Foetal safety of old and new antiepileptic drugs

Verrotti, Alberto; Mencaroni, Elisabetta; Castagnino, Miriam; Zaccara, Gaetano

doi:10.1517/14740338.2015.1084288

Cited by 15 publications

(14 citation statements)

References 83 publications

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“…For a smaller group, more than one AED is necessary, which requires extra attention to side effects, drug interactions, and monitoring of serum levels of AEDs (103,104). AEDs are sometimes categorised into newer AEDs, such as gabapentin, LTG and oxcarbazepine, and older AEDs, for instance VPA, CBZ and phenytoin, with older AEDs referring to medications introduced before 1993 (105,106). For most AEDs the complete mode of action is not clear.…”

Section: Treatment Of Epilepsymentioning

confidence: 99%

Psychiatric comorbidity and social aspects in pregnant women with epilepsy — The Norwegian Mother and Child Cohort Study

Reiter

Veiby

Daltveit

et al. 2013

Epilepsy & Behavior

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Symptoms of depression were associated with epilepsy both during and before pregnancy. Epilepsy was linked to eating disorders before pregnancy. Unemployment, single parenting, and low educational level were linked to epilepsy in young pregnant females. Efforts aiming at treatment and screening for psychiatric comorbidity in pregnant women with epilepsy are important in the follow-up of these patients.

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Section: Treatment Of Epilepsymentioning

confidence: 99%

Psychiatric comorbidity and social aspects in pregnant women with epilepsy — The Norwegian Mother and Child Cohort Study

Reiter

Veiby

Daltveit

et al. 2013

Epilepsy & Behavior

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“…It is one of the most commonly used antiepileptic drugs in Europe among women of childbearing age. Recent pharmacoepidemiological studies have shown a prevalence of major malformations of 3.3% after carbamazepine monotherapy in the first trimester with a dose dependent increased risk of spina bifida (0.9% vs. 0.18% in the general population) (Jentink et al, 2010; Tomson et al, 2011; Verrotti et al, 2015) CBZ is furthermore excreted in breast milk.…”

Section: Introductionmentioning

confidence: 99%

“Late” Withdrawal Syndrome after Carbamazepine In Utero Exposure in a CYP2C9 Slow Metabolizer Newborn

et al. 2017

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We report a case of carbamazepine withdrawal syndrome following in utero exposure to carbamazepine related to a pharmacogenetic predisposition factor. The infant was born at 37 1/7 weeks’ gestation by cesarean section to a mother treated for epilepsy with carbamazepine. One hour and thirty minutes after birth, the infant presented a respiratory distress with severe oxygen desaturation requiring intubation 5 h after birth. On the third day of life the infant developed clinical signs of a withdrawal syndrome which resolved progressively after 16 days and symptomatic treatment. The infant genotype analysis showed two low activity CYP2C9 allelic variants (∗2/∗3 heterozygote) predicting a CYP2C9 slow metabolizer phenotype which could explain reduced carbamazepine elimination and a late and long-lasting withdrawal symptoms observed 3 days after birth. The association of a withdrawal syndrome with carbamazepine exposure has not been previously reported and pharmacogenetic tests might therefore be useful in identifying patients at risk.

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“…To date, it has been increasingly used in childbearing women with epilepsy. Recent studies have suggested that newborns of women receiving oxcarbazepine monotherapy during pregnancy do not show an increased risk for major congenital malformations; however, one case reported an infant with unilateral radius aplasia related to intrauterine lamotrigine and oxcarbazepine exposure …”

mentioning

confidence: 99%

“…Recent studies have suggested that newborns of women receiving oxcarbazepine monotherapy during pregnancy do not show an increased risk for major congenital malformations; however, one case reported an infant with unilateral radius aplasia related to intrauterine lamotrigine and oxcarbazepine exposure. [1][2][3][4][5] Neonatal abstinence syndrome (NAS) is characterized by signs and symptoms that indicate central nervous system hyperirritability (e.g., increased muscle tone, seizures, tremors, and excessive crying) and dysfunction of the autonomic nervous system (e.g., sweating, fever, and nasal congestion), gastrointestinal tract (e.g., poor feeding, vomiting, diarrhea, and dehydration), and respiratory system (e.g., tachypnea). 6 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.…”

mentioning

confidence: 99%

In Utero Oxcarbazepine Exposure and Neonatal Abstinence Syndrome: Case Report and Brief Review of the Literature

Chen

et al. 2017

Pharmacotherapy

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Oxcarbazepine is a second‐generation antiepileptic drug that is used to treat partial seizures. Although it has been increasingly used in pregnant women, its fetal safety has not been fully validated. We describe a 12‐hour‐old neonate who developed neonatal abstinence syndrome (NAS) after intrauterine exposure to oxcarbazepine. The neonate was born via cesarean section to a mother who took oxcarbazepine 300 mg/day for treatment of seizures throughout her pregnancy. Approximately 12 hours after birth, the infant developed paroxysmal jitter, which mainly presented as increased excitability, irritability, limb shaking, and increased muscle tone. These symptoms resolved by day 9 of life. Although NAS occurs most often after in utero exposure to opioids, exposure to other drugs during pregnancy may contribute to a small proportion of NAS cases. To our knowledge, this is the second case report of oxcarbazepine‐induced NAS. Pregnant women with epilepsy should weigh the pros and cons of continuing oxcarbazepine during their pregnancy when they are prescribed this drug. For infants with in utero oxcarbazepine exposure, comprehensive assessments and examinations are necessary for screening oxcarbazepine‐induced NAS.

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Foetal safety of old and new antiepileptic drugs

Abstract: Where possible, Valproate should be avoided in women of childbearing potential. Results about the safety of newer antiepileptic drugs require validation and further investigation.

Cited by 15 publications

References 83 publications

Psychiatric comorbidity and social aspects in pregnant women with epilepsy — The Norwegian Mother and Child Cohort Study

Psychiatric comorbidity and social aspects in pregnant women with epilepsy — The Norwegian Mother and Child Cohort Study

“Late” Withdrawal Syndrome after Carbamazepine In Utero Exposure in a CYP2C9 Slow Metabolizer Newborn

In Utero Oxcarbazepine Exposure and Neonatal Abstinence Syndrome: Case Report and Brief Review of the Literature

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