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Bergemann N, Paulus WE. [Psychopharmacotherapy during pregnancy : Which antipsychotics, tranquilizers and hypnotics are suitable?]. DER NERVENARZT 2016; 87:943-54. [PMID: 27573673 DOI: 10.1007/s00115-016-0192-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When administering psychotropic drugs during pregnancy not only the potential teratogenic effects on the child must be addressed but also the fetotoxic implications for pregnancy and/or the peripartum phase as well as possible neurocognitive developmental disorders must be considered. OBJECTIVE Evaluation of the risks and benefits of administering psychotropic drugs during pregnancy or for women who wish to become pregnant. METHODS The literature has been reviewed with the purpose of providing information on psychotropic drugs which can safely be administered during pregnancy. The review considers antipsychotics as well as tranquilizers and hypnotics. RESULTS Data are available for a multitude of psychotropic drugs that allow a safe estimation on their suitability for use during pregnancy. CONCLUSION When treating mental illnesses during pregnancy the option of administering drugs must not principally be ruled out. What is required is an individual assessment of benefits and risks. The risk of an untreated mental illness versus the benefit of a suitable treatment, which may include the use of medication and the potential harm to the infant must be evaluated. If certain rules are observed and a suitable drug is selected the risk to the newborn child and/or mother during pregnancy can be minimized. During pregnancy, therapeutic drug monitoring is indicated and increases the safety for use of drugs and preventing harm to both mother and infant.
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Affiliation(s)
- N Bergemann
- Sächsisches Krankenhaus Rodewisch, Zentrum für Psychiatrie, Psychotherapie, Psychosomatik und Neurologie, Bahnhofstraße 1, 08228, Rodewisch, Deutschland.
| | - W E Paulus
- Institut für Reproduktionstoxikologie, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
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Gils C, Pottegård A, Ennis ZN, Damkier P. Perception of drug teratogenicity among general practitioners and specialists in obstetrics/gynecology: a regional and national questionnaire-based survey. BMC Pregnancy Childbirth 2016; 16:226. [PMID: 27531162 PMCID: PMC4988043 DOI: 10.1186/s12884-016-1025-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimating the true risk of fetal malformations attributable to the use of medications is difficult and perception of risk by health professionals will impact their counseling and treatment of patients who need medication during pregnancy. The objective of this study was to assess the perception of the teratogenic risk of 9 commonly and 3 rarely prescribed drugs among general practitioners and specialists in obstetrics/gynecology. METHODS All 811 general practitioners in the Region of Southern Denmark and all 502 specialist obstetricians/gynecologists in Denmark as a whole were invited to participate in the study based on an online questionnaire. Medians and interpercentile ranges of the perceived background risk and perceived risks for each of the drugs were included in the questionnaire. RESULTS One hundred forty three (18 %) general practitioners and 138 (27 %) obstetricians/gynecologists participated. Estimates provided by the participants were generally in accordance with current knowledge of drugs with established safety during pregnancy. Perceptions of risks associated with warfarin and retinoid exposure were severely underestimated. CONCLUSIONS Understanding of teratogenic background risk and specific risks associated with in utero exposure to 12 different drugs generally approached the established knowledge. The risk associated with warfarin and retinoid exposure was severely underestimated by both groups of health care professionals, while general practitioners specifically overestimated the risk of sertraline and citalopram to some extent. In Denmark, general practitioners can prescribe antidepressants, and even minor misconceptions of the teratogenic potential of citalopram and sertraline may be of clinical relevance. In Denmark, systemic retinoids can only be prescribed by a dermatologist, and warfarin treatment is only rarely initiated in women of the fertile age without involvement of specialists in internal medicine. Hence, the active knowledge on the teratogenic potential of these drugs is likely to be less accurate among general practitioners and obstetricians/gynecologists; although still of clinical importance since these specialists are largely involved in the counselling of pregnant women.
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Affiliation(s)
- Charlotte Gils
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Zandra Nymand Ennis
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark. .,Clinical Pharmacology and Pharmaceutics, Department of Public Health, University of Southern Denmark, Odense, Denmark.
