Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data addressing the reproductive safety of these medications.
A clinician asks: “I am a psychiatrist treating a patient with Bipolar Disorder on Seroquel and Topamax. I would like to know what information is available regarding the safety of these medications to the infant if used during breastfeeding.”
Atypical antipsychotics are increasingly used to treat psychiatric disorders such as bipolar disorder or schizophrenia. In spite of the important role they play for many patients in treating serious psychiatric disorders, atypicals have been associated with negative side effects that may worsen a patient's cardiovascular health profile. This includes a greater risk for weight gain, glucose dysregulation/diabetes, and dyslipidemia (elevated triglycerides/cholesterol).
CYP3A4 is an intestinal enzyme that is part of the Cytochrome P450 metabolic system. It is important in many drug-drug and drug-food interactions, and it is one of the first enzymes to break down medications when they enter the body.
Although primarily used to treat schizophrenia and other psychotic disorders, the newer “atypical” antipsychotic agents are now used widely to treat a spectrum of psychiatric disorders, including major depression, bipolar disorder, PTSD and other anxiety disorders. While the reproductive safety of the older typical antipsychotic drugs, such as haloperidol (Haldol) and perphenazine (Trilafon), is supported by data accumulated over the past 40 years, we have far less data on the newer atypical agents: olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), and clozapine (Clozaril).
