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Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition
Author(s) -
Westin Andreas A.,
Brekke Malin,
Molden Espen,
Skogvoll Eirik,
Castberg Ingrid,
Spigset Olav
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.770
Subject(s) - ziprasidone , quetiapine , perphenazine , therapeutic drug monitoring , medicine , olanzapine , clozapine , pregnancy , aripiprazole , risperidone , haloperidol , drug , pharmacokinetics , antipsychotic , confidence interval , pharmacology , schizophrenia (object oriented programming) , psychiatry , biology , dopamine , genetics
Although pregnancy is known to cause changes in drug pharmacokinetics, little is known about its impact on serum levels of antipsychotics. In this study we retrospectively assessed 201 routine serum antipsychotic therapeutic drug monitoring concentration measurements obtained from a total of 110 pregnancies in 103 women, and 512 measurements from the same women before and after pregnancy. Serum concentrations in the third trimester were significantly lower than baseline for quetiapine (−76%; confidence interval (CI), −83%, −66%; P < 0.001) and aripiprazole (−52%; CI, −62%, −39%; P < 0.001), but not for olanzapine (−9%; CI, −28%, +14%; P = 0.40). For the remaining antipsychotics (perphenazine, haloperidol, ziprasidone, risperidone, and clozapine), our dataset was limited, but it indicates that concentrations may decline at least for perphenazine and possibly also for haloperidol. Even though the clinical consequence of the serum concentrations decline remains to be elucidated, our results warrant close clinical monitoring throughout pregnancy, preferentially supported by therapeutic drug monitoring.