在怀孕期间和怀孕后,在患有的妇女中,拉莫特里金性质的变化
Ashwin Karanam1,2, Page B Pennell3, Kimford J Meador4
1Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA.
Pharmacotherapy
|January 7, 2025
概括
大多数患有的孕妇 (PWWE) 经历了显著的lamotrigine清除变化,但有一小部分没有. 在PWWE中,拉莫特里金的药理动力学有所不同,这会影响怀孕期间和之后的剂量调整.
科学领域:
- 药理动力学 药理动力学
- 症管理 症管理
- 怀孕和药物新陈代谢 怀孕和药物新陈代谢
背景情况:
- 在患有的孕妇 (PWWE) 中,拉莫素清除量的变化使剂量复杂化.
- 在怀孕和产后期间了解PWWE中lamotrigine的药理动力学至关重要.
研究的目的:
- 在整个怀孕和产后期间,在PWWE中描述拉莫特里金的药理动力学.
- 为了比较PWWE和患有的非孕妇 (NPWWE) 之间的lamotrigine药理动力学.
主要方法:
- 美国20个地点 (2012-2016) 的前性观察队列研究 (MONEAD).
- 包括170名PWWE和51名NPWWE年龄在14-45岁之间,接受了lamotrigine.
- 人口混合效应建模用于分析lamotrigine清除变化,在七次访问中测量了血药物和激素水平.
主要成果:
- 在PWWE和NPWWE (2.79 L/小时) 之间,基线拉莫特里金清除值相似.
- 确定了PWWE的两个亚群:约91%的孕期清除增加了275%,而约9%的清除变化很小.
- 通过单指数下降,拉莫特里金清除恢复到产后基线;以雌激素为基础的药物和诱导酶的抗发作药物增加了非孕妇清除.
结论:
- 大约91%的PWWE在怀孕期间表现出显著的lamotrigine清除变化,需要调整剂量.
- 一个明显的PWWE亚群 (~9%) 显示出最小的清除变化,可能避免实质性的剂量修改.
- 含有雌激素的药物与PWWE和NPWWE的非孕妇拉莫特里金清除率较高有关.
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