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[Pharmacokinetics of anticonvulsants in the perinatal period]
F P Meyer1, B Quednow, A Potrafki
1Institut für Klinische Pharmakologie, Medizinischen Akademie Magdeburg.
Insights
This study measured anticonvulsant drug levels in pregnant patients, finding significant variations in serum, amniotic fluid, and breast milk. Therapeutic drug monitoring is recommended for pregnant patients and neonates receiving these medications.
Area of Science:
- Pharmacology
- Obstetrics
- Neonatology
Context:
- Pregnant patients often require anticonvulsant therapy.
- Drug concentrations can vary significantly during pregnancy and postpartum.
Purpose:
- To quantify anticonvulsant drug concentrations in maternal serum, cord serum, amniotic fluid, and breast milk.
- To assess drug transfer and distribution in pregnant patients and neonates.
Summary:
- Measurements of primidone, phenobarbitone, carbamazepine, phenytoin, ethosuximide, and valproic acid were taken in 23 pregnant patients.
- Drug concentrations showed wide ranges across maternal serum, cord serum, amniotic fluid, and breast milk.
- Cord serum concentrations ranged from 60-162% of maternal serum levels, amniotic fluid from 5-230%, and breast milk from 2-228%.
Impact:
- Highlights the variability of anticonvulsant drug levels during pregnancy and postpartum.
- Underscores the need for therapeutic drug monitoring in pregnant patients and neonates.
- Informs clinical practice regarding medication management in pregnancy.
Abstract:
We have examined the concentration of a range of anticonvulsant drugs in serum, amniotic fluid and breast milk in 23 pregnant patients. Drug determinations were made during the last 3 months of pregnancy, at birth and during the first week postpartum. In the cord serum the range of concentrations, expressed as a percentage of the maternal serum concentration was: primidone (67-131%), phenobarbitone (80-108%), carbamazepine (60-76%), phenytoin (95-162%), ethosuximide (104%), and valproic acid (125-147%). In the amniotic fluid the corresponding ranges were: primidone (62-230%), phenobarbitone (28-59%), carbamazepine (18-45%), phenytoin (18-60%), ethosuximide (111%) and valproic acid (5-11%). In breast milk the corresponding percentages were: primidone (44-228%), phenobarbitone (20-50%), carbamazepine (32-80%), phenytoin (46-53%), ethosuximide (92%) and valproic acid (2-8%). Anticonvulsant drugs can be given in relatively high doses during pregnancy. Pregnant patients and neonates are patients with therapeutic problems. For this group of patients is recommendable a therapeutic drug monitoring.