4411 Malarial drugs

M P quotients of between 2 and 6 have been calculated for chloro-quine. Following oral administration of 600 mg chloroquinc base to breastfeeding mothers, peak values of 4.4mg l of milk were measured (Ogunbona 1987). However, the main metabolite, desmethyl-chloroquine, also needs to be considered. With the very long half-life, continuing high plasma milk levels can be expected despite weekly intake of malaria prophylaxis. Assuming a weekly (prophylactic) dosage of 500 mg chloroquine phosphate...

415 Selective cyclooxygenase2 COX2 inhibitors

This group of drugs includes celecoxib, etoricoxib, lumiracoxib, parecoxib, rofecoxib, and valdecoxib. Their half-lives range from 8 to 17 hours. Celecoxib is a lipophilic substance, of which 97 is bound to plasma protein, and it exhibits a high distribution volume. A peak concentration of 133ng ml was measured in the milk 5 hours after the administration of 100 mg, which corresponds to 20 pg kg per day to a breastfed infant, or a weight-adjusted dose of approximately 1 (Knoppert 2003). A more...

Hormones and hormone antagonists

Methylergometrine (methylergonovine) Bromocriptine and other prolactin inhibitors Thyroid hormones and thyroid receptor antibodies Estrogens, gestagens, and hormonal contraceptives Cyproterone acetate and other sex-hormone inhibitors 4.11.1 Pituitary and hypothalamic hormones There are only a few publications that discuss tolerance of hypothalamic and pituitary hormones during breastfeeding. 4.11.2 Methylergometrine (methylergonovine) In a series of studies on the contraceptive effect of 600...

34 Milk plasma ratio

The milk plasma (M P) ratio for drugs has been measured and reported for a number of medications. The milk plasma ratio is the concentration of the drug in the milk at the same moment that the concentration in maternal plasma is measured. It assumes that the relationship that between the two remains constant, but in most cases it does not. Therefore, the M P ratio is often calculated from the average concentrations in the blood and milk over a longer period of several hours. These average...

2825 Aldosterone antagonists

Spironolactone is the most important representative of the aldosterone antagonists, in which the diuretic action depends on the inhibition of receptors for aldosterone and other mineral corticoids in the tubule cells. An antiandrogen action is also recognized, which can be used in women who suffer from hirsutism and in boys who have pubertas praecox. For men, treatment with spironolactone can cause gynecomastia. In contrast to the saluretics discusscd above, spironolactone leads to potassium...

References

Marlar H , Chesney CFet al. Teratogenicity studies on late blighted potatoes in non-human primates (Macaco mulatto and Saguinus labiatus), Teratology 1977 15 17-24. Anonymous. Aspirin overdose in mother and felus. North American Conference of Clinical Toxicology (NACCT) Abstract Review 2001. Aubard Y, Magne 1. Carbon monoxide poisoning in pregnancy. Br Obstet Gynaecol 2000 107 833-8, Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of...

4158 Herpes zoster shingles chickenpox

Perinatal varicella infection can lead to severe infection in the infant if the maternal rash develops 5 days or less before delivery, or within 2 days after delivery. Illness in the infant usually develops before 10 days of age, and is more severe because of lack of maternal antibodies. The infant should receive varicella zoster immunoglobulin (VZIG). The infant can be infected by aerosolized virus from lesions or the maternal respiratory track. Postnatal varicella can develop from...

2159 Diabetes mellitus and pregnancy

Diabetes mellitus is the collective name for heterogeneous disturbances of metabolism which all are characterized by chronic hyperglycemia. In essence, there are three different types. While type I is caused by a disturbed secretion of insulin, type II and gestational diabetes are characterized by a disturbed action of insulin. Both causes can also occur simultaneously. A poor glyccmic control in prcgestational diabetes, as measured by glycosylated hemoglobin (HbAlc > 6.5 ), is correlated...

2633 Other malarial agents

As multidrug resistance of the parasite to the well-known medicines is emerging - especially for Plasmodium falciparum (malaria tropica) - more than 10 combinations of various antimalarial drugs are used. In some regions, the combination of chloroquine plus pyrimethamine or doxycycline has proven effective. Clindamycin combined with quinine is used to treat multidrug-resistant malaria in pregnancy in some areas (Alecrim 2000). A recent trial comparing quinine-clindamycine ( 64) with artesunate...

21516 Antiestrogens antiandrogens and danazol

Bicalutamide, cyproterone, and flutamide belong to the group of antiandrogens. Aminoglutethimide, anastrozole, formestan, raloxifene, and tamoxifen are antiestrogen drugs. Danazol is a gonadotropin inhibitor with androgenic activity. (Foraminoglutethimide and tamoxifen, see Chapter 2.13.) Cyproterone acetate is the antiandrogen most commonly used during the reproductive years. It is available in combination with ethinylestradiol. This preparation is frequently prescribed as the pill, especially...

Interspecies Breastfeeding

The human spermatozoon - nol waving but drowning. Adv Exp Med Biol 2003 51 85-98. Barker Df P. Mothers. Babies and Health in Later Life, 2nd edn, Edinburgh Churchill Livingstone, 1998. Briggs GG. Freeman RK. Yaffe SJ, Classification of drugs for teratogenic risk an anachronistic way of counseling a reply to Merlob and Slahl. Birth Defects Res A 2003 67 207-8, Briggs GG. Freeman RK, Yaffe S . Drugs in Pregnancy and Lactation, 7th edn. Baltimore Williams & Wilkins, 2005....

2143 Ergot alkaloids see also Chapter

Ergot alkaloids (ergotamine derivatives) are used to increase the strength of uterine contraction to limit postpartum bleeding and promote postpartum involution. Because ergot-associated contractions are tonic rather than rhythmic, these agents cannot be used during labor. Tonic contraction of the uterus during labor could result in fetal hypoxia and even death. Pharmacologic agents in this group include ergometrine and methylergometrine (methylergonovine). Recommendation. Ergot alkaloids are...

