21117 Psychoanaleptic drugs

Pharmacology and toxicology

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 retardation as well as neonatal withdrawal symptoms have been reported in infants of mothers abusing methylphenidate together with other substances (DeBooy 1993). It is important to be aware that this drug is increasingly prescribed not only during childhood but also to women of reproductive age for attention deficit and hyperactivity syndrome.

Modafinil, with a different mode of action from amphetamines, is used for narcolepsy. Pemolin is an oxazolidine that has been used for attention deficit disorder.

Data are insufficient for risk evaluation of these drugs during pregnancy.

Recommendation. Psychoanaleptic drugs are contra indicated during pregnancy. Inadvertent use of these drugs during pregnancy Is not grounds for termination of pregnancy, or for invasive diagnostic procedures. Detailed fetal ultrasonography may be performed after recurrent or high-dose exposure in the first trimester. If drug treatment for narcolepsy is required, methylphenidate Is recommended.

2.11.18 Parkinson drugs

Pharmacology and toxicology

Parkinsonism is mainly seen in older patients, and is not normally a disease in pregnant women. Parkinson drugs which are given also for juvenile parkinsonism and restless leg syndrome are l-dopa/ benserazide. Some 15 exposed pregnancies have been reported, with uneventful delivery of normal children (e.g. Arai 1997, Noinoto 1997, von Graeventiz 1996).

Parkinson drugs such as the dopamine agonists bromocriptine, cabergoline, i\-dihydroergocryptine, lisuride, and pergolide, are used in women of reproductive age to inhibit prolactin secretion. For information on these drugs, see Chapter 2.15.

Additional Parkinson drugs, some of them used for extrapyramidal symptoms caused by "classical" neuroleptic drugs, are the virustatic amantadine, biperiden, benzatropin, bornaprin, budipin, carbidopa, dexetimid, entacapon, metixen, pergolide, pramipexol, pridinol, procyclidine, ropinirol, tiapride, and trihexyphenidyl, as well as the monoaminooxydase-B- (MAO-B-) inhibitors selegilin and rasigilin. With the exception of the broadly used ergotamine derivatives, data are insufficient for risk assessment in pregnancy. There is a case report of a woman treated with high doses of pramipexol during pregnancy (Mucchiut 2004).

Recommendation. Combined treatment of a neuroleptic drug with biperiden is acceptable in pregnancy when indicated. For restless leg syndrome, better-evaluated drug groups should be used. Inadvertent use of a Parkinson drug not belonging to the broadly used ergotamine derivatives is not grounds for termination of pregnancy, or for invasive diagnostic procedures. Detailed fetal ultrasonography may be considered where first-trimester exposure to less-used drugs has occurred.

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