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Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation

Tomson, Torbjörn; Palm, Ragnar; Källén, Kristina LU ; Ben-Menachem, Elinor; Soderfeldt, Birgitta; Danielsson, Bo; Johansson, Rune; Luef, Gerhard and Ohman, Inger (2007) In Epilepsia 48(6). p.1111-1116
Abstract
Purpose: To study pharmacokinetics of levetiracetam (LEV) during pregnancy, delivery, lactation, and in the neonatal period. Methods: Fourteen women with epilepsy receiving LEV treatment during pregnancy and lactation contributed with 15 pregnancies to this prospective study in which LEV concentrations in plasma and breast milk were determined. Trough maternal plasma samples were collected each trimester, and at baseline after delivery. Blood samples were obtained at delivery from mothers, from the umbilical cord, and from newborns during 2 days after delivery. LEV concentration was also determined in breast milk and in plasma collected from 11 of the mothers and their suckling infants after birth. Results: The umbilical cord/maternal... (More)
Purpose: To study pharmacokinetics of levetiracetam (LEV) during pregnancy, delivery, lactation, and in the neonatal period. Methods: Fourteen women with epilepsy receiving LEV treatment during pregnancy and lactation contributed with 15 pregnancies to this prospective study in which LEV concentrations in plasma and breast milk were determined. Trough maternal plasma samples were collected each trimester, and at baseline after delivery. Blood samples were obtained at delivery from mothers, from the umbilical cord, and from newborns during 2 days after delivery. LEV concentration was also determined in breast milk and in plasma collected from 11 of the mothers and their suckling infants after birth. Results: The umbilical cord/maternal plasma concentration ratios ranged from 0.56-2.0 (mean 1.15, n = 13). LEV plasma concentrations in the neonates declined with an estimated half-life of 18 h (n = 13). The mean milk/maternal plasma concentration ratio was 1.05 (range, 0.78-1.55, n = 11). The infant dose of LEV was estimated to 2.4 mg/kg/day, equivalent to 7.9% of the weight-normalized maternal dose. Plasma concentrations in breastfed were approximately 13% of the mother's plasma levels. Maternal plasma concentrations during third trimester were only 40% of baseline concentrations outside pregnancy (p < 0.001, n = 7) Conclusions: Our observations suggest considerable transplacental transport of LEV and fairly slow elimination in the neonate. Plasma concentrations of LEV in nursed infants are low despite an extensive transfer of LEV into breast milk. Pregnancy appears to enhance the elimination of LEV resulting in marked decline in plasma concentration, which suggests that therapeutic monitoring may be of value. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
pharmacokinetics, levetiracetam, epilepsy, pregnancy, breast milk
in
Epilepsia
volume
48
issue
6
pages
1111 - 1116
publisher
Wiley-Blackwell
external identifiers
  • wos:000247124700011
  • scopus:34249776676
ISSN
0013-9580
DOI
10.1111/j.1528-1167.2007.01032.x
language
English
LU publication?
yes
id
f648134a-c7ca-4704-9249-07374852d2fd (old id 651082)
date added to LUP
2007-12-19 09:52:35
date last changed
2017-10-22 03:54:24
@article{f648134a-c7ca-4704-9249-07374852d2fd,
  abstract     = {Purpose: To study pharmacokinetics of levetiracetam (LEV) during pregnancy, delivery, lactation, and in the neonatal period. Methods: Fourteen women with epilepsy receiving LEV treatment during pregnancy and lactation contributed with 15 pregnancies to this prospective study in which LEV concentrations in plasma and breast milk were determined. Trough maternal plasma samples were collected each trimester, and at baseline after delivery. Blood samples were obtained at delivery from mothers, from the umbilical cord, and from newborns during 2 days after delivery. LEV concentration was also determined in breast milk and in plasma collected from 11 of the mothers and their suckling infants after birth. Results: The umbilical cord/maternal plasma concentration ratios ranged from 0.56-2.0 (mean 1.15, n = 13). LEV plasma concentrations in the neonates declined with an estimated half-life of 18 h (n = 13). The mean milk/maternal plasma concentration ratio was 1.05 (range, 0.78-1.55, n = 11). The infant dose of LEV was estimated to 2.4 mg/kg/day, equivalent to 7.9% of the weight-normalized maternal dose. Plasma concentrations in breastfed were approximately 13% of the mother's plasma levels. Maternal plasma concentrations during third trimester were only 40% of baseline concentrations outside pregnancy (p &lt; 0.001, n = 7) Conclusions: Our observations suggest considerable transplacental transport of LEV and fairly slow elimination in the neonate. Plasma concentrations of LEV in nursed infants are low despite an extensive transfer of LEV into breast milk. Pregnancy appears to enhance the elimination of LEV resulting in marked decline in plasma concentration, which suggests that therapeutic monitoring may be of value.},
  author       = {Tomson, Torbjörn and Palm, Ragnar and Källén, Kristina and Ben-Menachem, Elinor and Soderfeldt, Birgitta and Danielsson, Bo and Johansson, Rune and Luef, Gerhard and Ohman, Inger},
  issn         = {0013-9580},
  keyword      = {pharmacokinetics,levetiracetam,epilepsy,pregnancy,breast milk},
  language     = {eng},
  number       = {6},
  pages        = {1111--1116},
  publisher    = {Wiley-Blackwell},
  series       = {Epilepsia},
  title        = {Pharmacokinetics of levetiracetam during pregnancy, delivery, in the neonatal period, and lactation},
  url          = {http://dx.doi.org/10.1111/j.1528-1167.2007.01032.x},
  volume       = {48},
  year         = {2007},
}