Pregnancy- Associated Changes in Pharmacokinetics and their Clinical Implications

  title={Pregnancy- Associated Changes in Pharmacokinetics and their Clinical Implications},
  author={Gideon Koren and Gali Pariente},
  journal={Pharmaceutical Research},
PurposeTo critically review pregnancy-induced pharmacokinetic changes and their clinical application.MethodsStructured review of Pubmed, MBASE and published books.ResultsFor many drugs, advanced pregnancy is associated with lower maternal serum concentrations. As most drug concentrations are not measured routinely, such changes are not evident to the clinician. Moreover, even for drug concentrations measured clinically, one cannot interpret lower total drug levels as evidence of lower fraction… 

Perinatal pharmacology and safety profiles.

  • K. Allegaert
  • Medicine, Biology
    Handbook of clinical neurology
  • 2020

Understanding the Pharmacokinetics of Antibiotics in Pregnancy: Is There a Role for Therapeutic Drug Monitoring? A Narrative Review

Knowing about the impact on pharmacokinetics and fetal exposure is especially helpful for complicated or severe infections, including intra-amniotic infection and sepsis in pregnancy, where both mother and fetus are at risk.

Drug therapy during pregnancy

Drug therapy in pregnancy may cause anxiety to both providers and patients due to uncertainty regarding dosing and safety, but research has found that medications are widely used during pregnancy, with the prevalence of using at least one drug ranging from 60% to 90%, excluding vitamins and minerals.

Prevalence and profile of adverse drug reactions in high-risk pregnancy: a cohort study

Lower gestational age is a risk factor for high-risk pregnant women, increasing the likelihood of adverse reactions, with parenteral medications being those that have the highest potential risk of harm.

Physiologically Based Pharmacokinetic Modeling in Pregnant Women Suggests Minor Decrease in Maternal Exposure to Olanzapine

D dose adjustment of olanzapine can hardly be recommended for pregnant women if effective treatment was achieved before the onset of pregnancy and if fetal toxicity can be ruled out.

When special populations intersect with drug–drug interactions: Application of physiologically‐based pharmacokinetic modeling in pregnant populations

A raltegravir pPBPK model implementing UGT1A1 induction during the second and third trimesters of pregnancy was developed in the current work and verified against clinical data and illustrated the advantages of pP BPK modeling for mechanistic evaluation of complex interplays of pregnancy‐ and drug‐related effects in support of model‐informed approaches in drug development.

Impact of pregnancy related hormones on drug metabolizing enzyme and transport protein concentrations in human hepatocytes

These results provide the first comprehensive quantitative proteomic evaluation of PRH effects on non-CYP DMEs and transport proteins in SCHH and offer mechanistic insight into the altered disposition of drug substrates cleared by these pathways during pregnancy.

Therapeutic Drug Monitoring of Levetiracetam in Select Populations.

  • D. JarvieS. Mahmoud
  • Medicine, Biology
    Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques
  • 2018
Routine TDM of levetiracetam is not recommended for all populations, however, it may be beneficial to maintain an individual therapeutic range in patients where the PK of LEV may be altered, such as in patients who are critically ill patients, pregnant, pediatrics or elderly.



Pregnancy-Associated Changes in Pharmacokinetics: A Systematic Review

A significant gap is identified between the accumulating knowledge of PK changes in pregnant women and the authors' understanding of their clinical impact for both mother and fetus, and it is essential for clinicians to be aware of these unique pregnancy-related changes in PK, and to critically examine their clinical implications.

Antiepileptic drug treatment in pregnancy: Changes in drug disposition and their clinical implications

It is suggested that monitoring of AED serum concentrations in pregnancy could be important, in particular when women have been titrated to the lowest effective AED dose and serum concentration before pregnancy, and when that individual optimal concentration can be used as reference.

Physiologic and pharmacokinetic changes in pregnancy

Understating the changes in maternal physiology during pregnancy and their profound impact on the pharmacokinetic properties of drugs in pregnancy is essential to optimize maternal and fetal health.

Physiologically-based pharmacokinetic modeling of renally excreted antiretroviral drugs in pregnant women.

Pregnancy PBPK models are useful tools to quantify a priori the drug exposure changes during pregnancy for renally excreted drugs and can be applied to evaluate alternative dosing regimens to optimize drug therapy during pregnancy.

Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition

Serum concentrations in the third trimester were significantly lower than baseline for quetiapine and aripiprazole, and for the remaining antipsychotics, this indicates that concentrations may decline at least for perphenazine and possibly also for haloperidol.

Oral Nifedipine Pharmacokinetics in Pregnancy‐Induced Hypertension

The pharmacokinetics of oral nifedipine were studied in 15 women with pregnancy‐induced hypertension in the third trimester of pregnancy to determine if the drug's disposition was different from that

Disposition of Carbamazepine and Phenytoin in Pregnancy

Summary: Free and total plasma concentrations of phenytoin (PHT) and carbamazepine (CBZ) and its active metabolite carbamazepine‐10,11‐epoxide (CBZ‐E) were determined in a prospective study of 86

Amoxicillin Pharmacokinetics in Pregnant Women: Modeling and Simulations of Dosage Strategies

Simulations suggest that amoxicillin concentrations adequate to prevent anthrax may be difficult to achieve during pregnancy and postpartum, and may not be an appropriate antibiotic for post‐anthrax exposure prophylaxis.

Pregnancy and use of oral contraceptives reduces the biotransformation of proguanil to cycloguanil

Late pregnancy and OCP use impair biotransformation of the active antimalarial metabolite CG from the parent PG, which may be mediated by oestrogen inhibition of CYP2C19 activity.

Pharmacokinetics of Metformin during Pregnancy

The results indicate that metformin pharmacokinetics are affected by pregnancy-related changes in renal filtration and net tubular transport and can be roughly estimated by the use of creatinine clearance.