Carbamazepine in pregnancy

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6582 (Published 2 December 2010)
Cite this as: BMJ 2010;341:c6582

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  1. Irena Nulman, associate professor of paediatrics, University of Toronto
  1. 1Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, ON, Canada, M5G 1X8
  1. irena.nulman{at}sickkids.ca

Has the best safety profile, and is therefore the drug of choice

Epilepsy is the most common neurological disorder seen in pregnant women. It often needs drug treatment, and it causes complications in about 0.25% of all pregnancies. Seizure control is the primary goal when treating a convulsive disorder. Epilepsy itself is not associated with an increased risk of major congenital malformations,1 although some risk cannot be excluded. All first line antiepileptic drugs, such as valproic acid, carbamazepine, and phenytoin, are associated with a twofold to threefold increase in rates of major congenital malformations compared with the general population. In the linked review of observational data (doi:10.1136/bmj.c6581), Jentink and colleagues assessed major congenital malformations associated with the use of carbamazepine in the first trimester of pregnancy.2

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The benefits of seizure control during pregnancy should not be underestimated. For many pregnant women, discontinuing antiseizure drugs is not an option. The choice of drug is challenging to patients and doctors because of the conflict between the optimal treatment of the mother and the wellbeing of the fetus. Women should plan their pregnancy, receive evidence based …

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