Pregnancy: Tegretol & Zyprexa
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Q:  Pregnancy: Tegretol & Zyprexa

I think there is a possiblity I am a few days pregnant.  I have been on Tegretol and Zyprexa for three years.  Are these drugs very dangerous to the fetus?  I don't know if I should continue taking my meds.  My doctor says to, but I would not want to abort if I was in fact pregnant.  Are there complication-free pregnancies related to these drugs.  What am I dealing with here?  What are the risks involved?

Hello Dawn
First, if you are indeed pregnant, and still taking Tegretol, make sure your doc' knows (I wasn't certain if that's already done).  If you haven't done that already, do it today.  

However, you need to know that the odds of having a problem with your baby, if you are indeed pregnant, are pretty small.  The risk of one's child having a malformation is about 2-4% for women who aren't taking any medications.  That risk goes up to 4-8% if you're taking carbamazepine during the first trimester.  Please note: this means that in at least 9 cases of 10 in your circumstance, the baby will be normal (using the higher risk of around 8 percent); and maybe as high as 19 children out of 20 would be okay (using the lower risk of around 5%). 

So, yes, the great majority of pregnancies conceived on these medications are normal.  (Women who would consider abortion who might end up reading this later should know that there is a test to check for the abnormality that Tegretol can occasionally cause, called a neural tube defect, using fetal ultrasound early in the pregnancy). 

Without a doubt you should continue taking the medications until you and your doctor have an alternative plan.  If you're near or beyond the end of your first trimester now, your doctor would probably recommend continuing the medications.  There is no clear problem for the fetus after the first trimester with Tegretol, but it cannot be used while breastfeeding, so some planning for that would be needed. 

And what about Zyprexa?  We just don't know much at all.  It might seem like it's safer because people are not talking about neural tube defects with Zyprexa, anyway.  But Tegretol's been around for a long time, Zyprexa only briefly by comparison.  However, so far there are no clear problems associated with Zyprexa in pregnancy, to my knowledge.  

For other women readers, and for you Dawn for later, the trick to handling pregnancy in bipolar disorder is to make a detailed plan for starting a pregnancy while off the medications we know are a problem (using an alternative medication that's not a problem, if necessary).  Usually this plan would involve getting back on the medications that have kept you well after the first trimester.  The other half of this trick, of course, is to have a sure means of preventing pregnancy until the time that you've planned out with your doctor.  

Dr. Phelps

Published October, 2002


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