Clozapine placental passage at delivery: an update
Introduction Clozapine is an effective second-generation antipsychotic that is approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. Its available pregnancy pharmacikinetics data remain limited, which presents...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822006101/type/journal_article |
| _version_ | 1797617137719705600 |
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| author | M.L. Imaz S. Lera E. Roda A. Roca A. Torres E. Solé S. Andres A. Mallorquí L. Garcia-Esteve |
| author_facet | M.L. Imaz S. Lera E. Roda A. Roca A. Torres E. Solé S. Andres A. Mallorquí L. Garcia-Esteve |
| author_sort | M.L. Imaz |
| collection | DOAJ |
| description |
Introduction
Clozapine is an effective second-generation antipsychotic that is approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. Its available pregnancy pharmacikinetics data remain limited, which presents a challenge for clinicians managing women taking clozapine during perinatal period .
Objectives
The aim of this study was to provide new data of clozapine and norclozapine placental passage and neonatal outcomes.
Methods
We retrospectively studied a consecutive case series of six pregnancies where there was clozapine exposure (5 in politherapy and 1 in monotherapy). Clozapine and norclozapine serum concentrations were determined in the mother-infant pairs on the day of delivery (intrapartum maternal blood and umbilical cord blood respectively) and measured using a validated high-performance liquid chromatography method. The within- and between-day precision expressed as the coefficient of variation (CV)% were both <10%. The limit of quantification (LoQ) was 5 ng/mL. Neonatal outcomes were reviewed from pediatric records.
Results
The mean infant-mother clozapine and norclozapine ratio at delivery were 0.44 (SD=0.13) and 0.28 (SD=0.05) respectively. There was a weak positive correlation between maternal and umbilical cord clozapine and norclozapine serum concentratios (Pearson correlation coefficient 0.183, p=0.769 and 0.827, p=0.084 respectively). The rate of neonatal complications was 16%. One neonate (16%) , whose mother had drug abuse history during pregnancy, presented with a generalized neurodevelopment delay and the consequent need for continuous intensive care.
Conclusions
In our study, placental passage of clozapine and norclozapine was partial during delivery. Statistical power was limited for examining te association between neonatal clozapine levels and neonatal outcomes.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:51:31Z |
| format | Article |
| id | doaj.art-699581f493564ed1aa524a5e3a0f845f |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:51:31Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-699581f493564ed1aa524a5e3a0f845f2023-11-17T05:06:41ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S235S23610.1192/j.eurpsy.2022.610Clozapine placental passage at delivery: an updateM.L. Imaz0S. Lera1E. Roda2A. Roca3A. Torres4E. Solé5S. Andres6A. Mallorquí7L. Garcia-Esteve8Hospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, SpainHospital Clinic, Unit Of Perinatal Mental Health Clínic-bcn. Department Of Psychiatry And Psychology, Barcelona, Spain Introduction Clozapine is an effective second-generation antipsychotic that is approved for treatment-resistant schizophrenia and risk reduction of recurrent suicidal behavior in schizophrenia or schizoaffective disorder. Its available pregnancy pharmacikinetics data remain limited, which presents a challenge for clinicians managing women taking clozapine during perinatal period . Objectives The aim of this study was to provide new data of clozapine and norclozapine placental passage and neonatal outcomes. Methods We retrospectively studied a consecutive case series of six pregnancies where there was clozapine exposure (5 in politherapy and 1 in monotherapy). Clozapine and norclozapine serum concentrations were determined in the mother-infant pairs on the day of delivery (intrapartum maternal blood and umbilical cord blood respectively) and measured using a validated high-performance liquid chromatography method. The within- and between-day precision expressed as the coefficient of variation (CV)% were both <10%. The limit of quantification (LoQ) was 5 ng/mL. Neonatal outcomes were reviewed from pediatric records. Results The mean infant-mother clozapine and norclozapine ratio at delivery were 0.44 (SD=0.13) and 0.28 (SD=0.05) respectively. There was a weak positive correlation between maternal and umbilical cord clozapine and norclozapine serum concentratios (Pearson correlation coefficient 0.183, p=0.769 and 0.827, p=0.084 respectively). The rate of neonatal complications was 16%. One neonate (16%) , whose mother had drug abuse history during pregnancy, presented with a generalized neurodevelopment delay and the consequent need for continuous intensive care. Conclusions In our study, placental passage of clozapine and norclozapine was partial during delivery. Statistical power was limited for examining te association between neonatal clozapine levels and neonatal outcomes. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822006101/type/journal_articleDeliveryMother-infant pairPlacental passageclozapine |
| spellingShingle | M.L. Imaz S. Lera E. Roda A. Roca A. Torres E. Solé S. Andres A. Mallorquí L. Garcia-Esteve Clozapine placental passage at delivery: an update European Psychiatry Delivery Mother-infant pair Placental passage clozapine |
| title | Clozapine placental passage at delivery: an update |
| title_full | Clozapine placental passage at delivery: an update |
| title_fullStr | Clozapine placental passage at delivery: an update |
| title_full_unstemmed | Clozapine placental passage at delivery: an update |
| title_short | Clozapine placental passage at delivery: an update |
| title_sort | clozapine placental passage at delivery an update |
| topic | Delivery Mother-infant pair Placental passage clozapine |
| url | https://www.cambridge.org/core/product/identifier/S0924933822006101/type/journal_article |
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