Lorazepam
Lorazepam
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Ativan, Ativan West-ward, Lorazepam, Lorazepam Baxter, Lorazepam Dorom......
Ativan, Ativan West-ward, Lorazepam, Lorazepam Baxter, Lorazepam Dorom, Lorazepam Intensol, Lorazepam Macure, Lorazepam Orifarm, Lorazepam Orion, Lorazepam Tablets, Lorazepam sublingual, Tavor, Tavor Pro Injectione 2 mg, Temesta, Temesta ExpidetATC-koder
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lorazepam
lorazepamBedömning
Behandling med bensodiazepiner inklusive lorazepam under graviditet bör, om möjligt, undvikas. Någon säkerställd ökad risk för fosterskador finns dock inte, förutom möjligen vid mycket höga doser. Användning av bensodiazepiner i sen graviditet kan bland annat ge övergående utsättningssymptom hos barnet. Doseringen ska därför hållas så låg som möjligt om behandling sker under senare delen av graviditeten.
Behandling med bensodiazepiner inklusive lorazepam under graviditet bör, om möjligt, undvikas. Någon säkerställd ökad risk för fosterskador finns dock inte, förutom möjligen vid mycket höga doser. Användning av bensodiazepiner i sen graviditet kan bland annat ge övergående utsättningssymptom hos barnet. Doseringen ska därför hållas så låg som möjligt om behandling sker under senare delen av graviditeten.Bakgrund
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Riskerna med användning av bensodiazepiner under graviditeten har varit föremål för mycket forskning [1-17]. En ökad risk för fosterskador, särskilt läppgomspalt, visades i tidiga studier men har inte verifierats i senare undersökningar med bättre studiedesign [1,6,11,13, 17]. Det var främst retrospektiva fall-kontrollstudier, där uppgifter om exponering inhämtats efter det att barnet fötts, som visade en ökad förekomst av fosterskador [3-4]. De motsägelsefulla fynden kan bero på olika studiedesign, men också på att samtidig medicinering med andra läkemedel, dolt missbruk och sociala problem kan ha påverkat resultaten [2,5].
Vid mycket hög dosering......
Referenser
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Ban L, West J, Gibson JE, Fiaschi L, Sokal R, Doyle P et al. First trimester exposure to anxiolytic and hypnotic drugs and the risks of major congenital anomalies: a United Kingdom population-based cohort study. PLoS One. 2014;9:e100996.
Bellantuono C, Tofani S, Di Sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry. 2013;35:3-8.
Dolovich LR, Addis A, Vaillancourt JM et al. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ 1998;317:839-43.
Bonnot O, Vollset SE, Godet PF, d'Amato T, Dalery J, Robert E. In utero exposure to benzodiazepine. Is there a risk for anal atresia with lorazepam? Encephale 2003;29:553-9.
Wikner BN, Stiller CO, Källén B, Asker C. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: maternal characteristics. Pharmacoepidemiol Drug Saf. 2007;16:988-94.
Wikner BN, Stiller CO, Bergman U, Asker C, Källén B. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiol Drug Saf 2007;16:1203-10.
Eros E, Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J. A population-based case-control teratologic study of nitrazepam, medazepam, tofisopam, alprazolum and clonazepam treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;101:147-54.
Ornoy A, Arnon J, Shechtman S et al. Is benzodiazepine use during pregnancy really teratogenic? Reprod Toxicol 1998;12:511-5.
Laegreid L, Hagberg G, Lundberg A. The effect of benzodiazepines on the fetus and the newborn. Neuropediatrics 1992;23:18-23.
Laegreid L, Olegård R, Wahlström J et al. Abnormalities in children exposed to benzodiazepines in utero. Lancet 1987;1:108-9.
Källén B, Borg N, Reis M. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel). 2013;6:1221-86.
Grigoriadis S, Graves L, Peer M, Mamisashvili L, Ruthirakuhan M, Chan P et al. Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A Systematic Review and Meta-analysis. Can J Psychiatry. 2020;65(12):821-834.
Grigoriadis S, Graves L, Peer M, Mamisashvili L, Dennis CL, Vigod SN et al. Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis. J Clin Psychiatry. 2019;80(4):18r12412.
Brandlistuen RE, Ystrom E, Hernandez-Diaz S, Skurtveit S, Selmer R, Handal M et al. Association of prenatal exposure to benzodiazepines and child internalizing problems: A sibling-controlled cohort study. PLoS One. 2017;12(7):e0181042.