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Hatters Friedman S, Moller-Olsen C, Prakash C, North A. Atypical antipsychotic use and outcomes in an urban maternal mental health service. Int J Psychiatry Med 2016. [PMID: 28629296 DOI: 10.1177/0091217417696739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective Despite many women suffering from psychosis in their childbearing years, limited data exist about the use of atypical antipsychotic agents in pregnancy. Atypical antipsychotic agents are often used to treat bipolar disorder, instead of lithium or valproate because of the known teratogenicity of those agents. As well, atypical antipsychotics are often prescribed in anxiety disorders and depression. This study sought to describe pregnancy outcomes for women prescribed atypical antipsychotics during pregnancy. Methods This retrospective review included all cases treated by Auckland Maternal Mental Health services in which atypical antipsychotic agents were utilized during pregnancy over three years. Results Over the three years, 45 pregnant women were prescribed atypical antipsychotic agents, most commonly quetiapine or olanzapine. Two-fifths (40%) were diagnosed with bipolar disorder and almost one-third (31%) with a psychotic disorder. Two-thirds (64%) were prescribed multiple psychotropic medications during their pregnancy. Instrumental delivery rates were elevated at 38%. A minority (13%) of the women developed gestational diabetes mellitus. Although 7% of infants were born premature, all were born after 35 weeks. Two major malformations were noted, similar to baseline community rates. Conclusions This naturalistic study adds to the limited literature about treatment with atypical antipsychotic agents in pregnancy, though not adequately powered to detect small differences in malformations or obstetrical outcomes. It also highlights the myriad of indications for which pregnant women are prescribed atypical antipsychotics, and the multiple other risk factors seen in this population.
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Kaczor AA, Targowska-Duda KM, Budzyńska B, Biała G, Silva AG, Castro M. In vitro, molecular modeling and behavioral studies of 3-{[4-(5-methoxy-1H-indol-3-yl)-1,2,3,6-tetrahydropyridin-1-yl]methyl}-1,2-dihydroquinolin-2-one (D2AAK1) as a potential antipsychotic. Neurochem Int 2016; 96:84-99. [PMID: 26964765 DOI: 10.1016/j.neuint.2016.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/02/2016] [Accepted: 03/05/2016] [Indexed: 12/29/2022]
Abstract
Antipsychotics currently available to treat schizophrenia suffer several limitations: (1) they are efficient against positive but not negative and cognitive symptoms of the disease; (2) they help only a half of patients; (3) they have severe side effects including neurological and metabolic side effects. Thus, novel drugs to treat schizophrenia are highly demanded. We identified a novel dopamine D2 receptor antagonist, D2AAK1, with Ki of 58 nM using structure-based virtual screening. D2AAK1 possesses additional nanomolar or low micromolar affinity to D1, D3, 5-HT1A and 5-HT2A receptors, making it an ideal candidate for a multi-target drug. Here we present homology modeling, molecular docking and molecular dynamics of D2AAK1 and its molecular targets and animal studies of D2AAK1 as a potential antipsychotic. The main contact of D2AAK1 and all the receptors studied is the electrostatic interaction between the protonable nitrogen atom of the ligand and the conserved Asp(3.32) as typical for orthosteric ligands of aminergic GPCRs. We confirmed antagonistic/partial agonistic properties of D2AAK1 towards all the receptors in in vitro essays and in in silico studies as the ligand stabilizes the ionic lock interaction. We also demonstrated neuroleptic, anxiolytic and, importantly, procognitive properties of D2AAK1 in mouse models.
