Haloperidol in pregnancy and breastfeeding


Risk Factor: CM
Class: Central nervous system drugs/ Tranquilizers

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary

Fetal Risk Summary

Animal reproductive studies with haloperidol in mice, rats, rabbits, and dogs have not revealed a teratogenic effect attributable to this tranquilizer (1,2). In rodents, doses 2 to 8 times the usual maximum human dose (oral or parenteral) were associated with an increased incidence of resorption, reduced fertility, delayed delivery, and pup mortality (1,2). With single injections up to maternal toxic levels in hamsters, haloperidol was associated with fetal mortality and dose-related anomalies (3). Exposure of male rats in utero to haloperidol throughout most of gestation had no effect on typical parameters of adult sexual activity other than subtle changes involving ultrasonic vocalization (4).

Two reports describing limb reduction malformations after 1st trimester use of haloperidol have been located (5,6). In one of these cases, high doses (15 mg/day) were used (6). Other investigations have not found these defects (7,8,9,10 and 11). Defects observed in the two infants were: ectromelia (phocomelia) (5), multiple upper and lower limb defects, aortic valve defect, and death (6).

In 98 of 100 patients treated with haloperidol for hyperemesis gravidarum in the 1st trimester, no effects were produced on birth weight, duration of pregnancy, sex ratio, or fetal or neonatal mortality, and no malformations were found in abortuses, stillborn, or liveborn infants (7). Two of the patients were lost to followup. In 31 infants with severe reduction deformities born over a 4-year period, none of the mothers remembered taking haloperidol (8). Haloperidol has been used for the control of chorea gravidarum and manic-depressive illness during the 2nd and 3rd trimesters (12,13). During labor, the drug has been administered to the mother without causing neonatal depression or other effects in the newborn (9).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 56 newborns had been exposed to haloperidol during the 1st trimester (F. Rosa, personal communication, FDA, 1993). Three (5.4%) (two expected) major birth defects were observed, two of which were cardiovascular defects (0.6 expected). No anomalies were observed in five other defect categories (oral clefts, spina bifida, polydactyly, limb reduction defects, and hypospadias) for which specific data were available.

Premature labor, loss of fetal cardiac variability and acceleration, an unusual fetal heart rate pattern (double phase baseline), and depression at birth (Apgar scores of 4 and 7 at 1 and 5 minutes, respectively), were observed in a comatose mother and her infant after an acute overdose of an unknown amount of haloperidol and lithium at 31 weeks’ gestation (14). Because of progressive premature labor, the 1526-g female infant was delivered about 3 days after the overdose. The lithium concentrations of the maternal plasma, amniotic fluid, and cord vein plasma were all greater than 4 mmol/L (severe toxic effect >2.5 mmol/L) whereas the maternal level of haloperidol at delivery was about 1.6 ng/mL (14). The effects observed in the fetus and newborn were attributed to cardiac and cerebral manifestations of lithium intoxication. No follow-up on the infant was reported.

Breast Feeding Summary

Haloperidol is excreted into breast milk. In one patient receiving an average of 29.2 mg/day, a milk level of 5 ng/mL was detected (15). When the dose was decreased to 12 mg, a level of 2 ng/mL was measured. In a second patient taking 10 mg daily, milk levels up to 23.5 ng/mL were found (16). A milk:plasma ratio of 0.60.7 was calculated. No adverse effects were noted in the nursing infant.

A 1992 Reference measured haloperidol in the breast milk of three women receiving chronic therapy (17). The maternal doses were 3, 4, and 6 mg/day, and the corresponding haloperidol concentrations in their milk were 32, 17, and 4.7 ng/mL, respectively. The patient receiving 6 mg/day, but with the lowest milk concentration, was thought to be noncompliant with her therapy. No mention of nursing infants was made (17).

A study published in 1998 described 12 mothers who breast-fed their infants while taking haloperidol, chlorpromazine or trifluoperazine for bipolar depression (3 cases), manic disorder (1 case), schizo-affective disorder (5 cases), or schizophrenia (3 cases) (18). Haloperidol was given in a dose ranging from 1 to 40 mg/day. The age of the nursing infants at the start of therapy ranged from 1 to 18 weeks. Using an enzyme immunoassay technique, the range of concentrations in fore-milk and hind-milk were
The American Academy of Pediatrics classifies haloperidol as an agent whose effect on the nursing infant is unknown but may be of concern (19).



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