Antipsychotic use in females of childbearing potential

Effectiveness of hormonal contraception is not reduced by concurrent antipsychotic use, but the following contraceptives increase clozapine blood concentration:

Because of the risk of toxicity associated with this interaction, use an alternative contraceptive method if a patient takes clozapine—see Overview of factors affecting contraceptive choice for contraception advice. If a patient taking clozapine starts or stops an interacting contraceptive, monitor for adverse effects or efficacy (as relevant), check clozapine concentration and consider dosage adjustment; see here for adviceSeeman 2011. For further information on drug interactions, consult a drug information resource.

Some antipsychotics increase blood prolactin concentration and reduce fertility; see Approximate relative frequency of common adverse effects of antipsychotics for the approximate relative frequency of hyperprolactinaemia with antipsychotics. Inform a patient who takes an antipsychotic that causes hyperprolactinemia that fertility may be impaired and that if the antipsychotic is stopped, the risk of pregnancy may increase.

If a patient taking an antipsychotic wishes to become pregnant, see Principles of psychotropic use in females of childbearing potential for advice on preconception planning, and Antipsychotic use during pregnancy for information on antipsychotic choice and adverse effects during pregnancy. If the decision is made to stop the antipsychotic as part of the preconception plan, see Stopping an antipsychotic. Consider the time required for elimination of the drug and its active metabolites, and whether the patient should be advised to delay pregnancy until the drug has been eliminated.