Sundbakk LM, Wood M, Gran JM, Nordeng H. Impact of prenatal exposure to benzodiazepines and z-hypnotics on behavioral problems at 5 years of age: A study from the Norwegian Mother and Child Cohort Study. PLoS One. 2019;14(6):e0217830.
Lupattelli A, Chambers CD, Bandoli G, Handal M, Skurtveit S, Nordeng H. Association of Maternal Use of Benzodiazepines and Z-Hypnotics During Pregnancy With Motor and Communication Skills and Attention-Deficit/Hyperactivity Disorder Symptoms in Preschoolers. JAMA Netw Open. 2019;2(4):e191435.
Noh Y, Lee H, Choi A, Kwon JS, Choe SA, Chae J et al. First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea. PLoS Med. 2022;19(3):e1003945.
- Ban L, West J, Gibson JE, Fiaschi L, Sokal R, Doyle P et al. First trimester exposure to anxiolytic and hypnotic drugs and the risks of major congenital anomalies: a United Kingdom population-based cohort study. PLoS One. 2014;9:e100996.
- Bellantuono C, Tofani S, Di Sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry. 2013;35:3-8.
- Dolovich LR, Addis A, Vaillancourt JM et al. Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ 1998;317:839-43.
- Bonnot O, Vollset SE, Godet PF, d'Amato T, Dalery J, Robert E. In utero exposure to benzodiazepine. Is there a risk for anal atresia with lorazepam? Encephale 2003;29:553-9.
- Wikner BN, Stiller CO, Källén B, Asker C. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: maternal characteristics. Pharmacoepidemiol Drug Saf. 2007;16:988-94.
- Wikner BN, Stiller CO, Bergman U, Asker C, Källén B. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiol Drug Saf 2007;16:1203-10.
- Eros E, Czeizel AE, Rockenbauer M, Sorensen HT, Olsen J. A population-based case-control teratologic study of nitrazepam, medazepam, tofisopam, alprazolum and clonazepam treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;101:147-54.
- Ornoy A, Arnon J, Shechtman S et al. Is benzodiazepine use during pregnancy really teratogenic? Reprod Toxicol 1998;12:511-5.
- Laegreid L, Hagberg G, Lundberg A. The effect of benzodiazepines on the fetus and the newborn. Neuropediatrics 1992;23:18-23.
- Laegreid L, Olegård R, Wahlström J et al. Abnormalities in children exposed to benzodiazepines in utero. Lancet 1987;1:108-9.
- Källén B, Borg N, Reis M. The use of central nervous system active drugs during pregnancy. Pharmaceuticals (Basel). 2013;6:1221-86.
- Grigoriadis S, Graves L, Peer M, Mamisashvili L, Ruthirakuhan M, Chan P et al. Pregnancy and Delivery Outcomes Following Benzodiazepine Exposure: A Systematic Review and Meta-analysis. Can J Psychiatry. 2020;65(12):821-834.
- Grigoriadis S, Graves L, Peer M, Mamisashvili L, Dennis CL, Vigod SN et al. Benzodiazepine Use During Pregnancy Alone or in Combination With an Antidepressant and Congenital Malformations: Systematic Review and Meta-Analysis. J Clin Psychiatry. 2019;80(4):18r12412.
- Brandlistuen RE, Ystrom E, Hernandez-Diaz S, Skurtveit S, Selmer R, Handal M et al. Association of prenatal exposure to benzodiazepines and child internalizing problems: A sibling-controlled cohort study. PLoS One. 2017;12(7):e0181042.
- Sundbakk LM, Wood M, Gran JM, Nordeng H. Impact of prenatal exposure to benzodiazepines and z-hypnotics on behavioral problems at 5 years of age: A study from the Norwegian Mother and Child Cohort Study. PLoS One. 2019;14(6):e0217830.
- Lupattelli A, Chambers CD, Bandoli G, Handal M, Skurtveit S, Nordeng H. Association of Maternal Use of Benzodiazepines and Z-Hypnotics During Pregnancy With Motor and Communication Skills and Attention-Deficit/Hyperactivity Disorder Symptoms in Preschoolers. JAMA Netw Open. 2019;2(4):e191435.
- Noh Y, Lee H, Choi A, Kwon JS, Choe SA, Chae J et al. First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea. PLoS Med. 2022;19(3):e1003945.
Författare
Karin Källén och Katarina Wide för Region Stockholm.
Karin Källén och Katarina Wide för Region Stockholm.Uppdaterat
Innehållet uppdaterat 4/13/2022
Uppgifterna från födelseregistret är hämtade 4/1/2020
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