Table-III.
Pharmacological Interventions with Safety Profile.
| Non-Benzodiazepines | ||||
| Drug | Pregnancy Risk | Lactation Risk | Comments | Evidence for Safety |
| Chloral Hydrate | C | L3 | Limited Risk | +++ |
| Eszopiclone | C | NA | Limited Risk | +++ |
| Zaleplon | C | L2 | Limited Risk | +++ |
| Zolpidem | B | L3 | Limited Risk | +++ |
| Diphenhydramine | B | NA | Limited Risk | +++ |
| Benzodiazepines | ||||
| Drug | Pregnancy Risk | Lactation Risk | Comments | Evidence/Safety |
| Estazolam | X | L3 | Significant risk | +/- |
| Flurazepam | X | L3 | Significant risk | +/- |
| Temazepam | X | L3 | Significant risk | +/- |
| Triazolam | X | L3 | Significant risk | +/- |
| Tricyclic Antidepressants | ||||
| Drug | Pregnancy Risk | Lactation Risk | Comments | Evidence/Safety |
| Amitriptyline | C | L2 | Useif primary disorder is depression | +/- |
| Clomipramine | C | L2 | Use if primary disorder is depression | +/- |
| Doxepin | C | L5 | Useif primary disorder is depression | +/- |
| Imipramine | C | L2 | Useif primary disorder is depression | +/- |
| Selective Serotonin Reuptake Inhibitors | ||||
| Drug | Pregnancy Risk | Lactation Risk | Comments | Evidence/Safety |
| Fluvoxamine | C | L2 | Useif primary disorder is depression | +/- |
| Paroxetine | D | L2 | Increased risk of congenital cardiac problems. Not recommended | -negative |
| Other Antidepressants | ||||
| Drug | Pregnancy Risk | Lactation Risk | Comments | Evidence/Safety |
| Mirtazapine | C | L2 | Use if primary disorder is depression | +/- |
| Trazodone | C | L2 | Adjunctiveuse for sleep induction | +/- |
| Antipsychotics | ||||
| Chlorpromazine | C | L3 | Useif primary Disorder is psychosis | +/- |
| Olanzapine | C | L2 | Useif primary Disorder is psychosis | +/- |
| Quetiapine | C | Use if primary Disorder is psychosis | +/- | |
| Mood Stabilizers | ||||
| Carbamazepine | D | L2 | Use only if primary diagnosis is bipolar disorder. Avoid in first trimester to prevent neural tube defects | +/- |
| Lamotrigine | C | L3 | Use only if primary diagnosis is bipolar disorder | +/- |
| Lithium | D | L4 | Use only if primary Diagnosis is bipolar disorder. Avoid in first trimester to prevent Epstein cardiac anomaly | +/- |
| Valproic Acid | D | L2 | Use only if primary diagnosis is bipolar. Avoid in first trimester to prevent neural tube defects | +/- |
FDA Pregnancy Drug Safety Rating: A=No Risk noted in controlled studies; B=Evidence of Risk in Humans; C=Risk cannot be ruled out; D= Positive Evidence of Risk; X=Contraindicated in Pregnancy. Lactation Risk Categories: L1=Safest; L2=Safer; L3=Moderately Safe; L4=Possibly Hazardous; L5+ Contraindicated NA= Not available. Adapted from: Armstrong C. Practice Guidelines: ACOG Guidelines on Psychiatric Medication Use During Pregnancy and Lactation. Am Fam Physician 2008; 78:772-778. ++++ Recommended, +++ May be recommended, ++Recommended only if benefits clearly out way risk,+Use with extreme caution due to risk to developing fetus, +/- Not recommended unless underlying condition is severe enough to pose significant risk to fetus and/or mother e.g. florid mania or psychosis, severe agitation, active suicidal or homicidal ideation in context of a psychiatric illness.