Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

Langan, Julie; Perry, Andrea; Oto, Maria

doi:10.1186/1471-244x-13-234

Cited by 16 publications

(13 citation statements)

References 19 publications

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“…The trend appears to be shifting from the use of valproate predominantly for bipolar disorder to the use in several other psychiatric disorders like schizoaffective disorder, paranoid schizophrenia, and personality disorder showing flexible use for different conditions within psychiatry. This trend for off-license prescribing has been shown in other studies [21].…”

Section: Discussionsupporting

confidence: 84%

Valproate Prescribing in Women of Childbearing Age: An Audit of Clinical Practice

Atturu

Odelola

2015

Advances in Psychiatry

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Background. Evidence is accruing regarding the risks of valproate exposure in women of childbearing age. Recommendations have recently been made for a higher standard of prenatal counselling and prescribing practice in respect of valproate use in this patient group.Aim and Method. A reaudit was carried out to review the standard of clinical discussion around teratogenic risk and pregnancy planning offered to women of child-bearing age prescribed valproate. Case notes and prescription charts of women 45 years old or less were examined and compared with the results of a previous audit in 2005.Results. The use of valproate was increased overall by 64% and there was an 18% increase in off-label valproate use. The rate of clinical discussion carried out during commencement declined from 70% to 35% and at annual review from 50% to 22%. There was less clinical discussion in outpatients and in older patients. More than 40% of doctors surveyed were not confident about giving information to women.Clinical Implication. There is a need for a multidisciplinary approach and action at Healthcare Trust level, to increase awareness and reduce risks associated with valproate prescribing in childbearing women.

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Section: Discussionsupporting

confidence: 84%

Valproate Prescribing in Women of Childbearing Age: An Audit of Clinical Practice

Atturu

Odelola

2015

Advances in Psychiatry

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“…There is an increased risk of neurodevelopmental deficits when polytherapy involves the use of valproate versus other agents [34]. In a recent study, a suboptimal evidence of teratogenic risk counseling at antiepileptic drug initiation was found, involving 40 % of individuals prescribed carbamazepine and 22 % of valproate [120]. Thus, given the high rates of unplanned pregnancies, a detailed appraisal of the risks and benefits associated with anticonvulsant medication is fundamental and strongly recommended.…”

Section: Teratogenicmentioning

confidence: 96%

Management of Adverse Effects of Mood Stabilizers

Murru

Popović

Pacchiarotti

et al. 2015

Curr Psychiatry Rep

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Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

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“…One factor could be the data sources used by the different studies. Some studies relied on medical records as their source of data (Atturu & Odelola, 2015;Bhakta et al, 2015;Cheetham et al, 2006;Crijns et al, 2012;Force et al, 2012;Fritsche et al, 2011;Gotlib et al, 2016;Hayward et al, 2016;James et al, 2007;Langan et al, 2013;Martin et al, 2008;Mody, Farala, et al, 2015;Mulryan et al, 2018;Paton et al, 2018;Pinheiro et al, 2013;Raguideau et al, 2015;Ruiter et al, 2012;E. B. Schwarz et al, 2010;E.…”

Section: Risk Managementmentioning

confidence: 99%

Risk management of teratogenic medicines: A systematic review

Shroukh

Steinke

Willis

2020

Birth Defects Research

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Aim: To systematically identify studies of implementing risk management measures when prescribing teratogenic medicines for women of childbearing age and studies reporting risk perceptions of teratogenic medications. Methods: MEDLINE, CINAHL, Scopus, EMBASE, and International Pharmaceutical Abstracts were searched. Studies were included in the risk management section if they reported any of the following risk management measures: teratogenic counseling, contraceptive counseling, pregnancy testing before starting treatment, pregnancy testing during treatment, use of contraception before starting treatment, and use of contraception during treatment. Studies were included in the perceptions section if they reported perceived teratogenic risk as numerical value. Results: Fifty-five studies were included in the risk management section and seven studies were included in the perceptions sections. Prevalence of risk management measures varied as follows: teratogenic counseling (9.5%-99.3%), contraceptive counseling (6.1%-98%), pregnancy testing before starting treatment (0%-95.1%), pregnancy testing during treatment (12.7%-100%), contraception use before starting treatment (15.7%-94%), and contraception use during treatment (1.7%-100%). A proper estimation of the teratogenic risk was reported for thalidomide (by general practitioners and obstetric/gynecologists), for etretinate (by pregnant women), and for misoprostol (by pregnant and nonpregnant women). An underestimation was reported for warfarin and retinoids (by general practitioners and obstetric/gynecologists). And overestimation was reported for thalidomide, valproate, lithium, isotretinoin, phenytoin, warfarin and etretinate by different populations. Conclusion: Considerable variation in the implementation of risk management measures when prescribing teratogenic medicines to women of childbearing age is reported in the literature. A common tendency to overestimate the risk of teratogenic medications was evident.

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Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

Cited by 16 publications

References 19 publications

Valproate Prescribing in Women of Childbearing Age: An Audit of Clinical Practice

Valproate Prescribing in Women of Childbearing Age: An Audit of Clinical Practice

Management of Adverse Effects of Mood Stabilizers

Risk management of teratogenic medicines: A systematic review

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