Olanzapine treatment during pregnancy and breastfeeding: a chance for women with psychotic illness?

Stiegler, Anette; Schaletzky, R.; Walter, G.; Wüst, Richard; Abele, Harald; Goelz, Rangmar; Farger, Gisbert; Wiatr, Gerlinde; Fallgatter, Andreas J.; Batra, Anil

doi:10.1007/s00213-014-3647-6

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…However, several cases of healthy outcome are available. The first one involved a 41-year-old woman diagnosed with paranoid schizophrenia at the age of 27 years 17 . She was on olanzapine treatment for about 3 years when she became pregnant.…”

Section: Resultsmentioning

confidence: 99%

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Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Gentile

Fusco²

2016

CNS Spectr.

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The proportion of pregnancies exposed to either second-generation antipsychotics (SGAs) or first-generation antipsychotics (FGAs) varies between 0.3%-2% of all pregnancies, but, until now, little is known about the potential neurobehavioral teratogenicity of antipsychotics. Assessing this safety facet is the aim of this article. PubMed, Scopus, and Google Scholar were searched for eligible articles. PubMed (1954 to May 2016) was searched using several medical subject headings, variously combined. PubMed search results were also limited using the search filter for human studies published in English. Scopus and Google Scholar searches were filtered for article title (antipsychotics/neuroleptics, pregnancy). After excluding duplicates, 9,250 articles were identified and 29 met the following inclusion criteria: only articles that provided original/primary data on neurodevelopmental outcome in human offspring older than 4 months of age, independently of the study design, were selected for review. Indeed, some relevant neurodevelopmental milestones are achieved at this time. Length of study and neurodevelopmental assessment methodology did not influence the study selection. Unfortunately, published data on neurodevelopmental teratogenicity of SGAs mainly derive from case reports and small case-series studies. Even findings emerging from case-control and prospective/retrospective studies are of limited clinical relevance because of their small sample sizes. Limited data are also available on FGAs. Hence, we have to conclude that the long-term neurodevelopmental outcomes for children exposed in utero remain unclear. Low to very low quality evidence of retrieved data makes impossible to confirm or exclude potential long-lasting untoward effects on infant neurocognitive development associate with antenatal exposure to either SGAs or FGAs.

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Section: Resultsmentioning

confidence: 99%

“…The first one involved a 41-year-old woman diagnosed with paranoid schizophrenia at the age of 27 years. 17 She was on olanzapine treatment for about 3 years when she became pregnant. The pregnancy proceeded without complications except for significant weight gain (64 to 88 kg at delivery).…”

Section: Olanzapinementioning

confidence: 99%

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Gentile

Fusco²

2016

CNS Spectr.

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“…Our findings on the excretion of olanzapine and quetiapine into milk and infant doses were comparable with the previous reports. [9][10][11][12][13][14][15][16][17] Relative infant doses of olanzapine and quetiapine were found to be much less than the generally accepted safety threshold, which was 10% of the maternal dose. 5 Promoted breastfeeding strategy with q.h.s.…”

mentioning

confidence: 83%

Olanzapine and Quetiapine Use During Breastfeeding

Aydın

Nayir

Şahin

et al. 2015

Journal of Clinical Psychopharmacology

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“…The F:M concentration ratios of olanzapine ranged widely from 0.08 to 1.68, according to 17 determined values collected from five clinical studies. [82][83][84][85][86] The median value (IQR) was 0.53 (0.66). The geometric mean was calculated to be 0.51.…”

Section: Atypical Antipsychoticsmentioning

confidence: 99%

Antidepressants and Antipsychotics in Human Pregnancy: Transfer Across the Placenta and Opportunities for Modeling Studies

Zheng

Yang

Dallmann

2022

The Journal of Clinical Pharma

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There is limited information about the transfer of antidepressants and antipsychotics across the human placenta. The objective of the current review was to systematically screen the scientific literature using relevant keywords to collect quantitative data on placental transfer of these drugs in humans and to give an overview of current modeling approaches used in this context. The collected data encompassed clinically measured fetal:maternal (F:M) concentration ratios (ie, the ratio between drug concentrations measured in the umbilical cord and drug concentrations measured in the mother) and transfer data obtained from ex vivo cotyledon perfusion experiments. These data were found for 18 antidepressants and some of their pharmacologically active metabolites, and for 10 antipsychotics and the metabolites thereof. Based on the collected data, similar maternal and fetal exposure could be observed for only a few compounds (eg, norfluoxetine and desvenlafaxine), whereas for most drugs (eg, paroxetine, sertraline, and quetiapine), fetal exposure appeared to be on average lower than maternal exposure. Venlafaxine appeared to be an exception in that the data indicated equivalent or higher concentrations in the umbilical cord than in the mother. Physiologically based pharmacokinetic (PBPK) models were sporadically used to investigate maternal pharmacokinetics of antidepressants or antipsychotics (eg, for sertraline, aripiprazole, and olanzapine), although without explicitly addressing fetal drug exposure. It is recommended that PBPK modeling is applied more frequently to these drugs. Although no substitute for clinical studies, these tools can help to better understand pregnancy‐induced pharmacokinetic changes and ultimately contribute to a more evidence‐based pharmacotherapy of depression and psychosis in pregnant subjects.

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Olanzapine treatment during pregnancy and breastfeeding: a chance for women with psychotic illness?

Cited by 12 publications

References 9 publications

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Neurodevelopmental outcomes in infants exposed in utero to antipsychotics: a systematic review of published data

Olanzapine and Quetiapine Use During Breastfeeding

Antidepressants and Antipsychotics in Human Pregnancy: Transfer Across the Placenta and Opportunities for Modeling Studies

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