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Unisom or quetiapine for sleep in pregnancy?

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  • Unisom or quetiapine for sleep in pregnancy?

    Is it safe to take Unisom 25mg throughout entire pregnancy? I am on Seroquel 100 mg for sleep and i am thinking in weaning off it and try unisom instead. I am trying to conceive.

  • #2
    Andreia,

    There are two formulations for Unisom, one is doxalamine and the second is diphenhydramine.

    The first is doxalamine which is rated a P1-minimal risk to the fetus. "Doxylamine is an antihistamine used in combination with pyridoxine to treat nausea and vomiting in pregnancy. Doxylamine is used in the United States in medications to treat common cold symptoms and insomnia.[1] Antihistamines, as a class, do not appear to increase the risk of congenital malformations.[2] Nulman et al reported no long-term neurodevelopmental effects in children exposed to doxylamine and pyridoxine in utero.[3] Vomiting itself during pregnancy has been linked with an increased risk for microcephaly and cataracts.[4] In summary, doxylamine does not appear to increase the risk of congenital anomalies but should only be used if the benefit to the mother outweighs the risk to the fetus. Doxyalmine causes drowsiness and when used for nausea and vomiting giving 1/2 the dose may be considered." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    1.##Briggs G, Freeman, R., and Yaffe, S. Drugs in Pregancy and Lactation. Vol Seventh Ed. Philadelphia PA: Lippincott, Williams, and Wilkins; 2005.
    2.##Koren G. Medication Safety in Pregnancy and Breastfeeding. McGraw-Hill. Accessed June, 23, 2010, 2007.
    3.##Nulman I, Rovet J, Barrera M, Knittel-Keren D, Feldman BM, Koren G. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr. Jul 2009;155(1):45-50, 50 e41-42.
    4.##Shiono PH, Klebanoff MA. Bendectin and human congenital malformations. Teratology. Aug 1989;40(2):151-155.


    The second is diphenhydramine which is rated a P2-benefits likely to exceed the risk. "Use of this drug in pregnancy appears to be safe, but should only be used when necessary. Studies have shown that antihistamine use during pregnancy, including the first trimester, does not increase the risk of birth defects above that observed in the general population. Diphenhydramine is an antihistamine that has also been used as an antiemetic for hyperemesis. [1] In a study done by the department of OB/GYN at the University of California at Irvine, the drug was not only found to be cost-effective, but also beneficial in the treatment of hyperemesis gravidarum.[2] Other studies have shown that antihistamine use during pregnancy, including the first trimester, does not increase the risk of birth defects above that observed in the general population.[3] Diphenhydramine, in overdose, has also been linked to uterine contractions and has an oxytocin-like effect. [4] Its use should be avoided in infants and young children as there have been several reports of seizures and death from drug intoxication.[5] It is believed that this drug has a paradoxical effect on the CNS in children and causes CNS stimulation.[5] Use of this drug in pregnancy appears to be safe, but should only be used when necessary." (Medications and Mothers' Milk database, Dr Thomas Hale PhD).

    1.##Briggs G, Freeman R, Yaffe S. A Reference Guide to Fetal and Neonatal Risk: Drugs in Pregnancy and Lactation. Vol 1. Seventh Edition ed. Philadelphia, PA: Lippincott Williams & Williams; 2005.
    2.##Nageotte MP, Briggs GG, Towers CV, Asrat T. Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol. Jun 1996;174(6):1801-1805; discussion 1805-1806.
    3.##Gilboa SM, Strickland MJ, Olshan AF, Werler MM, Correa A. Use of antihistamine medications during early pregnancy and isolated major malformations. Birth Defects Res A Clin Mol Teratol. Feb 2009;85(2):137-150.
    4.##Brost BC, Scardo JA, Newman RB. Diphenhydramine overdose during pregnancy: lessons from the past. Am J Obstet Gynecol. Nov 1996;175(5):1376-1377.
    5.##Baker AM, Johnson DG, Levisky JA, et al. Fatal diphenhydramine intoxication in infants. J Forensic Sci. Mar 2003;48(2):425-428.

    Sandra Lovato R.N.
    InfantRisk Center

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