A 27-year-old woman with well-controlled OCD is maintained on paroxetine 50 mg daily. She now wishes to conceive. What is the most appropriate management?
- A Continue paroxetine unchanged through pregnancy
- B Switch to sertraline before conception ✓
- C Stop all psychotropic medication abruptly
- D Add clomipramine to paroxetine
Correct answer: B. Switch to sertraline before conception
Explanation
Paroxetine is the SSRI to avoid in pregnancy because first-trimester exposure is associated with an increased risk of cardiovascular malformations, particularly septal defects. Sertraline has among the most favourable pregnancy safety data within the SSRI group and is a reasonable choice for maintaining OCD control. Abrupt discontinuation risks relapse of OCD, and combining clomipramine with an SSRI raises serotonergic and cardiac toxicity concerns.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.