Pregnancy‐related pharmacokinetic changes

Tasnif, Yasar; Morado, J; Hebert, MF

doi:10.1002/cpt.382

Cited by 107 publications

(131 citation statements)

References 67 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…Quetiapine is metabolized mainly by CYP3A4,13 an enzyme known to be induced during pregnancy 4, 5, 6, 7. Similar drug concentration declines in pregnancy have also been reported for other CYP3A4 substrates,14, 15 and also in a previous case report for quetiapine 8.…”

Section: Discussionsupporting

confidence: 78%

“…CYP2D6 expression and activity also increase during pregnancy,4, 5, 6, 16 and for other CYP2D6 substrates a 2–13‐fold increase in clearance has been described 17. A previously published case series described aripiprazole plasma concentrations in three pregnancies in two women 9.…”

Section: Discussionmentioning

confidence: 96%

“…A myriad of physiological changes may occur during pregnancy and alter drug disposition 4, 5, 6, 7. Changes in volume of distribution may alter the concentration after the first dose and the loading dose requirements, and alter peak concentrations and elimination half‐life,6 but generally have little influence on the trough concentration at steady state.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in volume of distribution may alter the concentration after the first dose and the loading dose requirements, and alter peak concentrations and elimination half‐life,6 but generally have little influence on the trough concentration at steady state. Concentrations of binding protein for drugs in plasma (albumin and α‐1‐acid glycoprotein) may be reduced by 20–30% in the third trimester 10.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous physiological changes occur during pregnancy, some of which may cause changes in drug disposition, e.g., due to alterations in body weight, plasma volume, hepatic metabolic capacity, and renal function 4, 5, 6, 7. Thus, the right drug dose for a woman prior to conception or for the patient group in general is not necessarily the right dose during pregnancy.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition

Westin

Brekke

Molden

et al. 2017

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

Although pregnancy is known to cause changes in drug pharmacokinetics, little is known about its impact on serum levels of antipsychotics. In this study we retrospectively assessed 201 routine serum antipsychotic therapeutic drug monitoring concentration measurements obtained from a total of 110 pregnancies in 103 women, and 512 measurements from the same women before and after pregnancy. Serum concentrations in the third trimester were significantly lower than baseline for quetiapine (−76%; confidence interval (CI), −83%, −66%; P < 0.001) and aripiprazole (−52%; CI, −62%, −39%; P < 0.001), but not for olanzapine (−9%; CI, −28%, +14%; P = 0.40). For the remaining antipsychotics (perphenazine, haloperidol, ziprasidone, risperidone, and clozapine), our dataset was limited, but it indicates that concentrations may decline at least for perphenazine and possibly also for haloperidol. Even though the clinical consequence of the serum concentrations decline remains to be elucidated, our results warrant close clinical monitoring throughout pregnancy, preferentially supported by therapeutic drug monitoring.

show abstract