The safety of atovaquone-proguanil for the prevention and treatment of malaria in pregnancy: A systematic review

Andrejko, Kristin L; Mayer, Richard F.; Kovacs, Stéphanie; Slutsker, Emma; Bartlett, Emily; Tan, Kathrine R.; Gutman, Julie

doi:10.1016/j.tmaid.2019.01.008

Cited by 19 publications

(11 citation statements)

References 36 publications

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“…Polypharmacy due to polymorbidity is a special class of polypharmacy with potentially higher risk of foetal adverse effects compared with use of two or more different drugs due to a single disease. Polytherapy to treat one disease is a known phenomenon in epilepsy, 8 HIV, 9 malaria, 10 asthma 12 and often depression 11 . In these situations, the increased risk for congenital malformations and other foetal adverse effects 8–12 might be due to pharmacological interaction between the medications or as patients who need treatment with more than one drug suffer a more severe course of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Polytherapy to treat one disease is a known phenomenon in epilepsy, 8 HIV, 9 malaria, 10 asthma 12 and often depression 11 . In these situations, the increased risk for congenital malformations and other foetal adverse effects 8–12 might be due to pharmacological interaction between the medications or as patients who need treatment with more than one drug suffer a more severe course of the disease. In polypharmacy due to polymorbidity, an added possible interaction between both medications and the pathophysiology of the diseases is present, which might lead to a greater risk for the foetus.…”

Section: Discussionmentioning

confidence: 99%

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Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

Thunbo

Vendelbo

Volqvartz

et al. 2021

Basic Clin Pharma Tox

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With an increased prevalence of concurrent morbidities during pregnancy, polypharmacy has become increasingly common in pregnant women. The risks associated with polypharmacy may exceed those of individual medication because of drug–drug interactions. This systematic review aims to evaluate the risk of congenital malformations in polymorbid pregnancies exposed to first‐trimester polypharmacy. PubMed, Embase and Scopus were searched to identify original human studies with first‐ trimester polypharmacy due to polymorbidity as the exposure and congenital malformations as the outcome. After screening of 4034 identified records, seven studies fulfilled the inclusion criteria. Four of the seven studies reported an increased risk of congenital malformations compared with unexposed or monotherapy, odds ratios ranging from 1.1 to >10.0. Particularly, short‐term anti‐infective treatment combined with other drugs and P‐glycoprotein substrates were associated with increased malformation risks. In conclusion, knowledge is limited on risks associated with first‐trimester polypharmacy due to polymorbidity with the underlying evidence of low quantity and quality. Therefore, an increased focus on pharmacovigilance to enable safe drug use in early pregnancy is needed. Large‐scale register‐based studies and better knowledge of placental biology are needed to support the clinical management of polymorbid pregnancies that require polypharmacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

Thunbo

Vendelbo

Volqvartz

et al. 2021

Basic Clin Pharma Tox

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“…ATO is an effective drug for malaria prophylaxis and treatment that is not currently recommended for use by pregnant women due to insufficient data on its safety in pregnancy. Besides that, the use of anti-malarial in pregnancy is likely to occur before the woman in question knows of her pregnancy [68], even in the first weeks (3 to 8) after conception [69].…”

Section: Discussionmentioning

confidence: 99%

Uridine Prevents Negative Effects of OXPHOS Xenobiotics on Dopaminergic Neuronal Differentiation

Iglesias

Bayona‐Bafaluy

Pesini

et al. 2019

Cells

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Neuronal differentiation appears to be dependent on oxidative phosphorylation capacity. Several drugs inhibit oxidative phosphorylation and might be detrimental for neuronal differentiation. Some pregnant women take these medications during their first weeks of gestation when fetal nervous system is being developed. These treatments might have later negative consequences on the offspring’s health. To analyze a potential negative effect of three widely used medications, we studied in vitro dopaminergic neuronal differentiation of cells exposed to pharmacologic concentrations of azidothymidine for acquired immune deficiency syndrome; linezolid for multidrug-resistant tuberculosis; and atovaquone for malaria. We also analyzed the dopaminergic neuronal differentiation in brains of fetuses from pregnant mice exposed to linezolid. The drugs reduced the in vitro oxidative phosphorylation capacity and dopaminergic neuronal differentiation. This differentiation process does not appear to be affected in the prenatally exposed fetus brain. Nevertheless, the global DNA methylation in fetal brain was significantly altered, perhaps linking an early exposure to a negative effect in older life. Uridine was able to prevent the negative effects on in vitro dopaminergic neuronal differentiation and on in vivo global DNA methylation. Uridine could be used as a protective agent against oxidative phosphorylation-inhibiting pharmaceuticals provided during pregnancy when dopaminergic neuronal differentiation is taking place.

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“…Although the available safety data for its use in pregnancy are reassuring, well-established trials are needed before a definite recommendation can be made. 91 , 92 Doxycycline is also used during the first trimester in several European countries if there are compelling reasons for chemoprophylaxis and if no alternative is available. It is important to remember that doxycycline needs to be administered for 4 weeks after return from a malaria-endemic region.…”

Section: Special Populationsmentioning

confidence: 99%

An update on prevention of malaria in travelers

Higuita

White

Franco‐Paredes

et al. 2021

Therapeutic Advances in Infection

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Malaria, a parasitic disease caused by protozoa belonging to the genus Plasmodium, continues to represent a formidable public health challenge. Despite being a preventable disease, cases reported among travelers have continued to increase in recent decades. Protection of travelers against malaria, a potentially life-threatening disease, is of paramount importance, and it is therefore necessary for healthcare professionals to be up to date with the most recent recommendations. The present review provides an update of the existent measures for malaria prevention among travelers.

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The safety of atovaquone-proguanil for the prevention and treatment of malaria in pregnancy: A systematic review

Cited by 19 publications

References 36 publications

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

Polypharmacy in polymorbid pregnancies and the risk of congenital malformations—A systematic review

Uridine Prevents Negative Effects of OXPHOS Xenobiotics on Dopaminergic Neuronal Differentiation

An update on prevention of malaria in travelers

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