Alprazolam: Safe During Pregnancy?

Alprazolam, more commonly known by its brand name, Xanax, is a powerful drug used to treat anxiety and panic disorders. It is a central nervous system depressant that can lead to feelings of calm and relaxation. However, it is not safe to take during pregnancy.

Xanax is classified as a Category D pregnancy drug by the United States Food and Drug Administration (FDA), meaning it can harm your pregnancy. Taking Xanax during the first trimester may increase the risk of cleft lip and cleft palate, while taking it during the second and third trimesters can cause withdrawal syndrome and floppy infant syndrome in the baby. Untreated anxiety during pregnancy can also lead to behaviours that harm the mother and baby, such as missed doctor's appointments and alcohol or drug consumption.

Alprazolam may cause birth defects like cleft lip and cleft palate

Alprazolam is a type of drug called a benzodiazepine, which is used to treat anxiety and panic disorders. It is not safe to take during pregnancy as it is categorised as a pregnancy category D drug, which means it can harm the pregnancy.

Taking alprazolam during the first trimester of pregnancy (months 1 to 3) could increase the risk of birth defects in the baby. These include cleft lip and cleft palate, which occur when a baby's lip or mouth don't form properly. A cleft lip is when the tissue making up the upper lip doesn't join completely before birth, leaving a small or large opening that can go through the lip into the nose. A cleft palate occurs when the tissue that makes up the roof of the mouth doesn't join together completely.

These birth defects can affect the way a baby looks, develops, or functions for the rest of their life. They can cause problems with feeding and speaking clearly, as well as ear infections, hearing problems, and issues with teeth. Surgery to repair a cleft lip or palate is recommended within the first 12-18 months of life, and further surgical procedures are often needed as the child grows older. While most children with these conditions lead a healthy life, they may experience issues with self-esteem due to visible differences.

Although the link between alprazolam and cleft lip and palate is not yet definitive, it is still recommended to avoid taking this drug during pregnancy.

It can lead to neonatal abstinence syndrome (NAS) or neonatal withdrawal

Alprazolam is a drug that is unsafe to take during pregnancy. It is a pregnancy category D drug, which means it can harm the foetus. The effects on a pregnancy depend on when in the pregnancy the drug is taken. However, it can cause serious problems throughout the entire pregnancy, so it is advised to avoid it during all three trimesters.

Taking alprazolam during pregnancy can lead to neonatal abstinence syndrome (NAS) or neonatal withdrawal in the baby after birth. This is because alprazolam, a benzodiazepine, can pass through the placenta and cause the baby to become dependent on the drug. If the mother continues to take the drug within the week or so before delivery, the baby will be dependent on it at birth. Since the baby is no longer receiving the drug after birth, withdrawal symptoms may occur as the drug slowly clears from the baby's system.

Withdrawal symptoms in newborns exposed to alprazolam can include trouble regulating body temperature, trouble breathing, low energy, poor feeding, and vomiting. These symptoms can start soon after birth and could last several days. Not all babies exposed to alprazolam will experience these symptoms. However, it is important for healthcare providers to be aware if the mother is taking alprazolam so that the baby can receive appropriate care if symptoms occur.

NAS is a group of conditions caused when a baby withdraws from certain drugs, most often opioids, that they were exposed to in the womb before birth. In addition to opioids, antidepressants, barbiturates, and benzodiazepines can also cause NAS. Symptoms of NAS can vary depending on the type of drug used, the amount and duration of use, and the baby's gestational age. Symptoms may include excessive crying, high-pitched crying, hyperactive reflexes, increased muscle tone, stuffy nose, sneezing, poor feeding, slow weight gain, breathing problems, fever, sweating, blotchy skin, trouble sleeping, diarrhoea, and vomiting.

Treatment for NAS aims to manage withdrawal symptoms and typically involves medications such as morphine, methadone, or buprenorphine. These medications are gradually reduced over time to wean the baby off the drug. In addition to medical treatment, non-pharmacological approaches such as skin-to-skin care, swaddling, and breastfeeding can help comfort and soothe the baby.

