Uneventful use of haloperidol and trihehexyphenidyl during three consecutive pregnancies

Dear Editor, We present a woman who used haloperidol and trihexyphenidyl without adverse consequences all through three consecutive pregnancies, and subsequently during lactation, as well. We believe that our report of the use of haloperidol during pregnancy and lactation on three consecutive occasions is the first of its kind in literature. Mrs. S, a 30-year-old woman, was receiving haloperidol (7.5 to 10 mg/day) with trihexyphenidyl (4 mg/day) for a longstanding paranoid schizophrenic illness (DSM-IV). She became pregnant, while on treatment, during 2001. After discussing the benefits and risks with the treatment team, she and her husband elected to continue the medications without changes; their decision was influenced by past experiences of reemergence of schizophrenic symptoms associated with even small reductions in haloperidol dose. The pregnancy was closely monitored; it terminated uneventfully in the full-term, normal delivery of a healthy, 3.2-kg girl. A pregnancy in 2004 was likewise continued with the same doses of the same medicines. The outcome was again uneventful: she delivered a full-term, healthy, 3.3-kg boy. During week 14 of a third pregnancy in 2007, she suffered a psychotic exacerbation that was treated with an increase in the haloperidol dose to 15 mg/day, augmented (for 1 month) by risperidone 2 mg/day. Trihexyphenidyl (4 mg/day) was continued as before. The course of the pregnancy was otherwise medically uneventful. She delivered a full-term, healthy, 3.1-kg boy.