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Second-generation antiepileptic drugs and pregnancy : A guide for clinicians

Reimers, Arne LU and Brodtkorb, Eylert (2012) In Expert Review of Neurotherapeutics 12(6). p.707-717
Abstract

When treating pregnant women with antiepileptic drugs (AEDs), clinicians have to balance potential fetal adverse effects against the risks of uncontrolled maternal disease. Only recently have emerging scientic data provided a rational basis for treatment decisions considering both aspects. The focus of research is currently moving from the first to the second AED generation. Lamotrigine is relatively well studied, and data on other novel AEDs, such as levetiracetam, oxcarbazepine, topiramate, zonisamide, gabapentin and pregabalin, are in progress. Safety issues appear to be favorable for lamotrigine, and preliminary results are also promising for levetiracetam and oxcarbazepine. Drugs metabolized by uridine-diphospate glucuronosyl... (More)

When treating pregnant women with antiepileptic drugs (AEDs), clinicians have to balance potential fetal adverse effects against the risks of uncontrolled maternal disease. Only recently have emerging scientic data provided a rational basis for treatment decisions considering both aspects. The focus of research is currently moving from the first to the second AED generation. Lamotrigine is relatively well studied, and data on other novel AEDs, such as levetiracetam, oxcarbazepine, topiramate, zonisamide, gabapentin and pregabalin, are in progress. Safety issues appear to be favorable for lamotrigine, and preliminary results are also promising for levetiracetam and oxcarbazepine. Drugs metabolized by uridine-diphospate glucuronosyl transferase or excreted unchanged by the kidneys are particularly susceptible to increased body clearance during pregnancy. Lamotrigine is subject to both mechanisms, and therapeutic serum levels may sometimes be difficult to maintain. The authors review the recommendations and clinical research on modern AED treatment during pregnancy, highlighting current experience with second-generation drugs.

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author
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publishing date
type
Contribution to journal
publication status
published
keywords
breast feeding, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pharmacokinetics, pregabalin, pregnancy, teratogenicity, topiramate, zonisamide
in
Expert Review of Neurotherapeutics
volume
12
issue
6
pages
11 pages
publisher
Future Drugs Ltd
external identifiers
  • pmid:22650173
  • scopus:84861721283
ISSN
1473-7175
DOI
10.1586/ern.12.32
language
English
LU publication?
no
id
9f71fd16-16c6-41bc-9d1f-d3682eb7d82c
date added to LUP
2024-08-31 14:50:17
date last changed
2024-09-02 09:05:12
@article{9f71fd16-16c6-41bc-9d1f-d3682eb7d82c,
  abstract     = {{<p>When treating pregnant women with antiepileptic drugs (AEDs), clinicians have to balance potential fetal adverse effects against the risks of uncontrolled maternal disease. Only recently have emerging scientic data provided a rational basis for treatment decisions considering both aspects. The focus of research is currently moving from the first to the second AED generation. Lamotrigine is relatively well studied, and data on other novel AEDs, such as levetiracetam, oxcarbazepine, topiramate, zonisamide, gabapentin and pregabalin, are in progress. Safety issues appear to be favorable for lamotrigine, and preliminary results are also promising for levetiracetam and oxcarbazepine. Drugs metabolized by uridine-diphospate glucuronosyl transferase or excreted unchanged by the kidneys are particularly susceptible to increased body clearance during pregnancy. Lamotrigine is subject to both mechanisms, and therapeutic serum levels may sometimes be difficult to maintain. The authors review the recommendations and clinical research on modern AED treatment during pregnancy, highlighting current experience with second-generation drugs.</p>}},
  author       = {{Reimers, Arne and Brodtkorb, Eylert}},
  issn         = {{1473-7175}},
  keywords     = {{breast feeding; gabapentin; lamotrigine; levetiracetam; oxcarbazepine; pharmacokinetics; pregabalin; pregnancy; teratogenicity; topiramate; zonisamide}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{707--717}},
  publisher    = {{Future Drugs Ltd}},
  series       = {{Expert Review of Neurotherapeutics}},
  title        = {{Second-generation antiepileptic drugs and pregnancy : A guide for clinicians}},
  url          = {{http://dx.doi.org/10.1586/ern.12.32}},
  doi          = {{10.1586/ern.12.32}},
  volume       = {{12}},
  year         = {{2012}},
}