Drugs (AEDs)

Question 1

What drugs are unsafe in breast feeding?

Answer 1

LAMBAST Mothers Ceen taking:

Lithium
Aspirin
Methotrexate
Benzodiaxepines
Amiodarone
Sulfonyureas, sulphonamides
Tetracycline

Carbimazole
Ciprofloxacin
Chloramphenicol
Cytotoxic drugs
Clozapine

Question 2

What are benzodiazepines linked with?

Answer 2

1st trimester risk of oral cleft lip/plalate

3rd trimester risk of floppy baby syndrome (hypothermia, lethargy, feeding difficulties)

Question 3

What SSRI in pregnancy?

Answer 3

Sertraline
- risk similar to that of obese mothers

Avoid paroxetine - 1st trimester use associated with cardiac malforatmion

Fluoxetine and citalopram present in high conc in breast milk

SErtraline lower

Question 4

Risk of mood stabilisers in pregnancy?

Answer 4

Valproate - neural tube defects, craniofacial abnormalities, neurodevelopment problems

Carbemazepine - NTDs

Avoid all in breast feeding

Question 5

What is lithium linked with?

Answer 5

Heart defects - Ebstein’s anomaly
Neonatal thyroid abnormalities
Floppy baby syndrome

Only prescribe if alternatives ineffective
Counsel regarding risk

Fetal echo

Monitor drug levels

Question 6

What are signs of lithium toxicity?

Answer 6

Tremor
Drowsiness
Visual disturbance

Question 7

What should be done with lithium in labour?

Answer 7

Stop during labour
Check 12h post dose level and restart based on this result
Breastfeeding contraindicated - risk of neonatal toxicity

Question 8

What are risks of antipsychotics in pregnancy?

Answer 8

Raised prolactin with amisulpride, sulphide and risperidone
Weight gain - OGTT
Clozapine - do not breastfeed due to risk of fetal agranulocytosis