Topiramate in pregnancy

Hunt, Stephen; Craig, John; Russell, Aline; Guthrie, Eleanor; Parsons, Linda M.; Robertson, Ian; Waddell, R.; Irwin, B.; Morrison, Patrick J.; Morrow, Jim

doi:10.1212/01.wnl.0000318293.28278.33

Cited by 260 publications

(173 citation statements)

References 15 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…MCM rates are reported as 4.2 % to 4.9 % for monotherapy use, with an increased risk of cleft lip and cleft palate and hypospadias [11,12]. The Australian pregnancy register reported a particularly high rate of MCMs for TPM when used as polytherapy, at 14.1 % with a relative risk of 4.32 (95 % CI 1.57-11.05) compared with no AED exposure [13].…”

Section: Tpmmentioning

confidence: 99%

Use of Antiepileptic Drugs During Pregnancy: Evolving Concepts

Pennell

2016

Neurotherapeutics

View full text Add to dashboard Cite

Although prenatal exposure to antiepileptic drugs (AEDs) is known to impart relatively higher risks of major congenital malformations, prospective studies have provided refined data that allow us to differentiate the risks of different types and doses of AEDs. As the number of AED prescriptions has dramatically increased in reproductive-aged women with a variety of neuropsychiatric indications, the evolving concepts learned from studies in women with epilepsy can be applied to a much larger group of pregnant women to improve child outcomes while maintaining maternal disease control. In addition to careful selection of the type of medication, the amount of fetal exposure at conception and in the first trimester probably matters across all AEDs. Some AED polytherapy regimens are not associated with a higher risk of malformations, although other outcomes have not yet been formally studied. The individual woman's drug target concentration should be established preconception and maintained during pregnancy, to prevent seizure worsening. Substantial pharmacokinetic changes occur with many of the medications during pregnancy and postpartum, and interindividual variability supports the use of therapeutic drug monitoring for most AEDs. During pregnancy, vigilance and close monitoring should also include intrauterine fetal growth, obstetric complications, and neonatal complications. Breastfeeding can provide additional neurodevelopmental benefit and should be an option for women on AEDs. Knowledge of these key principles enhances our ability to make treatment recommendations with resultant improved maternal and child outcomes. Additional prospective studies are needed to further define the risk-benefit ratio across a variety of medications, dosing strategies, and neuropsychiatric disorders.

show abstract

Section: Tpmmentioning

confidence: 99%

Use of Antiepileptic Drugs During Pregnancy: Evolving Concepts

Pennell

2016

Neurotherapeutics

View full text Add to dashboard Cite

show abstract

“…While the mean birth weights were within normal limits; however, there was a clear trend toward lower birth weights amongst infants receiving TPM as part of AED polytherapy regimens, and in patients that received higher doses of TPM monotherapy. This observation has not yet been validated in other studies [Montouris et al, 2003;Hunt et al, 2008]. A more recent study also reported that TPM-exposed neonates presented a higher prevalence of low birth weight in non-malformed liveborn singletons (9.8%), than controls (3.6%), evidencing a RR of 2.7 (95%CI: 1.4-5.1).…”

Section: Topiramate (Topamax Topiragen)mentioning

confidence: 76%

Antiepileptic Drugs and Pregnancy Outcomes

Wlodarczyk

Palacios

George³

et al. 2012

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

The treatment of epilepsy in women of reproductive age remains a clinical challenge. While most women with epilepsy require anticonvulsant drugs for adequate control of their seizures, the teratogenicity associated with some antiepileptic drugs is a risk that needs to be carefully addressed. Antiepileptic medications are also used to treat an ever broadening range of medical conditions such as bipolar disorder, migraine prophylaxis, cancer and neuropathic pain. Despite the fact that the majority of pregnancies of women with epilepsy who are receiving pharmacological treatment are normal, studies have demonstrated that the risk of having a pregnancy complicated by a major congenital malformation is doubled when comparing the risk of untreated pregnancies. Furthermore, when antiepileptic drugs (AEDs) are used in polytherapy regimens, the risk is tripled, especially when valproic acid (VPA) is included. However, it should be noted that the risks are specific for each anticonvulsant drug. Some investigations have suggested that the risk of teratogenicity is increased in a dose-dependent manner. More recent studies have reported that in utero exposure to AEDs can have detrimental effects on the cognitive functions and language skills in later stages of life. In fact, the FDA just issued a safety announcement on the impact of VPA on cognition (Safety Announcement 6-30-2011). The purpose of this document is to review the most commonly used compounds in the treatment of women with epilepsy, and to provide information on the latest experimental and human epidemiological studies of the effects of antiepileptic drugs in the exposed embryos.

show abstract

“…However, side effects include nephrolithiasis and fetal deformities [13]. These factors limited its use in our patient.…”

Section: Discussionmentioning

confidence: 99%