Aripiprazole use during pregnancy and lactation

Introduction: Data on treatment with second generation antipsychotics during pregnancy and breast feeding are rare. Considering aripiprazole, published observations are confined to two single subjects. In one case exposure during pregnancy revealed no indication of teratogenicity. In the other case a low milk/plasma ratio was reported during breast feeding. Materials and Methods: We report a 34 year old patient with a diagnosis of schizophrenia paranoid type who suffered from two psychotic episodes since 2004. She remitted with 15 mg aripiprazole per day, while on treatment, she conceived. Medication was continued during pregnancy and lactation. After initiation of breast feeding we analysed 3 specimen of breast milk on day 27 after the infant's birth using high performance liquid chromatography (HPLC). Results: Apart from a perinatal group b streptococcal infection the newborn infant showed no morphological or developmental abnormality. No aripiprazole was detected in all obtained breast milk samples, whereas the detection limit was 10 ng/ml. Taking into account plasma aripiprazole concentration of 207 ng/ml and dehydroaripiprazole 42 ng/ml respectively, milk/plasma ratio was smaller than 0.04. No untoward side effect occurred during lactation in a 3 month follow up period. Conclusion: This case report gives evidence that aripiprazole use during pregnancy and lactation is relatively save, nevertheless no final conclusion can be drawn which antipsychotic agent should be preferred if treatment is required in the perinatal phase.