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Table 4. Benzodiazepine Tapering Considerations by
Pregnancy Trimester
1st trimester 2nd trimester 3rd trimester Postpartum
Considerations
for Tapering
BZDs
If alternative
planned (e.g.,
SSRI) start
alternative early to
allow 6–8 weeks
for effect before
tapering BZD.
Per above:
BZD effect may
decrease even
before taper
Lowest dose
possible to
avoid neonatal
withdrawal
Monitor
sleep closely
Alternative
Medication for
Insomnia
Diphenhydramine Antihistamines,
trazodone
Antihistamines,
trazodone
Alternative
Medication for
Acute Anxiety
Hydroxyzine
a
Hydroxyzine Hydroxyzine Hydroxyzine
Alternative
Medication for
Severe Chronic
Anxiety
SSRI SSRI
SSRI
b
Sertraline
has lowest
relative
infant dose
(RID)
a
Limited data suggest possible low risk with first trimester use, but hydroxyzine is generally
considered safe in practice.
b
Possible increase in persistent pulmonary hypertension of the newborn, with a number
needed to harm of 1,000.
(cont'd)
Recommendations