21115 Chloral hydrate

Chloral hydrate is one of the oldest hypnotic drugs on the market. Chloral hydrate is quickly metabolized to trichloroethanol and trichloroacetic acid. There are few data on its use in pregnancy, but to date no increased incidence of congenital malformations has been reported (Heinonen 1977). Recommendation. Chloral hydrate should not be prescribed to pregnant women. Its inadvertent use is not grounds for termination of pregnancy or for additional diagnostic procedures. The drugs of first...

41113 Prostaglandins

Prostaglandins are, for the most part, used in obstetrics for priming and inducing labor. After birth, other pharmaceuticals are used for uterine involution so that therapy during breastfeeding for obstetrical indications is not common. Latanoprost is administered as eye drops for glaucoma. Prostaglandin derivatives have short half-lives ranging from a few seconds to 20-40 minutes at maximum. Both milk-promoting and milk-inhibiting effects have been noted with the various prostaglandins. In a...

448 Nitroimidazole antibiotics

In the newborn period, the half-life of metronidazole is extended -in premature babies it can be up to 35-74 hours. In adults it is up to 10 hours. Following a single oral dosage of 2g for trichomoniasis, the highest concentration was found in the milk after 2-4 hours. This is on average around 21 mg 1 in a single case it reached 46 mg I (Erickson 1981). On average, 12 o (at most up to about 20 ) of a weight-related therapeutic child's dosage (15 mg kg per day) is calculated for a fully...

2113 Selective cydooxygenase2 COX2 inhibitors

Because of their selective inhibition of COX-2, which is released in inflammatory processes, these newer agents arc thought to have significantly fewer gastrointestinal side effects than the classic S l Ds. and not to exert any antiplatelet effect. Celecoxia Jicoxii jnm-coxib, parecoxib, rofecoxib, and valdecoxib are affiong themTThcre are few case reports on their use in pregnancy (such as those collected by the producer of rofecoxib), and these do not to date indicate a teratogenic effect in...

468 Dihydroergotamine and other antihypotensives

Dihydroergotamine could not be detected in mother's milk. Generally speaking, ergotamine derivatives, as prolactin inhibitors, could inhibit the milk production. There is insufficient experience with the antihypotonics, etilefrine and norfenefrine, as well as with amezinium, gepefrin, midodrin, and pholedrin. Recommendation. The use of dihydroergotamine during breastfeeding is considered safe. However, non-drug measures (sports, the use of cold water and brushes, moderate coffee consumption)...

21716 Diethyltoluamide and icaridin

Mosquito repellents, such as diethyltoluamide (DEET), are rubbed into or sprayed on the skin. Absorption through the skin is about 8-17 (Sudakin 2003). A mother in Africa who gave birth to a mentally retarded child had not only been using malarial prophylaxis (chloroquine), but also rubbing her arms and legs daily with a 25 DEET lotion (Schaefer 1992). Since DEET has neurotoxic properties and is absorbed through the skin, the authors cannot entirely eliminate a causal connection. However, there...

4156 Hepatitis E

A study covering 93 pregnant women with hepatitis E (36 anti-HEV positive and 57 HEV-RNA positive) infection was confirmed in a colostrum specimen. However, parameters were significantly lower compared to maternal blood (Chibbcr 2004). Some of the infants of mothers with acute infection also developed liver symptoms. There was no indication that transmission occurred via breast milk. The authors concluded that breast feeding is probably safe, but stress the need to confirm their results by...

2238 Metais

Some commonly encountered inorganic arsenic salts include the trivalent sodium arsenite and the pentavalent sodium arsenate. Arsenic is a by-product of smelting, and a contaminant in hazardous waste sites. Furthermore, arsenic can naturally leach from certain types of rock - e.g. granite - resulting in substantially elevated levels of arscnic in the aquifers used for drinking water. This is a particular problem for unfiltered well water. Organic arseni-cals have been...

2510 Cholinergics

In the past 30 years, numerous publications have appeared on use of pyridostigmine and neostigmine during pregnancy for the treatment of the autoimmune illness myasthenia gravis. According to these experiences, the use of these cholinergics has not been associated with congenital malformations or other adverse effects (review by Tellez-Zenteno 2004, Batocchi 1999). In 10-15 of babies born to mothers with myasthenia gravis, transient signs of neonatal myasthenia are noted, which are apparently...

21511 Oral antidiabetics

Oral antidiabetics are not hormones and do not work in the way that insulin does they are not substitutes. The most commonly used sulfonylurea derivatives merely stimulate those ,i-cells in the pancreas that still have the ability to function. Among these medications arc the second-generation sulfonylureas glibenchamide (glyburide), glibor-nuride, gliclazide, glimepiride, glipizide, gliquidone, and glisoxepide. First-generation sulfonylureas are acetohexamide, chlorpropamide, tolazamide, and...

495 Phenothiazine and thioxanthene neuroleptics

Although this group of neuroleptics has been used for a long time, there are only very few publications with a smalt number of cases regarding therapy during breastfeeding. In none of these reports, which have been published over a period of 40 years, is there any mention of serious or permanent effects on the child breastfed while his mother was being treated with this group of drugs (McElhatton 1992). The American Academy of Pediatrics considers phenoth-iazines compatible with breastfeeding...

447 Other antibiotics and urinary tract antiseptics

With clindamycin, a maximum of 3.1 mg 1 milk was measured. For the infant, this represents about 6 of the maternal weight-related dosage, or 15 of the daily dosage for an infant. In a ease report, hemorrhagic enteritis was described in an infant whose mother had taken clindamycin and gentamicin. The symptoms improved spontaneously after breastfeeding was interrupted (survey by Bennett 1996). With 1 g of vancomycin administered intravenously twice a day 12.7 mg 1 was found in milk (Reyes 1989)....

2157 Hyperthyroidism and thyrostatics

An uncontrolled hyperthyroidism of a pregnant woman is a risk for the outcome of pregnancy and the fetus fetal growth retardation, pre-eclampsia, prematurity, and intrauterine death or stillbirths occur more often (Glinoer 1997). In cases of Graves' disease or Hashimoto thyroiditis - the latter usually results in hypothyroidism - the maternal auto-antibodies should be tested at the beginning of pregnancy and early in the third trimester. A high concentration, especially of TSH-receptor...

