Girls taking anti-seizure drugs throughout being pregnant skilled important decreases in serum concentrations for such medicine throughout their being pregnant, in response to a examine printed in JAMA Neurology.
The findings recommend larger doses of these anti-seizure drugs could also be crucial to take care of seizure management whereas pregnant, in response to Elizabeth Gerard, MD, affiliate professor of Neurology within the Division of Epilepsy & Neurophysiology and a co-author of the examine.
This examine underscores the significance of therapeutic drug monitoring, the follow of checking anti-seizure drugs earlier than and through being pregnant and making dose changes accordingly.”
Elizabeth Gerard, MD, Affiliate Professor of Neurology, Division of Epilepsy & Neurophysiology
Analysis over the previous 20 years — principally with the medicine lamotrigine — has proven that some anti-seizure drugs will be metabolized quicker throughout being pregnant, in response to Gerard. Prior to those research, pregnant sufferers have been monitored utilizing “scientific options monitoring,” through which suppliers maintain sufferers on pre-pregnancy doses of anti-seizure drugs or therapies till indicators or signs indicated an adjustment was wanted — on this case, suppliers would wait till a seizure occurred to regulate drugs in being pregnant.
“This strategy permits for extra seizures in being pregnant and places mom and toddler in danger, significantly if the seizures are convulsive,” Gerard stated.
Within the present cohort examine, investigators examined drug focus of a number of different anti-seizure drugs in pregnant sufferers with epilepsy and in non-pregnant ladies with epilepsy. The examine enrolled 430 whole sufferers and drug focus was measured by way of blood draw throughout seven visits over 18 months.
Dose-normalized concentrations — concentrations relative to a affected person’s non-pregnant baseline — considerably decreased over the course of being pregnant for lamotrigine, levetiracetam, lacosamide and zonisamide. In distinction to different drugs, concentrations of unbound carbamazepine and a carbamazepine metabolite didn’t change considerably throughout being pregnant.
These outcomes recommend that elevated drug metabolism throughout being pregnant is extra widespread amongst anti-seizure drugs than beforehand thought, in response to Gerard, and energetic drug monitoring must be customary for these sufferers. Suppliers ought to set up a therapeutic baseline for a affected person previous to being pregnant and examine ranges all through the being pregnant, sometimes each month, on the identical time of day.
Sufferers taking carbamazepine might not want as frequent monitoring, however these make up a minority of pregnant sufferers who’re prescribed anti-seizure medicine, Gerard stated.
Pennell, P.B., et al. (2022) Antiseizure Medicine Concentrations Throughout Being pregnant. Outcomes From the Maternal Outcomes and Neurodevelopmental Results of Antiepileptic Medicine (MONEAD) Research. JAMA Neurology. doi.org/10.1001/jamaneurol.2021.5487.
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