Pregnancy- Associated Changes in Pharmacokinetics and their Clinical Implications

@article{Koren2018PregnancyAC,
  title={Pregnancy- Associated Changes in Pharmacokinetics and their Clinical Implications},
  author={Gideon Koren and Gali Pariente},
  journal={Pharmaceutical Research},
  year={2018},
  volume={35},
  pages={1-7}
}
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… 
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References

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Pregnancy-Associated Changes in Pharmacokinetics: A Systematic Review
TLDR
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
TLDR
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.
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TLDR
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.
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TLDR
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.
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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
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TLDR
The disposition of oral metoprolol was studied in 5 women during the last trimester of pregnancy and 3 to 5 months after delivery, resulting in an average apparent oral clearance (Clo) of metobrolol that was 4.4times higher during than after pregnancy.
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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
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TLDR
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.
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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.
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