449 Aminoglycoside antibiotics

With an intramuscular gentamicin dosage of 80 mg three times daily, a maximum of 0.78 mg I of milk was measured (Celiloglu 1994). This is about 3 of the weight-related maternal dosage. However in 5 of the 10 newborns included in this study, gentamicin concentrations equivalent to 10 of the maternal values were measured in the serum. This leads to the conclusion that newborns absorb aminoglycosides enterally, or accumulate them due to reduced excretion at levels that cannot be ignored. Kanamycin...

2239 Hazardous waste landfill sites

Waste disposal sites are a potential hazard to health. There has been a series of publications to assess reproductive disorders and birth defects in communities near hazardous chemical sites (Boyle 1997, Goldman 1997, Holmes 1997, Kimmel 1997, Savitz 1997, Scialli 1997, Wyrobek 1997). These studies investigated structural anomalies, genetic changes, mutagenesis, stillbirth and infant death, functional deficits, and growth retardation. Menstrual dysfunction, infertility, prcgnancy loss,...

Herbs during pregnancy

2.19.1 The safety of herbs during pregnancy 485 2.19.2 Counseling a pregnant woman about herbs 436 2.19.3 General concepts regarding the use of herbs during 2.19.4 Herbs used as foods 489 2.19.5 Essential oils that are safe during pregnancy 489 2.19.6 Herbs frequently used during pregnancy 490 2.19.7 Herbs controversially used during pregnancy 491 2.19.8 Herbs contraindicated during pregnancy 491 Plants and plant extracts have been used for medicinal purposes since before recorded time. Many...

2232 Formaldehyde and formalin

Formaldehyde is a hydrocarbon that is widely used as a disinfectant and tissue preservative. Formalin is a solution of formaldehyde in water, often with 10-15 methanol to prevent polymerization. Data on the potential reproductive toxicity of formaldehyde exposure in human pregnancy are limited. One study that repotted on the effects of occupational exposure to formaldehyde in hospital workers did not demonstrate an increased incidence of spontaneous abortions or birth defects when compared with...

4112 Gout therapy

Allopurinol reduccs the uric acid concentration in the blood by inhibiting the enzyme xanthin oxidase. One report describes an unremarkable infant whose mother took 300 mg of allopurinol daily. The active metabolite, oxypurinol, could be detected in the milk at about 50mg l in the child's serum it was 7 mg l. The therapeutically effective serum concentration is 13-19 mg l. The daily dosage that the infant received - just about 8 mg of oxypurinol kg -just reaches the lower therapeutic dose level...

281 Arterial hypertension and pregnancy

Different kinds of arterial hypertension should be distinguished from one another as follows (for pulmonary hypertension, see section 2.8.14) m Chronic hypertension (with or without proteinuria) which was diagnosed before, during or after pregnancy Pre eclampsia, eclampsia that is proteinuria (> 300mg d), and newly diagnosed hypertension (edemas are no longer necessary symptoms) Pre-eclampsia in a pregnant woman with pre-existing chronic hypertension, which occurs in 20-25 percent of all...

Antiallergics antiasthmatics and antitussives

4.2.1 Antihistamines (H,-blockers) 639 4.2.2 Sympathomimetics for asthma treatment 641 4.2.3 Other sympathomimetics 642 4.2.4 Anticholinergics for asthma treatment 642 4.2.6 Cromoglycic acicf and nedocromi 643 4.2.8 Leukotrien-receptor antagonists 644 4.2.9 Acetylcysteine and other mucolytics 644

4210 Antitussives

Codeine has a half-life of 3-4 hours less than 25 is bound to the plasma protein, and the M P ratio is 2. Bradycardia was observed in a 1-week-old infant after a single maternal dose of 30 mg codeine (Smith 1982). in another case, following a 60-mg single maternal dose, a maximum ot 455 ng I in milk was measured (Findlay 1981). Mathematically, for the infant this means a maximum of 7 of the weight-related maternal dosage. Here, and also in other studies, breastfed infants showed no symptoms...

2644 Aciclovir and other herpes antivirals

Aciclovir (acyclovir is an acyclic nucleoside analog, highly specific for HSV-infected cells. It inhibits viral ribonucleotide production in Herpes 1 and 2 and in varicella zoster infections. Valaciclovir is the prodrug of aciclovir, with the benefit of a greater bioavailability and a longer half-life (less frequent dosing). Aciclovir can cross the placenta, and fetal aciclovir levels arc comparable to maternal levels once a steady state is reached. It is concentrated in the amniotic fluid,...

41110 Estrogens gestagens and hormonal contraceptives

The amount of milk produced can decrease as a result of the Influence of estrogen. With the older, higher-dosage contraceptives, a reduction of up to 40 was described. Changes in the caloric, protein, nitrogen, and lipid content were also observed, and arc apparently dependent on the starting point. With normally nourished women, the alterations slay within the physiological bounds. However, when there is a prior milk-supply problem, the influence on the milk production can be unfortunate when...

254 Protonpump inhibitors

Proton-pump inhibitors such as omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole suppress gastric acid secretion by inhibiting the H ' K -ATPase enzyme system on the surface of the parietal cell. Proton-pump inhibitors are used to treat gastroesophageal reflux and peptic ulcers. Omeprazole has been shown to be well-absorbed and to cross the placenta. The best-studied agent is omeprazole, with documented experience on approximately 1300 exposed pregnancies altogether. In one...

285 Nifedipine and other calcium antagonists

Nifedipine is a frequently prescribed calcium antagonist for the treatment of hypertension (Easterling 1999B, Levin 1994). A recent meta-analysis of trials involving 27743 patients has shown that calcium antagonists are inferior to other types of antihypertensive drugs as first-line agents in reducing the major complications of hypertension, although they are equally effective in reducing blood pressure (Pahor 2000). Nifedipine and verapamil have been studied in the most detail. There is little...

