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phenobarbital in pregnancy

Jessica Degiacomo, Sherry Luedtke
Selective serotonin reuptake inhibitor (SSRI) exposure during pregnancy can result in symptoms of serotonin syndrome or serotonin withdrawal. In contrast to other SSRIs, reports of serotonin behavioral syndrome following in utero exposure to escitalopram and citalopram are limited. We describe a case of suspected toxicity following in utero exposure to 20 mg escitalopram throughout pregnancy. The infant was transferred to our neonatal intensive unit at 9 hours of life for further evaluation of lethargy, weak cry, bradycardia, and non-reactive pupils...
November 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Manisha Goyal, Ashok Gupta, Manish Sharma, Priyanshu Mathur, Naresh Bansal
Epilepsy is a common disorder and exposure to antiepileptic drugs during pregnancy increases the risk of teratogenicity. Older AEDs such as valproate and phenobarbital are associated with a higher risk of major malformations in the fetus than newer AEDs like lamotrigine and levetiracetam. Exposure to valproic acid during first trimester can result in fetal valproate syndrome (FVS), comprising typical facial features, developmental delay, and a variety of malformations such as neural tube defects, cardiac and genitourinary malformations, and limb defects...
2016: Case Reports in Pediatrics
Jennifer Weston, Rebecca Bromley, Cerian F Jackson, Naghme Adab, Jill Clayton-Smith, Janette Greenhalgh, Juliet Hounsome, Andrew J McKay, Catrin Tudur Smith, Anthony G Marson
BACKGROUND: There is evidence that certain antiepileptic drugs (AEDs) are teratogenic and are associated with an increased risk of congenital malformation. The majority of women with epilepsy continue taking AEDs throughout pregnancy; therefore it is important that comprehensive information on the potential risks associated with AED treatment is available. OBJECTIVES: To assess the effects of prenatal exposure to AEDs on the prevalence of congenital malformations in the child...
7, 2016: Cochrane Database of Systematic Reviews
M Martinez Ferri, P Peña Mayor, I Perez López-Fraile, A Escartin Siquier, M Martin Moro, M Forcadas Berdusan
INTRODUCTION: The prescription pattern of antiepileptic drugs (AEDs) during pregnancy is changing but to what extent this is occurring in Spain remains unknown. The efficacy of newer drugs for controlling seizures is a key issue and may have changed over the years as doctors gained familiarity with these drugs during pregnancy. To assess these 2 topics, we report the results from the Spanish EURAP register gathered over a 12-year period. MATERIAL AND METHODS: After signing informed consent forms, patients were included in the register and evaluated at onset of pregnancy, at the end of the second and third trimesters, after delivery, and one year after delivery...
July 21, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Azadeh Ashtarinezhad, Ataollah Panahyab, Shahrzad Shaterzadeh-Oskouei, Hessam Khoshniat, Baharak Mohamadzadehasl, Farshad H Shirazi
Biospectroscopic investigations have attracted attention of both the clinicians and basic sciences researchers in recent years. Scientists are discovering new areas for FTIR biospectroscopy applications in medicine. The aim of this study was to measure the possibility of FTIR-MSP application for the recognition and detection of fetus abnormalities after exposure of pregnant mouse to phenobarbital (PB) and levamisole (LEV) alone or in combination. PB is one of the most widely used antiepileptic drugs (AEDs), with sedative and hypnotic effects...
September 5, 2016: Journal of Pharmaceutical and Biomedical Analysis
Antonio Simone Laganà, Onofrio Triolo, Valeria D'Amico, Sandy Maria Cartella, Vincenza Sofo, Francesca Maria Salmeri, Eda Vrtačnik Bokal, Edoardo Spina
PURPOSE: The physiological changes during pregnancy can significantly alter antiepileptic drug (AED)'s absorption, distribution, metabolism and elimination, thus influencing their plasma concentration. Considering that the risks of using old and new AEDs during pregnancy are still debated, our aim is to review the available evidence on this topic. METHODS: Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases...
March 2016: Archives of Gynecology and Obstetrics
Zhi-Xu He, Xiao-Wu Chen, Zhi-Wei Zhou, Shu-Feng Zhou
With only 1.3-4.3% in total hepatic CYP content, human CYP2D6 can metabolize more than 160 drugs. It is a highly polymorphic enzyme and subject to marked inhibition by a number of drugs, causing a large interindividual variability in drug clearance and drug response and drug-drug interactions. The expression and activity of CYP2D6 are regulated by a number of physiological, pathological and environmental factors at transcriptional, post-transcriptional, translational and epigenetic levels. DNA hypermethylation and histone modifications can repress the expression of CYP2D6...
