RT Journal Article
SR Electronic
T1 Why the Maternal Medication List Matters: Neonatal Toxicity From Combined Serotonergic Exposures
JF Pediatrics
JO Pediatrics
FD American Academy of Pediatrics
SP e20192250
DO 10.1542/peds.2019-2250
VO 147
IS 2
A1 Brajcich, Michelle R.
A1 Palau, Mauricio A.
A1 Messer, Ricka D.
A1 Murphy, Michael E.
A1 Marks, Jill
YR 2021
UL http://pediatrics.aappublications.org/content/147/2/e20192250.abstract
AB Serotonergic medications are used for the prevention and treatment of depression during pregnancy. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (SNRIs) can cause poor neonatal adaptation, which has been attributed to withdrawal versus toxicity. Bupropion, a norepinephrine-dopamine reuptake inhibitor, is often used as an adjunctive agent to selective serotonin reuptake inhibitors or SNRIs for refractory depression. Quetiapine, an atypical antipsychotic, may also be used in more complex cases. When combined with serotonergic drugs, bupropion and quetiapine are associated with increased risk of serotonin syndrome in adults. We describe a neonate exposed to venlafaxine (an SNRI), bupropion, and quetiapine in utero who presented nearly immediately after birth with encephalopathy and abnormal movements. The severity and rapidity of symptoms may be attributable to potentiation of venlafaxine’s serotonergic effects by bupropion and quetiapine. Neonatal providers should be aware of maternal medications and prepare for possible adverse effects, particularly from common psychotropic exposures.