Maternal and Infant Pharmacokinetics of Psychotropic Medications During Pregnancy and Lactation

Kokras, Nikolaos; Sotiropoulos, Marinos G; Poulogiannopoulou, Eleni; Dalla, Christina

doi:10.1007/978-3-319-92919-4_2

Cited by 4 publications

(8 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main function of sertraline, as with all SSRIs, is as a serotonin reuptake inhibitor acting on the serotonin transporter to increase serotonin levels in the synaptic cleft. Sertraline and its metabolite norsertraline are evident in the bloodstream and previous studies in pregnant women report a decrease in the mean dose-corrected plasma concentration of sertraline during the last half of gestation with a return to early gestational levels at 12 weeks postpartum (Freeman et al, 2008;Kokras et al, 2019b;Sit et al, 2008). Reduced levels of sertraline and increased levels of its main metabolite are attributed mainly to pregnancy-related changes in the activity of the cytochrome P450 family of enzymes.…”

Section: Discussionmentioning

confidence: 92%

“…isozymes (for example decrease 1A2 and induce 2D6) (Jeong, 2010;Kokras et al, 2011;Kokras et al, 2019b) and because sertraline is metabolized by many CYP isozymes, it could be that the responsible isozymes for sertraline metabolism are differentially affected during the rat and the human pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…To date no research has investigated sertraline (Zoloft®), one of the most commonly prescribed SSRIs during pregnancy (Liang et al, 2019), on the brain when pregnant. A recent study of 6 pregnant women prescribed sertraline showed a decrease in the mean dose-corrected plasma concentration of sertraline during the last half of gestation with a return to early gestational levels at 12 weeks postpartum (Kokras et al, 2019b;Sit et al, 2008). How changes in sertraline metabolism affect the maternal brain during pregnancy remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

“…Direct effects of SSRIs on the brain plasticity in the peripartum female exists only in animal models, has only investigated effects during the postpartum period, and focuses on the effects of the SSRIs fluoxetine and escitalopram (Gemmel et al, 2018b;Gemmel et al, 2016c;Gobinath et al, 2018a;Gobinath et al, 2018b;Haim et al, 2016;Pawluski et al, 2012b;Workman et al, 2016). Serum SSRI levels are known to change markedly during gestation, particularly during the late stages of gestation when the activity of cytochrome P450 enzymes, key players in drug metabolism, is reduced (Kokras et al, 2019b). To date no research has investigated sertraline (Zoloft®), one of the most commonly prescribed SSRIs during pregnancy (Liang et al, 2019), on the brain when pregnant.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effect of sertraline on central serotonin and hippocampal plasticity in pregnant and non-pregnant rats

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of sertraline on central serotonin and hippocampal plasticity in pregnant and non-pregnant rats

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the beneficial effects of breastfeeding for both infant and mother, including the establishment of emotional bond, reduction of the incidence and severity of many infectious, respiratory, endocrine, and hematological diseases, cannot be underscored. Therefore, breastfeeding is recommended for all newborns, being drug use a relative contraindication (116). The lactation risk categories during lactation of commonly used medications to treat mania can be seen in Table S3 (7).…”

Section: Special Populationsmentioning

confidence: 99%

How to treat mania

Pacchiarotti

Anmella

Colomer

et al. 2020

Acta Psychiatr Scand

View full text Add to dashboard Cite

Objective In this paper, we aimed at reviewing evidence‐based treatment options for bipolar mania and proposed tentative evidence‐based clinical suggestions regarding the management of a manic episode, especially regarding the choice of the proper mood stabilizer and antipsychotic medication. Method A narrative review was undertaken addressing 'treatment of bipolar mania'. Findings have been synthesized and incorporated with clinical experience into a model to support different treatment choices. Results To date, there is solid evidence supporting the use of several medications, such as lithium, divalproex, and carbamazepine, and antipsychotics, such as chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, inhaled loxapine, asenapine, and cariprazine in acute mania, and some evidence supporting the use of clozapine or electroconvulsive therapy in treatment‐refractory cases. However, in clinical practice, when making decisions about treatment, personalized treatment is needed, according to the different clinical presentations and more complex clinical situations within the manic episode and considering a long‐term view and with the objective of not only a symptomatic but also functional recovery. After remission from acute mania, psychoeducation strategies are useful to ensure adherence. Discussion Despite the evidence forefficacy of many currently available treatments for mania, the majority of RCTs provide little direction for the clinician as to what steps might be optimal in different presentations of mania as well as in the presence of specific patient characteristics. Manic episodes should be managed on a personalized basis considering the clinical course and patient criteria and with the expectation of maintaining that treatment in the long‐term.

show abstract

Optimizing Therapeutic Drug Monitoring in Pregnant Women: A Critical Literature Review

Moreira

Benzi

Pinto

et al. 2023

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

Background: More than 90% of pregnant women take at least one drug during pregnancy. Drug dose adjustments during pregnancy are sometimes necessary due to various pregnancy-induced physiological alterations frequently associated with lower plasma concentrations. However, the clinical relevance or benefits of therapeutic drug monitoring (TDM) in pregnant women have not been specifically studied. Clinical pharmacokinetic studies in pregnant women are incredibly challenging for many reasons. Despite this, regulatory agencies have made efforts to encourage the inclusion of this population in clinical trials to achieve more information on the pharmacotherapy of pregnant women. This review aims to provide support for TDM recommendations and dose adjustments in pregnant women. Methods:The search was conducted after a predetermined strategy on PubMed and Scopus databases using the MeSH term "pregnancy" alongside other terms such as "Pregnancy and dose adjustment," "Pregnancy and therapeutic drug monitoring," "Pregnancy and PBPK," "Pregnancy and pharmacokinetics," and "Pregnancy and physiological changes." Results:The main information on TDM in pregnant women is available for antiepileptics, antipsychotics, antidepressants, antibiotics, antimalarials, and oncologic and immunosuppressive drugs.Conclusions: More data are needed to support informed benefitrisk decision making for the administration of drugs to pregnant women. TDM and/or pharmacokinetic studies could ensure that pregnant women receive an adequate dosage of an active drug. Mechanistic modeling approaches potentially could increase our knowledge about the pharmacotherapy of this special population, and they could be used to better design dosage regimens.

show abstract

Maternal and Infant Pharmacokinetics of Psychotropic Medications During Pregnancy and Lactation

Cited by 4 publications

References 67 publications

Effect of sertraline on central serotonin and hippocampal plasticity in pregnant and non-pregnant rats

Effect of sertraline on central serotonin and hippocampal plasticity in pregnant and non-pregnant rats

How to treat mania

Optimizing Therapeutic Drug Monitoring in Pregnant Women: A Critical Literature Review

Contact Info

Product

Resources

About