2137 Other alkylating agents

Busulfan exerts its alkylating effect specifically on the bone marrow, and therefore is used in leukemia therapy and in preparation for bone marrow transplantation. At least 49 pregnancies, including 31 with application during the first trimester, have been published six children or fetuses had various malformations without pattern (Briggs 2005). Four of 12 pregnant women treated with dacarbazine had been exposed during the first trimester. All newborn babies appeared to be normal (di Paolo...

2520 Drugs for chronic inflammatory bowel disease

Inflammatory bowel disease (1BD) often affects young adults, and young women with IBD may become pregnant. Several earlier retrospective studies suggest that the rates of prematurity, fetal loss, and congenital malformations in IBD approximate the incidence of these findings in the normal population (review by Katz 2001). Recent population-based studies, however, have demonstrated an increased risk of preterm delivery and have documented neonates born to mothers with IBD to have lower birth...

2118 Atypical antipsychotic drugs

Amisulprid, aripiprazole, clozapine, olanzapine, quetiapine, risperi-don, and ziprasidone are called atypical or second-generation antipsychotics. Compared with classical antipsychotics (butyrophenones, phcnothiazines), they have fewer neurological side effects (extrapyramidal or dyskinctic symptoms) and most of them have a relatively higher affinity for serotonin receptors than for dopamine receptors, resulting (apart from amisulprid and, as a transient effect, in risperi-don) in a lower or...

2619 Conazole antimycotics for systemic use

Itraconazole and miconazole are systemically used antimycotics belonging to the group of imidazole derivatives. These agents inhibit the ergosterol biosynthesis, thereby causing disturbances in the permeability and functions of the fungal cell membrane. In animal experiments, they cross the fetal-placenta barrier easily. Fluconazole and ketoconazole are triazole derivates. Their activity matches that of the structurally related imidazole derivatives. In animal experiments, teratogenic effects...

265 Lincomycin and clindamycin

Lincomycin and its derivative clindamycin inhibit bacterial protein synthesis and have bacteriostatic and bacteriocidal activity. No teratogenic or fetotoxic effects have been reported for lincomycin in 302 prcgnancics (Czcizcl 2000B). Clindamycin may causc pseudomembranous colitis, which recently has also been reported after intravaginal application (Trexler 1997). The drug is best avoided during pregnancy. Intravaginal clindamycin appears to be effective in the treatment of bacterial...

421 Antihistamines Hrblockers

Antihistamines are used to treat allergic illnesses, and as antiemetics (see Chapter 4.3). Rarely, mild restlessness, sedation or weak sucking - none of them needing treatment - are described in the breastfed baby (see, for example, Moretti 1995). Loratadine and cetirizine are the most used new-generation Hpblockcrs, which have practically no sedative effect, and do not cross the blood-brain barrier. The other (older) antihistamines discussed below are more or less sedative. The plasma...

452Efficacy of immunization in breastfed infants

Many myths have circulated regarding the efficacy of immunization of the infant during breastfeeding. Actually, the immunogenicity of some vaccines is increased by breastfeeding, but long-range enhancement of efficacy has not been studied. In any case the response to vaccines while breastfeeding is not diminished, and the usual vaccination schedules should be followed. Hepatitis A vaccine is available in two preparations which are prepared from cell culture-adapted hepatitis A virus which has...

European Israelian and Latin American Teratology information centers collaborating in the European Network of

Additional information and addresses not presented below can be found at www.entis-org.com L nea Salud Fetal, Servicio de Informaci n de Agentes Teratog nicos Health care professionals and general public Institut f r Zellbiologie, Histologie und Embryologie Harrachgasse 21 7 Medizinische Universit t 8010 Graz Tel, +43 316 3804256 Fax +43 316 3809625 E-mail herbert.juch meduni-graz.at Health care professionals and general public Sistema de Informato sobre Agentes Teratogenics (SIAT) Hospital de...

456 Polio vaccine

Oral polio vaccine (Sabin) is live attenuated vaccine combining three strains of the virus. The transfer of these vaccine viruses to an unvaccinated contact person, i.e. via a smear infection, can lead to a normal vaccination reaction and immunity against infection with the wild virus. However, it is also possible that the person will become ill with contact vaccine poliomyelitis. This complication -occurring once in 15.5 million immunizations - is very rare. In two cases, it has been reported...

4112 Methylergometrine methylergonovine

With therapy using 2 x 0.125 mg methylergometrine up to l.Ipg 1 was measured in the milk. This is a maximum of 0.16 pg kg of the infant's bodyweight, or 3.1 of the maternal weight-related dosage. In a more recent study on 20 women with postpartum uterine atony, either 250 pg methylergometrine or 200 pg misoprostol were applied 4.11.3 Bromocriptine and other prolactin inhibitors orally (see also section 4.11.13). The maximum methylergometrine concentration in milk was rcached at 2 hours. It has...

4111 Myotonolytics

Among the myotonolytics, in the broadest sense, there are very different agents, such as baclofen, carisoprodol, quinine ethyl carbon-ate, chlormezanone, Clostridium botulinum toxin, dantrolene, fenyramidol, mephenesin, methocarbamol, orphenadrine, pridinol, tetrazepam, tizanidine, and tolperisone. For antiepileptics used for the treatment of neuropathic pain, see Chapter 4.8. There is one case report on baclofen in which a maximum of 0.13 mg 1 was measured in the mother's milk following a...

21112 Benzodiazepines

Benzodiazepines arc among the most commonly used anxiolytic drugs by women of reproductive age and pregnant women. They have anxiolytic, anticonvulsant, hypnotic-sedating, and muscle-relaxing properties. They are structurally related, and act on specific benzodiazepine receptors. The half-life may vary considerably, and depends mainly on the biologic activity of the metabolites, which are formed in the liver via oxidation. Benzodiazepines cross the placenta. The rate of metabolism in the...

