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?
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
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
Published October, 2002