title: Perinatal use of aripiprazole: plasma levels, placental transfer, and child outcome in 3 new cases.
abstract: The use of new agents of second-generation antipsychotics in childbearing women is increasing and poses an unknown risk to the fetus; thus, information of pregnancy and child outcome are urgently needed. We reviewed the literature of 12 patients, 3 of them were exposed during the first trimester, and added 3 new cases of peripartum use of aripiprazole. No teratogenesis was observed despite all 3 women having received the substance during part or full first trimester. All 3 pregnancies were uncomplicated with spontaneous birth. Dosage had to be changed during the course of gestation from 2.5 to 15 mg and plasma levels (PL) were below recommended levels, although all 3 women remained in stable remission throughout pregnancy and postpartum period.The extent of placental transfer of aripiprazole (mean ratio of 56.2%) is comparable with that of other second-generation antipsychotics.Our observations have clinical implications: antipsychotic PLs show large-scale decreases, which may require dose adjustments during pregnancy. Pregnant women may require lower PLs. In our cases, a PL of one third of the previous effective PL was effective and safe. Repeated therapeutic drug monitoring during late gestation based on individual, previous effective PLs seems to be a feasible way for safe and effective antipsychotic therapy in unplanned pregnancy.
authors.affiliation: From the *Department of Psychiatry, Psychology and Psychotherapy, Klinikum Wels-Grieskirchen Wels, Wels, Austria; †Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea; ‡Experimental Psychiatry Unit, Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria; §Orygen Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; and Departments of ∥Child and Adolescent Psychiatry and ¶Child and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Elmar
authors.initials: E
authors.lastname: Windhager
authors.forename: Sung-Wan
authors.initials: SW
authors.lastname: Kim
authors.forename: Alois
authors.initials: A
authors.lastname: Saria
authors.forename: Katharina
authors.initials: K
authors.lastname: Zauner
authors.forename: Paul G
authors.initials: PG
authors.lastname: Amminger
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Klier
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics*; D000068180:Aripiprazole / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D010920:Placenta / Q000187:drug effects / Q000378:metabolism*; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D014150:Antipsychotic Agents; D000068180:Aripiprazole