2176 Camphor and menthol

A small amount of camphor applied to the skin has a cooling and local anesthetic effect. Rubbing it in vigorously enhances the circulation to the skin. Because of these effects, camphor and other essential oils arc included in a large number of hyperemia-causing dcrmatological products. Menthol is used topically for itching. No teratogenic action has, as yet, been observed in either animal or human studies for topical application. Recommendation. Camphor and other essential oils may be used...

2166 Epidural and spinal analgesiaanesthesia in pregnancy

These methods epidural anesthesia, spinal anesthesia, or a combination of both methods are commonly used for pain relief during labor or for cesarean deliveries because they are immediately effective, the failure and complication rates are low, ambulation is possible, and they do not seem to interfere with the progress of labor Mattingly 2003, Albright 2000 . Among the many anesthetics used are iido-caine, bupivacaine, ropivacaine, and fentanyl. These agents have already been discusscd...

2196 Herbs frequently used during pregnancy

Herbs are frequently used as teas or infusions. Although there are no clinical trials available, and there is no evidence-based proof in terms of Western medical standards, some herbal teas infusions have been used for many years without adverse effects, and arc considered to be safe. The evidence of their safety comes from their traditional use and from traditional evidence passed down through history by traditional users. Although there are no data to suggest how much is safe, it is suggested...

2198 Herbs contraindicated during pregnancy

There are numerous herbs that are thought to be contraindicated during pregnancy, or that traditional herbalists consider potentially contraindicated during pregnancy. Studies are minimal, however. See Low Dog 2005, Blumenthal, 2003, 1998, Weed 1986. These herbs can be classified into five subgroups for an understanding of their potential effect on a pregnant woman 1. Herbs used traditionally to stimulate menstruation Tabic 2.19.4 . Herbs that may stimulate the smooth muscle of the uterus may...

2111

In contrast, only 10 of maternal naproxen values were found in the fetus Siu 2002, 2000 . The ability of NSAIDs to compromise reproductive function by inhibition of ovulation Stone 2002 and as causative agents for miscarriage Nielsen 2004, 2001, Li 2003 is still under debate 0stensen 2004 . Discontinuation of treatment with an NSAID is sometimes recommended in women who have been trying to conceive, without result, for a long period. Until recently, first-trimester...

4182 Mercury

Elemental or metallic mercury is used in mercury thermometers and in combination with silver and other metals in dental amalgam. In China, dental amalgam was used to fill teeth over 1000 years ago cited in Drexler 1998 . Inorganic mercury, e.g. mercury chloride, has been used as a disinfectant. Organic mercury ethyl mercury is used for the preservation of vaccines, and is accumulated in contaminated seafood methyl mercury . Apart from high doses elemental mercury is hardly absorbed via...

2175 Polidocanol

Polidocanol is used externally in cases of itching. In addition, it is used intravenously to obliterate varicose veins, for lesions of the mouth mucosa, in vaginal spermicides, and in cosmetics. Polidocanol in combination with benzethonium and carbamide urea has been applied in wound therapeutics. No teratogenic action has been observed to date, in either animal or human studies, for this widely used substance. However, there have been no systematic studies published. Recommendation. Pregnant...

4122 Medications for lice and scabies

Medications for lice include over-the-counter preparations containing 1 pyrethrum, a natural insecticide. This is relatively non-toxic. and application can be repeated. Herbal preparations which also contain chrysanthemums can cause allergic reaction in individuals who are allergic to this family of plants chrysanthemums, ragweed, and Echinacea are all members of the Composite family . Perrtiethrin and allethrin are synthetic pyrethroids, and are used similarly. These are rapidly metabolized...

2181 Vitamin A retinol

Vitamin A is a fat-soluble vitamin that occurs in two forms in nature. It is found in food derived from animals, such as fish oils and liver. The body readily uses this form. Vitamin A values are expressed in different ways. The nutrient was originally measured in IU international units , but in 1974 the United States began using a measurement called Retinol Equivalents REs , where 1 RE 1 pg of retinol, or 6 ig of ,1-carotene, or 3.333 1U of vitamin A. The recommended daily allowance for...

21710 Retinoids for acne and psoriasis therapy Pharmacology

Isotretinoin 13-cis-retinoic acid and tretinoin all-trans-retinoic acid arc natural derivatives of vitamin A rctinol . In synthetic der vate form, they have been used with great success for over 20 years, both externally and systemicaliy, to treat cystic acne. Tretinoin is also licensed as a systemic preparation for treating promyelocyte leukemia. As far as we know today, tretinoin is identical to the body's own growth factor, which is in all cells and is bound to specific retinoid receptors...

2162 Ether diethyl ether

Ether is a fluid with a boiling point of 35 C. which is rarely used now this is mainly because of its undesirable characteristics and complications, such as post-anesthesia vomiting and excitability. Ether crosses the placenta and rcaches the fetus within a few minutes, achieving a steady-state concentration. The extent of the newborn respiratory depression is dependent on the length and depth of the anesthesia. There seem to be no human epidemiologic studies regarding the possible effects of...

2178 Local immunomodulators and neurodermatitis therapy

Tacrolimus and pimecrolimus are used as local treatment for neurodermatitis. Although there arc no studies regarding topical use, these exist for systemic use of tacrolimus in transplant medicine see Chapter 2.12 . The results do not indicate a risk of developmental disorders, Obviously, serum levels after local treatment with tacrolimus are much lower than in transplant patients. Therefore, this substance can be used topically when there are no acceptable alternatives. There are no data...

2167 Muscle relaxants

Muscle relaxants are usually used in surgical anesthesia because most anesthetics alone do not produce sufficient relaxation of the skeletal muscles. In contrast to general and local anesthetics, muscle relaxants cross the blood-brain barrier and the placenta only in limited amounts due to their high degree of ionization and limited lipid solubility. Thus, in fetal tissue these agents achieve only 5-10 of the concentration measured in the maternal blood Demetriou 1982, Abouleish 1980 . Hence,...