It may cause floppy infant syndrome or hypotonia

Alprazolam is not safe to take during pregnancy. It is a pregnancy category D drug, which means it can harm the pregnancy. The drug can cause floppy infant syndrome, which means the baby may have weak muscles and a rag-doll-like appearance. They may not be able to control their head, arms, and legs. This condition may last 2 to 3 weeks after birth.

Floppy infant syndrome is caused by the rapid placental transfer of diazepam, a drug with similar properties to alprazolam. High single doses and repeated, prolonged administration of benzodiazepines must be avoided during pregnancy.

Floppy infant syndrome can cause a low Apgar score, a measure of the physical condition of a baby. A low score can indicate problems with the baby's breathing, heart rate, or body temperature.

Untreated anxiety and depression can increase risks to a pregnancy, so it is important to talk to a healthcare provider about alternative treatments.

It is excreted in breast milk and can be passed on to infants

Alprazolam is excreted in breast milk and can be passed on to infants. While it is possible to breastfeed while taking alprazolam, it is not recommended due to the risks posed to the infant.

A safety scoring system has found that alprazolam is possible to use while breastfeeding. However, due to reports of effects in infants, including sedation, it is not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred.

If alprazolam is used long-term, the infant should be monitored for sedation, poor feeding, and poor weight gain. In one study, a mother reported drowsiness in her infant, but it did not require medical attention. Another study reported that a 1-week-old infant whose mother had taken alprazolam during pregnancy and continued to take it after delivery exhibited increased irritability following the withdrawal of breastfeeding. This reaction probably indicates that there was enough alprazolam in the breast milk to prevent withdrawal.

After a single dose of alprazolam, there is usually no need to wait to breastfeed. The product label for alprazolam recommends that breastfeeding people not use this medication. However, the benefits of using alprazolam may outweigh the possible risks. It is important to talk to a healthcare provider about using alprazolam while breastfeeding and to discuss alternative treatments.

Alprazolam is not recommended during pregnancy unless no alternatives exist

Alprazolam, more commonly known by its brand name, Xanax, is a powerful drug used to treat anxiety and panic disorders. It is a central nervous system depressant that can cause feelings of calm and relaxation. While alprazolam can be beneficial for people struggling with anxiety, it is not recommended for use during pregnancy unless no alternatives exist. This is because the drug can cross the placenta and have direct effects on the foetus, leading to potential harm.

The United States Food and Drug Administration (FDA) classifies alprazolam as a Category D pregnancy drug, indicating that the medication may cause harm to the pregnancy. The specific effects depend on the stage of pregnancy in which the drug is taken. During the first trimester, alprazolam use has been associated with an increased risk of birth defects, including cleft lip and cleft palate. Older studies suggest that this risk also extends to more serious problems that can affect the baby's appearance, development, and function. While more research is needed to confirm these findings, the potential risks to the foetus are concerning.

Taking alprazolam during the second and third trimesters can lead to withdrawal syndrome and floppy infant syndrome in the baby. Withdrawal syndrome, also known as neonatal abstinence syndrome (NAS), occurs because the baby was exposed to the drug in the womb and experiences postpartum withdrawal symptoms such as trouble gaining weight, blotchy skin, excessive crying, sneezing, and a stuffy nose. Floppy infant syndrome, or hypotonia, causes low muscle tone, resulting in a ragdoll-like appearance and difficulty holding up the head.

In addition to the physical risks, using alprazolam during pregnancy can also have emotional consequences for new mothers. Dealing with drug addiction or neonatal withdrawal syndrome can make the transition to motherhood more challenging. It is important to note that untreated anxiety during pregnancy can also lead to behaviours that harm both the mother and the baby, such as missed doctor's appointments and substance abuse. However, alternative treatments for anxiety during pregnancy are available, including cognitive-behavioural therapy, antidepressants, and natural mood-boosting activities like exercise and yoga.

In summary, while alprazolam can be a beneficial medication for treating anxiety, it is not recommended for use during pregnancy unless there are no other alternatives. The potential risks to the foetus and newborn baby are significant, and healthcare providers should carefully consider the benefits and risks before prescribing this medication to pregnant individuals.

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