21317 Antineoplastic drugs with endocrine effects

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The hormone antagonist tamoxifen is used for the treatment of breast cancer. Its effect on the endometrium might indirectly pose a risk to prenatal development. In 37 pregnancies collated by the manufacturer, 19 newborn babies were healthy and 2 children had craniofacial deformities. Two other case reports describe a child with anomalies resembling Goldenhar syndrome (Cullins 1994), and a newborn girl with indifferent genital development (Tewari 1997). An adenoma of the vagina was diagnosed in a girl aged 2 years whose mother had taken tamoxifen until the fourth month of pregnancy. There are also reports of apparently normal pregnancies (Andreadis 2004, Isaacs 2001, Lai 1994). Nine pregnancies following induction of ovulation with tamoxifen resulted in newborn babies that had no malformations (Ruiz-Velasco 1979). There is, however, insufficient data for a discriminative risk evaluation.

There is no information on toremifene and fulvestrant, an estrogen antagonist, during pregnancy. Enzyme inhibitors such as atnino-glutethimide arc also used for the therapy of Cushing's syndrome, with adrenocortical adenomas and carcinomas, and with ectopic ACTH syndrome. Some case reports with aminoglutethimide describe masculinization of female fetuses as well as normal development (overview in Schardein 2000).

The aromatase inhibitor letrozole is prescribed to postmenopausal women with hormone-dependent breast carcinoma. Recently, letrozole has also found application in the treatment of sterility, in order to stimulate ovulation - for example, as alternative to ciomiphene. A recently published retrospective study on 911 newborns from women who conceived following ciomiphene (>; = 397) or letrozole (n - 514) treatment found no difference in the overall rates of major and minor congenital anomalies (Tulandi 2006),

There are no data on the use of the aromatase inhibitor exemes-tane during pregnancy.

Regarding medroxyprogesterone, megestrol, and gosereline, see Chapter 2.15.

2.13.18 Cytostatic drugs of plant origin

For mistletoe preparations (Viscurn album), clinical observations in a few pregnancies do not indicate toxicity to the unborn. There were no cytotoxic or mutagenic effects in in vitro tests with amniotic fluid (Bussing 1995). However, because viscum album therapy may provoke fever and clinical data are insufficient to rule out prenatal toxicity, exposure should be avoided during pregnancy.

2.13.19 Occupational handling of cytostatic drugs

There has been some discussion about an increased risk of abortion for nurses who regularly handle cytostatic drugs during their pregnancy. I lowever, according to the available information, a causal relationship can be neither proven nor eliminated (Stucker 1990).

Recommendation. During pregnancy, regular professional handling of cytostatic drugs should be discontinued. However, if a nurse or pharmacist has been working in a relevant department before the pregnancy was known, there Is no need to take any diagnostic measures and no justification for the termination of the pregnancy on the basis of an assumed risk.

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Uterine contraction agents, tocolytics, vaginal therapeutics, and local contraceptives

Herman van Geijn

2.14.1

Prostaglandins

368

2.14.2

Oxytocin

371

2,14.3

Ergot alkaloids

372

2.14.4

Tocolytics in general

372

2,14.5

Ci2-sympathicomimetics

373

2.14,6

Calcium antagonists

373

2.14.7

Magnesium sulfate

374

2.14.8

Oxytocin receptor antagonists

375

2,14.9

Prostaglandin antagonists

375

2.14.10

Other tocolytics

375

2.14.11

Vaginal therapeutics

376

2.14.12

Spermicide contraceptives

377

2.14.13

Intrauterine devices

377

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