclobemide, B3
nefazodone B2
venlafaxine
Anticonvulsants
carbamazepine D Spina bifida occurs in about 1% of pregnancies in
which carbamazepine is used as monotherapy.
Carbamazepine taken during pregnancy also has
been associated with minor craniofacial defects,
fingernail hypoplasia and developmental disability.
Carbamazepine also can cause coagulation defects
with consequent risk of haemorrhage in the fetus
and the newborn infant, which may be
preventable by the prophylactic administration of
vitamin K to the mother prior to delivery.
phenytoin sodium D This drug taken during pregnancy has been
associated with craniofacial defects, fingernail
hypoplasia, developmental disability, growth
retardation and less frequently, oral clefts and
cardiac anomalies. This clinical pattern is
sometimes called the ‘fetal hydantoin syndrome’.
Phenytoin can also cause coagulation defects with
consequent risk of haemorrhage in the fetus and
the newborn infant, which may be preventable by
the prophylactic administration of vitamin K to the
mother prior to delivery.
sodium valproate D If taken in the first trimester of pregnancy, sodium
valproate (valproic acid) is associated with a 1–2%
risk of neural tube defects (especially spina bifida)
in the exposed fetus. Women taking sodium
valproate (valproic acid) who become pregnant
should be encouraged to consider detailed mid‐
trimester morphology ultrasound for prenatal CHAPTER 11
diagnosis of such abnormalities.
lamotrigine D Category changed June 2006
clonazepam C Clonazepam is a benzodiazepine. These drugs may
cause hypotonia, respiratory depression and
hypothermia in the newborn infant if used in high
doses during labour. Withdrawal symptoms in
newborn infants have been reported with this class
of drugs.
gabapentin B1
tiagabine, topiramate, pregabalin B3
lamotrigine D
Acute pain management: scientific evidence 385
