Anticonvulsants during Pregnancy and Lactation Transplacental, Maternal and Neonatal Pharmacokinetics

@article{Nau1982AnticonvulsantsDP,
  title={Anticonvulsants during Pregnancy and Lactation Transplacental, Maternal and Neonatal Pharmacokinetics},
  author={Heinz Nau and Wilhelm Kuhnz and H J Egger and Dietz Rating and Hans Helge},
  journal={Clinical Pharmacokinetics},
  year={1982},
  volume={7},
  pages={508-543}
}
SummaryFew data are available on placental transfer of anticonvulsants during early pregnancy. Nevertheless, it has been demonstrated that at this early stage of gestation, considerable amounts of Phenytoin, primidone/phenobarbitone and carbamazepine as well as some of their metabolites are already present in fetal tissues. Potentially reactive metabolites of anticonvulsants can be formed by the fetal liver and accumulate in some organs. At term, most anticonvulsants are present in neonatal… 

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References

SHOWING 1-10 OF 69 REFERENCES

Placental transfer of anticonvulsants (phenobarbital, phenytoin, valproic acid) and the elimination from neonates.

The half-life value of PB was found to be shorter than that observed postnatally in the previous reports, while that of VPA was two to three times as long as that reported from children or adults, but short than that from a neonate in the literature.

Valproic acid and its metabolites: placental transfer, neonatal pharmacokinetics, transfer via mother's milk and clinical status in neonates of epileptic mothers.

The pharmacokinetics of valproic acid (VPA) and several metabolites were measured in 11 epileptic mothers and their 12 newborns and the very low levels of VPA in mother's milk suggest apparent safety of breast feeding.

TERATOGENIC AND PHARMACOKINETIC STUDIES OF PRIMIDONE DURING PREGNANCY AND IN THE OFFSPRING OF EPILEPTIC WOMEN

Preliminary data suggest that primidone intake during pregnancy may be important in the pathogenesis of minor anomalies and in the induction of poor somatic development.

Phenytoin Metabolism in Pregnancy

Pregnancy is associated with altered DPH absorption or metabolism, or both, and periodic measurement of plasma DPH concentration is valuable when managing a pregnant epileptic patient, the authors conclude.

Transplacental passage of primidone

A neurologic syndrome of abnormal tremulousness in a newborn infant whose mother had received primidone during pregnancy is observed, and it is presented here a report of this case.

Placental transfer and neonatal elimination of diphenylhydantoin.

  • B. Mirkin
  • Medicine
    American journal of obstetrics and gynecology
  • 1971

Clinical Pharmacokinetics in Neonates

It is clearly emerging that drug disposition may vary greatly in the newborn in relation to its developmental age, and the significance of various factors on drug dispostion during development will be better clarified, thus allowing a more rational and safer therapy inThe newborn.

Urinary corticosteriod and diphenylhydantoin metabolite patterns in neonates exposed to anticonvulsant drugs in utero

The enhanced 6β‐hydroxylation of cortisol seen in adults after barbiturate or diphenylhydantoin was not observed in newborns exposed to these drugs in utero.
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