2015: Drug Metabolism Reviews
Kimford J Meador, David W Loring
Antiepileptic drugs (AEDs) are among the most common teratogenic drugs prescribed to women of childbearing age. AEDs can induce both anatomical (malformations) and behavioral (cognitive/behavioral deficits) teratogenicity. Only in the last decade have we begun to truly discriminate differential AED developmental effects. Fetal valproate exposure carries a special risk for both anatomical and behavioral teratogenic abnormalities, but the mechanisms and reasons for individual variability are unknown. Intermediate anatomical risks exist for phenobarbital and topiramate...
January 19, 2016: Neurology
Janki Bhakta, Jacquelyn Bainbridge, Laura Borgelt
BACKGROUND: Many antiepileptic drugs (AEDs) have the potential to cause teratogenicity. We evaluated eight antiepileptic drugs (AEDs) classified as Federal Drug Administration (FDA) pregnancy category D, X, or N designations and having documented teratogenic effects. These include carbamazepine, ethosuximide, fosphenytoin, phenobarbital, phenytoin, primidone, topiramate, and valproate. Women with epilepsy (WWE) may need one or more of these AEDs for seizure control but may be unaware of the potential teratogenicity associated with their use...
November 2015: Epilepsy & Behavior: E&B
Neelima Gopinath, Anila K Muneer, Syam Unnikrishnan, Ravi Prasad Varma, Sanjeev V Thomas
OBJECTIVE: To compare the cognitive outcome of children of women with epilepsy (CWE) with matched controls (CWO). METHODS: CWE (10-12 years) under follow up in Kerala Registry of Epilepsy and Pregnancy (n=190) were evaluated with WISC-IV, Trail Making Test (TMT), Rey Auditory Verbal Learning Test (RAVLT) and compared with age and sex matched children of women without epilepsy - CWO (n=149) drawn from schools in the same region. The dosage was expressed as prescribed daily dose/daily-defined dose (PDD/DDD) ratio in order to make comparisons...
November 2015: Epilepsy Research
Alberto Verrotti, Elisabetta Mencaroni, Miriam Castagnino, Gaetano Zaccara
INTRODUCTION: Drugs teratogenicity has been studied for many years, especially teratogenic effects of antiepileptic drugs, because of the important impact that epilepsy has always had for young women, but data from literature are often conflicting. AREAS COVERED: We have carried out a critical review of all human studies about the antiepileptic drugs teratogenicity. A systematic search was performed in Medline and PubMed up to May 1, 2015. The use of older antiepileptic drugs in pregnancy is associated with an increased risk of fetus malformations; in particular, Valproate can determine neural-tube-like defects; in Phenytoin and Phenobarbital-exposed pregnancies, orofacial clefts, cardiac and genitourinary malformations are the major anomalies described...
October 2015: Expert Opinion on Drug Safety
Rachel Charlton, Ester Garne, Hao Wang, Kari Klungsøyr, Sue Jordan, Amanda Neville, Anna Pierini, Anne Hansen, Anders Engeland, Rosa Gini, Daniel Thayer, Jens Bos, Aurora Puccini, Anne-Marie Nybo Andersen, Helen Dolk, Lolkje de Jong-van den Berg
PURPOSE: The aim of this study was to explore antiepileptic drug (AED) prescribing before, during and after pregnancy as recorded in seven population-based electronic healthcare databases. METHODS: Databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the Clinical Practice Research Datalink, representing the rest of the UK, were accessed for the study. Women with a pregnancy starting and ending between 2004 and 2010, which ended in a delivery, were identified...
November 2015: Pharmacoepidemiology and Drug Safety
Torbjörn Tomson, Dina Battino, Erminio Bonizzoni, John J Craig, Dick Lindhout, Emilio Perucca, Anne Sabers, Sanjeev V Thomas, Frank Vajda
OBJECTIVE: To compare the risk of spontaneous abortions and stillbirth associated with maternal use of different antiepileptic drugs (AEDs). METHODS: The EURAP registry is an observational international cohort study primarily designed to determine the risk of major congenital malformations (MCMs) after prenatal AED exposure. Using EURAP data, we prospectively monitored pregnancies exposed to the 6 most common AED monotherapies and to polytherapy. Intrauterine death (spontaneous abortion and stillbirth combined) was the primary endpoint...
