Pregnancy and Lorazepam/Ativan

[kelo]

Hello - Since my son was born 2 years ago i have had terrible anxiety during the night and sometimes panic attacks - my doctor initially prescribed Zoloft and then Lexapro - unfortunately neither of them did anything for me except make me feel worse. The only thing that has worked is taking .5mg Ativan in the middle of the night when I awaken. It helps me get back to sleep enough to have 5-6 hours total (as opposed to 2-3 initially.) I have also tried various sleeping pills through the years and nothing has helped me to sleep. The lorazepam is really the only thing that helps me get a little bit of sleep and helps with the night time anxiety (i do not have any anxiety during the day).

My question is - I'm thinking of becoming pregnant again soon and I would like to know if it is okay to continue taking .5mg of lorazepam during the night. If not - what would be recommended that would help me get back to sleep and control the anxiety as well? SSRIs do not seem to work for me at all (and the side effects were pretty awful).

Thank you so much for your time.

[admin]

Dear Kelo,

Lorazepam transfer into human milk is minimal, and it is the ideal choice for use in breastfeeding since it has a shorter half-life and is not as addicting. At least two studies suggest the relative infants dose range from 2.6% - 2.9%, which is low. Observe for sedation and withdrawal in the breastfed infant.

However, the use of lorazepam during pregnancy is possibly hazardous. Experience with this drug in pregnant women has demonstrated that it can cause birth defects. The benefits to the mother might exceed the possible risks to the fetus. Because the use of these drugs is rarely a matter of urgency, the use of lorazepam during the first trimester should be avoided. Increased states of anxiety may also adversely affect pregnancy outcome & this should be considered prior to discontinuing this medication. Buspirone is an alternative class B.

In humans, blood levels obtained from umbilical cord blood indicate placental transfer of lorazepam and lorazepam glucuronide. Infants of mothers who ingested benzodiazepines for several weeks or more preceding delivery have been reported to have withdrawal symptoms during the postnatal period. Symptoms such as hypoactivity, hypotonia, hypothermia, respiratory depression, apnea, feeding problems, and impaired metabolic response to cold stress have been reported in neonates born of mothers who have received benzodiazepines during the late phase of pregnancy or at delivery.

Hope this helps!

For further questions please contact us at the InfantRisk Center on 806-352-2519.

Tassneem Abdel Karim, MD
InfantRisk Center

[kelo]

Thank you for your response. In the past few weeks I have started Buspirone as you recommended but unfortunately it hasn't helped at all. I am still waking up with anxiety in the middle of the night, unable to fall back asleep. My doctor wanted to try Trazodone to see if that would help with my sleep but we weren't sure of how safe it is during pregnancy (which is the reason I was thinking of going off Ativan in the first place). They gave me a 50 mg pill to take at night, but I was thinking of cutting the pill in half to see if that would work. How safe is this? Thank you so much for your response.
-k.

[admin]

Dear Kelo,

Trazodone is a pregnancy category C drug (probably safe).

Trazodone is a phenylpiperazine antidepressant. In a recent study published in the Canadian Journal of Psychiatry, they found that the use of antidepressants in the first trimester of pregnancy does not seem to increase the risk of congenital malformations above that seen in the general population. In another study, women exposed to trazodone during pregnancy were compared with those taking other antidepressant drugs or drugs that have been deemed non-teratogenic. The study showed that there was no difference between the groups and that trazodone use during the first trimester of pregnancy does not increase the rate of congenital anomalies.

Tassneem Abdel Karim, MD
InfantRisk Center

[johnmeth01]

I am also agree with admin sugession. I have done also research on Trazodone drug. It is assigned to pragenancy category by FDA. It excreted into human milk in small amounts. And for your anxiety problem you can consern with someone other anxiety specialist.