2168 Occupational exposure to inhalation anesthetics

Pregnant women employed in operating rooms ORs may be chronically exposed to physical work load as well as to low doses of waste anesthetic gases. Volatile and gaseous inhalation anesthetics arc administered as mixtures in different combinations, and can be delivered to the patient through an endotracheal tube or via a face-mask. Until several years ago, ventilation systems were apparently not efficient enough in preventing exposure to relatively high levels of anesthetics. Modern ORs are...

21117 Psychoanaleptic drugs

The most commonly used analeptics, e.g. amphetamines, ampheta-minil, fenetylline. and methylphenidate, are derivatives of phenylethy-laminc. The prototype is the centrally acting drug, amphetamine, which can lead to addiction. In about 50 pregnancies where methylphenidate had been used, no substantial indication for teratogenicity was found e.g. Golub 2005, DeBooy 1993 . However, only some of them were exposed during the first trimester. An increased incidence of prematurity and growth...

283 adrenergic receptor blockers

i-blockers acebutolol, alprenolol, atenolol, betaxolol, bisoprolol, Celiprolol, Carvedilol, esniolol, labetalol, rnetoprolol, nadolol, nebivolol, oxprenolol, pindolol, propranolol, sotalol, and timolol have a wide spectrum of activity, and are often used to treat hypertension. There are two types of 3-receptors i -receptors predominate in the heart, and -receptors mediate relaxation dilatation of vascular and other smooth muscle e.g. in the airways and blood vessels . Metoprolol is...

2646 Ribavirin

Ribavirin is an antiviral with broad-spectrum activity. Severe viral infections, like hepatitis C in combination with interferon then and respiratory syncytial virus RSV infection in young infants. may be an indication. It was found to be teratogenic and or embry-olethal in several animal studies. The infants of nine women who were treated with ribavirin for severe measles during the second half of pregnancy did not have an increased incidence of anomalies Atmar 1992 . A woman treated at 7...

114 Risk communication prior to pharmacotherapeutic choice

Drug administration during pregnancy means that both the mother and unborn child are exposed. The drug or metabolite concentration may be even higher in the embryonic or fetal compartment than it is in the mother. The fetus as an additional patient therefore demands a strict pharmacotherapeutic approach, as it is imperative to try to restore maternal health without endangering the development of the child. In severe conditions, such as bronchial asthma, diabetes melli-tus, epilepsy or...

289 Diazoxide

Diazoxide is fully absorbed when given orally, and has a half-life of between 20 and 40 hours. It readily crosses ihe placenta, and fetal plasma concentrations are similar to those in ihe mother. After bolus injection, observable hypotensive states can be prevented with continual infusion, or repeated small doses Duley 1995 . its use should be reserved for the treatment of hypertensive crises. Diazoxide has a diabetogenic effect on the metabolism Sweetman 2002 . Case reports showed...

2810 Magnesium sulfate

Magnesium sulfate, although not actually an antihypertensive, has proven valuable in the treatment of pre-eclampsia. Magnesium sulfate is the drug of choice for treatment of seizures in eclampsia Oettinger 1993 . In a group of 31 fetuses where the mothers were administered the drug i.v. as an initial loading dose of 4-6g, followed by an infusion of 2-3.5 g h. magnesium sulfate was found not to be harmful Gray 1994 . A significantly lower risk of repeated convulsions in eclampsia was seen in a...

284 Hydralazine and dihydralazine

Hydralazine and dihydralazine are structurally similar vasodilator drugs that have been used for the treatment of hypertension in pregnancy for over 40 years. Following oral administration, up to 80 percent absorption occurs, and approximately 66 percent of the drug is deactivated in the liver. The half-life is 2-8 hours. Hydralazine and dihydralazine cross the placenta well, and cord-blood drug concentrations may exceed those in the mother Franke 1986 . Although results from animal studies...

268 Quinolones

Quinolones impair bacterial DNA metabolism by inhibiting DNA gyrase. They have bactericidal activity at normal doses at higher doses they have also bacteriostatic properties by inhibiting bacterial RNA and protein synthesis. Quinolones have a high affinity for cartilage and bone tissue this affinity is highest in immature cartilage. Pipemidic acid, cinoxacin, and nalidixic acid belong to the group of older quinolones. They concentrate in the urinary tract. Few data on their safety during...

2112 Nonsteroidal antiinflammatory drugs NSAIDs

NSAIDs are the mainstay of antirheumatic therapy. Pregnancy-related conditions such as premature labor, polyhydramnios, and pregnancy induced hypertension have also been indications for treatment with NSAIDs. This group of medications includes many drugs, and the number is still growing, so it is impossible to review them all. The most commonly used are acemetacin, azapropazon, diclofenac, etofenamat, fenbufen, flufenamic acid, flurbiprofen, ibuprofen, indomethacin, indoprofen, hetoprofen,...

2629 Quinine

Quinine is the oldest antimalarial agent. It has a good and rapid sch-izonticide activity against the erythrocytic forms of all Plasmodium species. In spite of relatively high toxicity and a narrow therapeutic range, it is used more often for the treatment of chloroquine-resistant malaria today. Concentrations in the fetus are just as high as in the mother, and arc potentially toxic. There are some reports describing eye defects and hearing loss in children after use of quinine in pregnancy....

2711 Poliomyelitis vaccine

Oral polio vaccine Sabin contains attenuated live poliomyelitis viruses of all three poliovirus types. It is no longer recommended for routine vaccinations because in very rare cases it may cause poliomyelitis. The inactivated form of the vaccine Salk , mostly in combinations with other vaccines injection , is now preferred. When there were outbreaks of poliovirus in Israel and Finland, mass oral polio vaccinations of the population, including pregnant women, were performed. Based on the...

2516 Anthraquinone derivatives

Anthraquinone derivatives with a laxative action occur in a number of plants folia sennae, rhizoma rhei, cortex frangulae, and aloe. They have a laxative effect by directly stimulating colonic smooth muscles. Anthraquinone derivatives occur as glycosides. After the sugar portion is cleaved in the intestine, these agents are partially absorbed and excreted in the urine colored . Anthraquinone derivatives do not appear to be teratogenic. Reported experience is the most extensive with senna...

