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DOC in Pregnancy & lactation

The various drugs used are causes Lithium – Ebstein’s anomaly 1:10,00
Carbamazepine – Neural tube defect 1:1300
Sodium valporate – Neural tube defect 1:700 Though the ebstein’s anomaly is problem with lithium but incidence is very low compared to carbamazepine, sodium valproate so, the drug of choice in pregnancy is lithium.
Lithium is excreted unchanged through kidneys and also is secreted in breast milk and infant kidneys are immature to handle lithium.
So in lactation we have to shift to either. Sodium valproate / carbamazepine.

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