Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM
Concurrent prescription of psychotropic medications and opioids in pregnant women may put their infants at increased risk for neonatal drug withdrawal, according to a study in The BMJ.
Using Medicaid data, researchers studied over 200,000 women who were prescribed opioids in the last 45 days of their pregnancy. Over 30,000 of these women also filled a prescription for an antidepressant, an antipsychotic, a benzodiazepine, gabapentin, or a non-benzodiazepine hypnotic.
Absolute risks for neonatal drug withdrawal were 2% for coprescribed nonbenzodiazepine hypnotics, 3% for antidepressants, 7% for antipsychotics, 8% for benzodiazepines, and 11% for gabapentin, compared with 1% for opioids alone. After adjustment for opioid dose and other potential confounders, the increased risk was only significant for coprescribed antidepressants, benzodiazepines, and gabapentin. Being prescribed two or more psychotropics was associated with a doubling of risk.
The authors conclude: “Clinicians should be cautious in prescribing these medications together in late pregnancy and in prescribing psychotropic medications to women with known or suspected illicit opioid use.”