2617 Other local conazole antimycotics

Bifonazole, croconazole, econazole, fenticonazole, isoconazole, ketoconazole, omoconazole, oxiconazole, sertaconazole, sulcona-zole, and tioconazole are imidazole derivatives, and structurally and functionally related to clotrimazole. No teratogenic effects have been observed as a result of local treatment with these antimycotics. For econazole, these findings were confirmed in a population-based case control study Czeizel 2003A . They are, however, less tried than clotrimazole and miconazole...

2312 Nonselective 3adrenergic agonists

Non-selective -adrenergic agonists are not recommended for asthma treatment. Some of ihesc drugs are used in oral OTC drugs for the common cold. These combinations do not follow good therapeutic practices, and arc not recommended during pregnancy. Hexoprenaline, isoprenaline, and orciprenaline Hexoprenaline, isoprenaline isoproterenol , and orciprenaline have a stimulating effect on .Vrcceptors. They are non-selective . -adrenergic agents that act on both and fij-receptors, and therefore have...

2634 Tuberculosis and pregnancy

The indications for treatment of active tuberculosis in pregnant women are no different from those for non-pregnant women. Transmission and infection arc felt to be the same as in the nonpregnant individual, and pregnancy does not seetn to influence the course of the disease Laibl 2005, Tripathy 2002. Espinal 1996 . Untreated tuberculosis represents a greater hazard to the mother and her fetus than does the treatment of the disease Bothamley 2001, Raju 1998, Brost 1997 . There are slight...

17 Pharmacokinetics in pregnancy

Metabolism and kinetics of medicinal products are more complicated in pregnancy than otherwise. In general, the effective concentration of a drug or its metabolites is influenced by the following the uptake, distribution, metabolism and excretion by the mother changes during pregnancy of some physiologic parameters influencing the metabolism of chemicals are summarized in Table 1.2 the passage and metabolism through the yolk sac and the placenta the distribution, metabolism and excretion by the...

264 Macrolide antibiotics

Macrolides inhibit bacterial protein synthesis and have bacteriostatic properties. Erythromycin is the oldest of the macrolides. Azithromycin, clarithromycin, dirithromycin, josamycin, mide-camycin, oleandomycin, and roxithromycin are newer macrolides. Azithromycin belongs to the azalides, a new class of macrolides which resemble erythromycin but have different pharmacokinetic profiles and antibacterial activity. The newer macrolides have a longer half-life and fewer gastrointestinal side...

2631 Primaquine

Primaquine, an 8-aminochinoline derivative, acts against vivax and ovale malaria by destroying the exoerythrocytic forms of the malaria parasite. It is used after suppressive therapy with chloroquine to eliminate the pathogen completely to prevent a relapse of vivax and ovale malaria. Primaquine should not be used in pregnancy because of the potential risk of hemolytic effects in the fetus. As yet, there arc no studies that permit a well-grounded risk assessment. However, there is no...

2655 Ivermectin and diethylcarbamazine

Ivermectin is a highly effective drug in the treatment of onchocerciasis river blindness and lymphatic filiriasis. Reports from animal studies do not indicate a teratogenic potential of this drug. In some cases inadvertent exposure during pregnancy has occurred without apparent adverse effects Gyapong 2003 , but data are not sufficient for risk estimation. Diethylcarbamazine is used for the treatment of filiriasis and onchocercosis. No teratogenicity was reported in animal studies. No...

232 Selective adrenergic agonists

. -adrenergic drugs specifically act at . -receptors. The intermediate-acting -adrenergic agonists bitolterol, fenoterol, metaproterenol, pir-buterol, reproterol, salbutamol albuterol , terbutaliiie, and tulobuterol, and the long-acting -adrenergic agonists jormoteral and salmeterol, belong to this group and are used for the treatment of asthma. , -agonists cause bronchodilation. They also inhibit uterine contractions in the second and third trimesters, and therefore are effective in the...

2612 Metronidazole and other nitroimidazole antibiotics

The nitroimidazole antibiotic metronidazole is an antibacterial and antiprotozoal agent used in trichomonas infections, amebiasis, giardiasis, bactcrial vaginosis, and anaerobic infections. It acts as an electron acceptor in the metabolism of the bacteria, and causcs growth disturbances in the susceptible microorganism. Active metabolites that interact with and disrupt the DNA-synthesis are responsible for the effect. After oral and intravenous administration, concentrations as high as those in...

2625 Chloroquine

Chloroquine, an antimalarial drug from the 4-aminochinoline group, is a rapidly-acting blood schizonticide, destroying the asexual blood forms of all Plasmodium species. Chloroquine resistance is common in many malaria-endemic regions, This resistance mainly concerns the pathogenic parasite of the severe and often deadly progressing malaria tropica pathogen Plasmodium falciparum . However, resistance against chloroquine has also been observed in Plasmodium vivax, the pathogenic parasite of the...

2651 Albendazole and thiabendazole

Albendazole is a highly effective broad-spectrum anthelmintic, structurally related to mebendazole. It also kills the parasite through inhibition of the glucose uptake. It is the first-line drug for the treatment of alveolar forms of echinococcosis Echinococcus multilocularis , and also for the advanced cystic forms Echinococcus granulosus . During a mass drug administration for lymphatic filiriasis in Ghana, 50 women were inadvertently because their pregnancy was not recognized treated with...

2654 Pyrantel

Pyrantel is a broad-spectrum anthelmintic that acts by inhibition of Cholinesterase, causing spastic paralysis and subsequent death of the parasite. Published experience on its use during pregnancy is not sufficient to determine risk. Recommendation. Pyrantel is not recommended during pregnancy because better-established anthelmintics are available for all indications. Inadvertent use does not require termination of pregnancy or invasive diagnostic procedures. A detailed ultrasound diagnosis...

