Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood &amp; breast milk: A systematic review &amp; combined analysis

Schmidt, Chiara Theresa; Deligiannidis, Kristina M.; Kittel‐Schneider, Sarah; Frodl, Thomas; Spigset, Olav; Paulzen, Michael; Schoretsanitis, Georgios

doi:10.1016/j.pnpbp.2023.110733

Cited by 4 publications

(1 citation statement)

References 122 publications

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“…A review of the Cochrane database also showed that prenatal exposure to topiramate may lead to facial malformations [ 3 ]. A systematic review by Schmidt and colleagues [ 18 ] examining umbilical cord transmission of ASM found that antiseizure medication associated with an increased risk of congenital malformations, such as TPM, CBZ or VPA showed relevant differences among each other with respect to penetration into the fetal circulation. Regarding topiramate, the authors reported an intermediate penetration rate of topiramate into the umbilical cord with a comparatively high penetration of TPM into breast milk.…”

Section: Discussionmentioning

confidence: 99%

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

Hahn,

Möller,

Menzler

et al. 2024

Neurol. Res. Pract.

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Background An increasing use of newer antiseizure medication (ASM) such as SV2A ligand brivaracetam is observed. However, data on newer antiseizure medication and therapeutic drug monitoring during pregnancy is scarce. Methods Therapeutic drug monitoring of brivaracetam (BRV) and topiramate (TPM) serum levels were performed during pregnancy, delivery and in the umbilical cord blood at delivery in a 34-year-old female patient with severe drug-resistant epilepsy. Results During pregnancy, the serum levels of brivaracetam and topiramate remained stable. At 39th week of pregnancy, the patient gave birth to a healthy daughter. 1.5 h after the last ASM intake, the penetration rate measured in umbilical cord blood was 45% lower for BRV and 35% lower for TPM. Conclusions While the pharmacokinetics of topiramate are well known and its use during pregnancy should only be undertaken under special circumstances, there have been few studies on newer ASM in pregnancy such as brivaracetam. Based on our results and other case reports of BRV use during pregnancy, further studies are necessary to confirm its pharmacokinetics and safety during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

Hahn,

Möller,

Menzler

et al. 2024

Neurol. Res. Pract.

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A literature review of drug transport mechanisms during lactation

Gong,

Bertagnolli,

Boulton

et al. 2024

CPT Pharmacom & Syst Pharma

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Despite the benefits of breastfeeding, lactating mothers who take prescribed medications may discontinue breastfeeding due to concerns associated with infant drug exposure in breastmilk. Consolidating the current knowledge of drug transport to breastmilk may inform understanding of the safety of medication use during lactation. This literature review summarizes the mechanisms of drug transport to breastmilk, details the physicochemical drug properties that may alter the extent of passive transport, and describes the expressional changes in mammary drug transporters that may affect active transport. During the period of 20 July 2023 to 11 August 2023, PubMed® was searched to identify journal articles pertinent to the mechanisms of drug transport from maternal plasma to breastmilk and the expression of mammary drug transporters during lactation. From the 28 studies included in this review, four mechanisms were identified for transporting drugs from maternal plasma to breastmilk: passive transport, active transport, lipid co‐transport, and transcytosis. The lactational expression of 20 drug transporters was further summarized, with 9 transporters demonstrating downregulated expression during lactation and 11 transporters demonstrating upregulated expression during lactation. Understanding the mechanisms of drug transport to breastmilk may aid in estimating infant drug exposure, developing physiologically based pharmacokinetic (PBPK) models that describe drug transfer, and initiating clinical drug development programs in the lactating population.

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Psychopharmaka in Schwangerschaft und Stillzeit

Paulzen,

Benkert

2023

Kompendium Der Psychiatrischen Pharmakotherapie

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Transfer of anticonvulsants and lithium into amniotic fluid, umbilical cord blood & breast milk: A systematic review & combined analysis

Cited by 4 publications

References 122 publications

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature

A literature review of drug transport mechanisms during lactation

Psychopharmaka in Schwangerschaft und Stillzeit

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