Table 9: Antipsychotic Drugs (Continued) Drugs Geriatric
Side Effects Sedation Extrapyram-idal Effects
Dosage (mg per day)
Anticho- linergic Effects
Orthostatic Hypotension
Tardive Dyskinesia
Olanzapine (Zyprexa)
10
Moderate to high
Low
Moderate to high
Moderate
Low
Quetiapine (Seroquel)
200
Moderate Low
High
Moderate
Low
Risperidone (Risperdal)
2
Low
Low
Low
Low
Low
PSYCHOTROPIC MEDICATION IN PREGNANT AND LACTATING INDIVIDUALS
The American College of Obstetrics and Gynecologists guidelines on psychiatric medication use during pregnancy and lactation is commonly referenced in the medical community. Since psychotropic medications generally cross the placenta and get distributed in the amniotic fluid and breast milk, these guidelines recommend a range of safe dosing and drug monitoring guidelines for the use of psychotropics in lactating
and pregnant individuals. Only select psychotropic medications are cleared for use in this population. Safety concerns are prioritized in this population, with the bulk of psychotropic medications contraindicated for use in pregnancy and lactation. Table 10 summarizes the U.S. Food and Drug Administration (FDA) categorization of psychotropic medication risk in pregnancy and lactation.
Table 10: FDA Categorization of Psychotropic Medication Risk in Pregnancy & Lactation Anxiolytics and Hypnotics Benzodiazepines Alprazolam (Xanax) D Unknown, of concern
L3
Chlordiazepoxide (Librium)
D
NA
L3
Clonazepam (Klonopin)
D
NA
L3
Clorazepate (Tranxene)
D
NA
L3
Diazepam (Valium)
D
Unknown, of concern
L3; L4 if used chronically
Estazolam (Prosom)‡
X
NA
L3
Flurazepam (Dalmane)
X
NA
L3
Lorazepam (Ativan)
D
Unknown, of concern
L3
Oxazepam (Serax)‡
D
NA
L3
Nonbenzodiazepine Anxiolytics & Hypnotics
Buspirone (Buspar)
B
NA
L3
Chloral hydrate
C
Compatible
L3
Eszopiclone (Lunesta)
C
NA
NA
Zaleplon (Sonata)
C
Unknown, of concern
L2
Zolpidem (Ambien)
B
NA
L3
Antiepileptics and Mood Stabilizers
Carbamazepine (Tegretol)
D
Compatible
L2
Lamotrigine (Lamictal)
C
Unknown
L3
Lithium
D
Contraindicated
L4
Valproic acid (Depakene)
D
Compatible
L2
Antidepressants
Page 184
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