219 Fentanyl alfentanil remifentanil and sufentanil

Fentanyl is used very commonly in obstetrics today. It is generally given intravenously and by epidural, but it is also available in oral, oromucosal and transdermal forms for analgesia. Placental transfer of fentanyl in early pregnancy has been demonstrated Cooper 1999 . There are no reports of teratogenic effects, but use during the first trimester or prolonged use during pregnancy is scarcely documented. A mild withdrawal syndrome without apparent long-term effects was observed after...

2118 Gout interval therapy

For women of childbearing age, therefore, gout therapy is only a minimal issue. Gout is caused by an elevated level of uric acid in the blood and in the tissue. Uric acid is the end product of purine metabolism. Interval treatment between gout attacks with uricosurics and allopurinol aims to lower uric acid levels. Uricosurics, like benzbromaron and probenecid, promote the excretion of uric acid by inhibiting renal absorption. Allopurinol causcs a decrease...

241 Nausea and vomiting in pregnancy

Of all pregnant women, 50-80 suffer from nausea and vomiting of pregnancy NVP , also known as morning sickness - although symptoms may persist throughout the whole day. Usually limited to the first trimester, NVP may continue for the entire pregnancy. NVP may range from mild discomfort to severe vomiting and nausea, weight loss, dehydration and metabolic compromise. In severe cases, NVP can be fatal. The death of the famous Charlotte Bronte, author of fane Eyre 1855 , reflects the potential...

2649 Mebendazole and flubendazole

Most infections of adults with common nematodes like ascaris and trichuris will be asymptomatic, and there is rarely an indication for treatment during pregnancy. Severe infections with hookworms may cause anemia, responsible, if during pregnancy, for increased perinatal mortality and morbidity worldwide. The WHO estimates that as many as 44 million pregnant women throughout the world are infected with hookworms WHO 1996B . Mebendazole is a highly effective and well-tolerated drug against...

248 Dopamine antagonists

The dopamine antagonists used to treat NVP are metoclopmmide, phenothiazines, domperidone, droperidol, and trimethobenzamide. Metocloprarnide is an effective antiemetic that acts both centrally causing dopamine blockade in the chemoreceptor trigger zone and decreasing sensitivity of the visceral nerves that transmit G1 impulses to the central emetic center and peripherally by stimulating motility of the upper gastrointestinal tract and increasing the lower esophageal sphincter basal tone....

18 Passage of drugs to the unborn and fetal kinetics

Most studies of drug transfer across the maternal and embryonic fetal barrier are concerned with the end of pregnancy. Little is known about the transport of substances in the early phases of pregnancy, in which, morphologically and functionally, both the yolk sac and the placenta develop and change in performance Miller 2005, Carney 2004, Garbis-Berkvens 1987 . This is not a major issue with single doses, but becomes a matter of concern with long-term therapy. The placenta is essentially a...

253 H2receptor antagonists

Cimetidine, famotidine, nizatidine, ranitidine, and roxatidine promote the healing of stomach and duodenal ulcers by blocking the H2-receptors in the gastric mucosa. In this way, the stimulation by histamine, which induces the secretion of hydrochloric acid, is prevented. Pepsin production is reduced as well. H2-receptor antagonists are used to treat gastroesophageal reflux and peptic ulcer disease. These agents are all well-absorbed and cross the placenta. Cimetidine showed weak...

2311 Antitussives

Codeine is the most widely used antitussive. It is a derivative of morphine, and has strong antitussive and analgesic properties. Because of its analgesic action, it is also used in compound antitussive preparations. An association between the prenatal use of codeine and congenital malformations has not been shown. When codeine is used in high doses for longer periods, or near term, respiratory depression and withdrawal symptoms can occur in the neonate see also Chapter 2.1 . Dextromethorphan...

224 Immunotherapy

Allergen immunotherapy allergy shots is an antiallergy therapy in which continuously increasing doses of an allergen arc injected sub-cutaneously. This therapy stimulates the production of immunoglobulins that bind the allergen before it can react with the mast cells. After immunotherapy, the allergic reaction on exposure to the allergen will be diminished because less histamine will be released by the mast cells. Immunotherapy is often effective for those allergic patients in whom the symptoms...

252 Antacids and sucralfate

Antacids are basic compounds which neutralize hydrochloric acid in the gastric secretions. For this purpose, the following arc used sodium hydrogen carbonate, aluminum hydroxide, aluminum phosphate, algeldrate, calcium carbonate, magnesium hydr oxide, magnesium carbonate, and magnesium trisilicate u combination preparations of aluminum, magnesium, and carbonate m the structurally newer aluminum-magnesium complexes almasi-late, hydrotalcite, and magaldrate and the aluminum saccharide...

262 Cephalosporins

Cephalosporins also belong to the -lactam antibiotics, but their pharmacokinetic and antibacterial properties are different from those of penicillins. They may cause hypersensitivity reactions. Some patients with penicillin allergy also react with cephalosporins. Cephalosporins are classified according to their antimicrobial activity. First-generation cephalosporins are cefaclor, cefradin, Cefadroxil, cefalexin, cefalotine, and cefazolirt. Second-generation cephalosporins are cefamandole,...

2525 Cholestyramine and other lipid reducers

Cholestyramine is an anion-cxchangc resin which is not absorbed systemically. It binds bile acids, producing an insoluble complex which is excreted in the stool. This leads to a reduction of cholesterol and the low-density LD lipoproteins in the serum. Cholestyramine is used in pregnancy for the treatment of obstetric cholestasis to relieve the itching. Ursodeoxycholic acid is, however, more effective than cholestyramine in intrahepatic cholestasis of pregnancy see ursodeoxycholic acid...

251 Gastritis and peptic ulcer during pregnancy

During prcgnancy, motility changes occur throughout the gastrointestinal tract. These changes are largely attributed to increased levels of progesterone and estrogen. The mechanisms promoting gastroesophageal reflux during gestation primarily involve decreased lower esophageal sphincter LF.S pressure and a decrease in the sphincter's adaptive responses, but mechanical factors may also be important. Gastroesophageal reflux and heartburn are common during pregnancy. In mild cases, lifestyle and...