August 18, 2015: Neurology
Ozlem Akman, Solomon L Moshé, Aristea S Galanopoulou
AIMS: Neonatal status epilepticus (SE) is often associated with adverse cognitive and epilepsy outcomes. We investigate the effects of three episodes of kainic acid-induced SE (3KA-SE) and maternal separation in immature rats on subsequent learning, seizure susceptibility, and consequences, and the anticonvulsant effects of phenobarbital, according to sex, type, and age at early life (EL) event. METHODS: 3KA-SE or maternal separation was induced on postnatal days (PN) 4-6 or 14-16...
February 2015: CNS Neuroscience & Therapeutics
Sarah Mary Bagley, Elisha M Wachman, Erica Holland, Susan B Brogly
Neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure is an increasing problem. Variability in assessment and treatment of NAS has been attributed to the lack of high-quality evidence to guide management of exposed neonates. This systematic review examines available evidence for NAS assessment tools, nonpharmacologic interventions, and pharmacologic management of opioid-exposed infants. There is limited data on the inter-observer reliability of NAS assessment tools due to lack of a standardized approach...
September 9, 2014: Addiction Science & Clinical Practice
Frederico Vitório Lopes Barroso, Edward Araujo Júnior, Cristina Aparecida Falbo Guazelli, Eduardo Felix Martins Santana, Liliam Cristine Rolo, Marília da Glória Martins, Antonio Fernandes Moron
OBJECTIVE: To evaluate the perinatal results from epileptic women using antiepileptic drugs during prenatal care. METHODS: This was a retrospective longitudinal study assessing the perinatal results of women exposed to antiepileptic drugs during pregnancy, and we compared these results with those of pregnant women who were not exposed. The development of pregnancy, gestational age at delivery, Apgar scores, biometric data, morbidity, stillbirths and neonatal mortality were analyzed...
August 2015: Journal of Maternal-fetal & Neonatal Medicine
S M L Dadah, M Ndiaye, M S Diop, L B Seck, N S Diagne, E H M Ba, O Cisse, N M Gaye, A M Basse, A D Sow, K Toure, A G Diop, M M Ndiaye
INTRODUCTION: Epilepsy is a public health problem in Senegal and Africa because of its severity and its social importance. It occurs at any age sparing no sex. It can influence sexual life and reciprocally. Our aims were to study the effects of antiepileptic drugs on the sexual lives of women with epilepsy, the influence of these drugs on pregnancy and breastfeeding. METHODS: We conducted a prospective study from 1st March to 31st August 2011 in the neurological department of the Fann-Dakar teaching hospital Senegal...
October 2014: Revue Neurologique
H Ivan Orup, Curtis K Deutsch, Lewis B Holmes
BACKGROUND: The "anticonvulsant face," with a short nose, broad nasal bridge, epicanthal folds, and wide mouth, was described in the 1970s in children who had been exposed during pregnancy to the anticonvulsant drugs phenytoin and phenobarbital. The laser light scan makes it possible to establish three-dimensional positions of physical features and to determine more objectively the changes in the size and shape of the affected soft tissues of the faces of children exposed to these anticonvulsant drugs during pregnancy...
December 2014: Birth Defects Research. Part A, Clinical and Molecular Teratology
Mary Beth Sutter, Lawrence Leeman, Andrew Hsi
Neonatal opioid withdrawal syndrome is common due to the current opioid addiction epidemic. Infants born to women covertly abusing prescription opioids may not be identified as at risk until withdrawal signs present. Buprenorphine is a newer treatment for maternal opioid addiction and appears to result in a milder withdrawal syndrome than methadone. Initial treatment is with nonpharmacological measures including decreasing stimuli, however pharmacological treatment is commonly required. Opioid monotherapy is preferred, with phenobarbital or clonidine uncommonly needed as adjunctive therapy...
June 2014: Obstetrics and Gynecology Clinics of North America
A Verrotti, A Scaparrotta, M Cofini, F Chiarelli, G M Tiboni
In utero exposure to antiepileptic drugs (AEDs) may affect neurodevelopment causing postnatal cognitive and behavioral alterations. Phenytoin and phenobarbital may lead to motor and learning dysfunctions in the pre-exposed children. These disorders may reflect the interference of these AEDs with the development of hippocampal and cerebellar neurons, as suggested by animal studies. Exposure to valproic acid may result in inhibition of neural stem cell proliferation and/or immature neuron migration in the cerebral cortex with consequent increased risk of neurodevelopmental impairment, such as autistic spectrum disorders...
September 2014: Reproductive Toxicology
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