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Affiliation(s)
- Agnieszka A Kaczor
- Department of Synthesis and Chemical Technology of Pharmaceutical Substances, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, 4A Chodzki St., PL-20093 Lublin, Poland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
| | - Katarzyna M Targowska-Duda
- Department of Biopharmacy, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, 4A Chodzki St., PL-20093 Lublin, Poland
| | - Barbara Budzyńska
- Department of Pharmacology and Pharmacodynamics, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, 4A Chodzki St., PL-20093 Lublin, Poland
| | - Grażyna Biała
- Department of Pharmacology and Pharmacodynamics, Faculty of Pharmacy with Division of Medical Analytics, Medical University of Lublin, 4A Chodzki St., PL-20093 Lublin, Poland
| | - Andrea G Silva
- Department of Pharmacology, Universidade de Santiago de Compostela, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Avda de Barcelona, E-15782 Santiago de Compostela, Spain
| | - Marián Castro
- Department of Pharmacology, Universidade de Santiago de Compostela, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Avda de Barcelona, E-15782 Santiago de Compostela, Spain
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Abstract
Medication management of bipolar depression in pregnancy and lactation is best done by assessing each patient's and family's needs in detail. Keeping pregnant patients as psychiatrically stable as possible is the most important principle for clinicians. Unfortunately, there is no risk-free situation for patients with psychiatric illness. This is often the most difficult and hard to accept reality for these patients, families, and clinicians. Clinicians serve these patients best by being as transparent as possible about the risk/benefit analysis of each patient's situation with the realization that ultimately the decisions are made by the patient and family.
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Affiliation(s)
- Marla F Wald
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Civitan Building, 2213 Elba Street, Durham, NC 27705, USA.
| | - Andrew J Muzyk
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Drue Clark
- Mission Health Outpatient Clinical Pharmacy Services, Asheville, NC, USA
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Abstract
Pregnancy and postpartum represent times of increased vulnerability for women with bipolar disorder, yet this condition remains under-diagnosed and under-treated. As 50 % of pregnancies are unplanned, the risks associated with the illness and the potential risks associated with treatment should be considered when a woman of reproductive age first presents for evaluation. This article reviews the epidemiology of perinatal bipolar disorder, screening recommendations, and treatment with pharmacotherapy and electroconvulsive therapy (ECT). An overview of the data in pregnancy and lactation is presented for lithium, lamotrigine, valproic acid, newer antipsychotics, and ECT. General principles of management include close monitoring in pregnancy and postpartum, careful adjustment of the treatment regimen to attenuate the risk of relapse, and avoidance of valproic acid when possible. Thoughtful consideration of these issues will minimize the risks to the mother and baby.
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Wlodarczyk BJ, Ogle K, Lin LY, Bialer M, Finnell RH. Comparative teratogenicity analysis of valnoctamide, risperidone, and olanzapine in mice. Bipolar Disord 2015; 17:615-25. [PMID: 26292082 PMCID: PMC4631615 DOI: 10.1111/bdi.12325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Based on the recent findings from animal studies, it has been proposed that the therapeutic use of valnoctamide, an anxiolytic drug developed in the early 1960s, be extended to treat other neurological disorders such as epilepsy and bipolar disease. Given the scarcity of adequate data on its prenatal toxicity, a comparative teratogenicity study of valnoctamide and two of the most commonly used drugs to treat bipolar disorder, risperidone and olanzapine, was carried out in a mouse model system. METHODS Pregnant dams were treated with the aforementioned three drugs at the dose levels calculated as an equal proportion of the respective LD50 values of these drugs. The main reproductive indices examined included the numbers of implantations and resorptions, viable and dead fetuses, and fetal gross, visceral and skeletal abnormalities. RESULTS The outcomes of the present study indicated that olanzapine was the most teratogenic of the three drugs, inducing maternal-, embryo-, and fetotoxicity. Risperidone also exerted a significant prenatal toxicity, but its adverse effect was less pronounced than that induced by olanzapine. Valnoctamide did not show any teratogenic effect, even when used in relatively higher dosages than olanzapine and risperidone. The observed increased skeletal abnormalities in one of the valnoctamide treatment groups were nonspecific and, as such, signaled a modest developmental delay rather than an indication that the compound could induce structural malformations. CONCLUSIONS Under our experimental conditions, valnoctamide demonstrated the lowest prenatal toxicity of the three tested drugs.
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Affiliation(s)
- Bogdan J Wlodarczyk
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Krystal Ogle
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Linda Ying Lin
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Meir Bialer
- School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Richard H Finnell
- Dell Pediatric Research Institute, Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA,Dell Pediatric Research Institute, Department of Chemistry and Biochemistry, The University of Texas at Austin, Austin, TX, USA
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