Reactions 1664, p10 - 12 Aug 2017 Opioids and psychotropic drugs: neonatal drug withdrawal There appears to be an increased risk of neonatal drug withdrawal after exposure to both opioids and psychotropic drugs, according to study results reported in the BMJ, particularly with concomitant antidepressants, benzodiazepines or gabapentin. The observational cohort study included 201 275 pregnant women, 12 55 years of age, from the Medicaid Analytic eXtract (MAX) for 2000 2010 who delivered liveborn neonates. They had received prescriptions for opioids ≤45 days prior to delivery. In addition, prescriptions for antidepressants, antipsychotics, benzodiazepines, gabapentin or Z-drugs were filled by 7.0%, 0.5%, 2.7%, 0.3% and 5.0% of women, respectively. The absolute risk of neonatal drug withdrawal after exposure from opioids alone was around 1%. The risk was significantly higher for neonates also exposed to antidepressants (1.34; 95% CI 1.22, 1.47), benzodiazepines (1.49; 1.35, 1.63), and gabapentin (1.61; 1.26, 2.06), and higher for antipsychotics (1.20; 0.95, 1.51) but not for Z-drugs (1.01; 0.88, 1.15). Adjusted for high dimensional propensity scores, the relative risks were 1.58, 1.40, 1.70, 1.03 and 1.00, respectively. Exposure to any of the psychotropic medication increased the risk of neonatal drug withdrawal (1.37; 1.26, 1.49), which was further increased by exposure to two or more medications (2.05; 1.77, 2.37). "We cannot exclude the possibility that pediatricians are more likely to diagnose withdrawal in infants with known exposure to polypharmacy," note the authors, who note that in some cases exposed to SSRIs their neonatal symptoms "could be better explained by potential toxicity associated with increased serotonin concentrations rather than withdrawal". The authors note that the increase risk of neonatal drug withdrawal after exposure to opioids and psychotropic medication suggests that "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". In an accompanying editorial reported in the BMJ, Stephen W Patrick (Vanderbilt University) and coauthors noted that "these findings are important in targeting prevention efforts and potentially in tailoring treatment of opioid exposed infants," and that "use of medications in pregnancy must balance the health of the mother with the potential impact on developing fetus". In addition, the study found different risks "based on exposure to specific psychotropic agents, suggesting opportunities to tailor postnatal monitoring and treatment for the highest risk infants". 1. Huybrechts KF, et al. Risk of neonatal drug withdrawal after intrauterine co- exposure to opioids and psychotropic medications: cohort study. British Medical Journal 358: j3326, 2 Aug 2017. Available from: URL: https://doi.org/10.1136/ bmj.j3326. 2. Patrick SW, et al. Prescribing opioids and psychotropic drugs in pregnancy. British Medical Journal 358: j3616, 2 Aug 2017. Available from: URL: https:// doi.org/10.1136/bmj.j3616. 0114-9954/17/1664-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 12 Aug 2017 No. 1664
Reactions Weekly – Springer Journals
Published: Aug 12, 2017
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