Combined effects of acetaminophen, isopropylantipyrine and caffeine on pregnant and nonpregnant liver

Developmental effects of propyphenazone in analgesic and antipyretic combination with caffeine or paracetamol

The aim of the study was to determine the influence of an over-the-counter (OTC) mixture of propyphenazone with caffeine or paracetamol on prenatal development. Propyphenazone:caffeine and propyphenazone:paracetamol mixtures were prepared with constant 3:1 and 3:5 ratios, respectively. Three dose levels of each of the mixtures were administered separately in Tween-80 water suspension once a day to pregnant Wistar rats on gestation days 8-14. The low dose was similar to the OTC preparations, 2.1 mg/kg of propyphenazone, 0.7 mg/kg of caffeine or 3.5 mg/kg of paracetamol. The middle dose was 21.0, 7.0 or 35.0 mg/kg, and the highest 210.0, 70.0 or 350.0 mg/kg for propyphenazone, caffeine or paracetamol, respectively. On day 21 of gestation the fetuses were delivered by hysterectomy. Dead or live fetuses, resorptions and the number of implantation sites were counted. Live fetuses were examined for external, visceral and skeletal malformation. Postimplantation mortality was calculated. Dose-dependent effects in the middle and high dose groups on fetal body weight/length and placental weight were found. No increase in external or internal congenital anomalies was found in any of the mixture-exposed groups. Prenatal coadministration of propyphenazone with caffeine or paracetamol caused intrauterine growth retardation but did not increase external or internal congenital anomalies. The risk of midline defects (umbilical hernia and gastroschisis) is discussed.

Evaluation of the reproductive and developmental risks of caffeine

A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the "pregnancy signal," which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine is an abortafacient for the wide range of human caffeine exposures. Almost all the congenital malformation epidemiology studies were negative. Animal pharmacokinetic studies indicate that the teratogenic plasma level of caffeine has to reach or exceed 60 µg/ml, which is not attainable from ingesting large amounts of caffeine in foods and beverages. No epidemiological study described the "caffeine teratogenic syndrome." Six of the 17 recent epidemiology studies dealing with the risk of caffeine and fetal weight reduction were negative. Seven of the positive studies had growth reductions that were clinically insignificant and none of the studies cited the animal literature. Analysis of caffeine's reproductive toxicity considers reproducibility and plausibility of clinical, epidemiological, and animal data. Moderate or even high amounts of beverages and foods containing caffeine do not increase the risks of congenital malformations, miscarriage or growth retardation. Pharmacokinetic studies markedly improve the ability to perform the risk analyses.

Gastrointestinal and hepatic toxicity of selective and non-selective cyclooxygenase-2 inhibitors in pregnant and non-pregnant rats

The aim of the study was to evaluate the toxicity of non-selective (tolmetin, ibuprofen and piroxicam) and selective (DFU) cyclooxygenase-2 inhibitors on pregnant and non-pregnant rats. The drugs were administered orally once (DFU, piroxicam) or three times (tolmetin, ibuprofen) a day from days 8 through 21 of gestation experiment in three doses. The initial dose was similar to the human antiinflammatory one and set as 8.5 mg/kg (tolmetin, ibuprofen), 0.3 mg/kg (piroxicam) and 0.2 mg/kg (DFU). The middle dose was increased 10 times and the highest one 100 times the initial dose. The highest dose for ibuprofen was set at 200mg/kg due to high mortality. On gestation/experimental day 21 animals were sacrificed, blood was collected and abdominal organs were taken for pathological examination. Activity of alanine and asparate aminotransferases and levels of total protein and urea were determined. Stomach, small and large intestines, and liver were grossly and histologically examined. Dose-dependent mortality, signs of gastrointestinal toxicity, and significant changes of biochemical parameters were found in groups exposed to non-selective COX inhibitors in both pregnant and non-pregnant rats. Mild regressive structural hepatic changes were observed. Significant decrease of protein level in non-pregnant rats treated with high DFU dose, and occasionally observed gastrointestinal changes were the only changes noted in groups exposed to the selective COX-2 inhibitor. Tolerability of non-selective COX inhibitors was lower in both pregnant and non-pregnant groups when compared with DFU. Insignificant mortality and histological changes were noted between pregnant and non-pregnant groups.

Prenatal effects of DuP-697-the irreversible, highly selective cyclooxygenase-2 inhibitor

DuP-697 (5-bromo-2-(4-fluorophenyl)-3-[4-(methylsulfonyl)phenyl]-thiophene), like celecoxib and rofecoxib, is a vicinal diaryl heterocycle highly selective cyclooxygenase-2 (COX-2) inhibitor. The aim of the study was to evaluate prenatal tolerability of DuP-697. The drug was administered orally in Tween 80 water suspension once a day to pregnant Wistar rats, on Days 7-18 of gestation. The initial dose, similar to the rat antipyretic dose, was set at 0.05 mg/kg. The middle dose, 3.5 mg/kg, corresponded to the rat anti-inflammatory and analgesic dose. The high dose was set at 35.0 mg/kg. Control animals received Tween 80 water suspension. On Day 21 of gestation, fetuses were delivered by laparotomy and double stained with alcian blue and alizarin red S or examined using the Wilson technique. Intrauterine growth retardation occurred in the groups exposed to the middle and highest dose of DuP-697. Minimal reactive and degenerative hepatic changes were found in both drug-exposed and control groups. Skeletal malformations were seen occasionally in all drug-treated and control groups. A significant increase in skeleton variations, such as delayed and asymmetrical ossification, was observed in fetuses exposed to the highest drug dose when compared with the control. These changes were not increased (P<0.1) in the middle drug-dose group. The experimentally-derived NOAEL for developmental toxicity was 0.05 mg/kg, and the corresponding LOAEL was 3.5 mg/kg.

Effects of prenatal exposure to combination of acetaminophen, isopropylantipyrine and caffeine on intrauterine development in rats

The common effects of acetaminophen (paracetamol), isopropylantipyrine (propyphenazone) and caffeine on fetal development were examined in rats. The mixture was given in Tween 80 solution once daily, in a constant proportion of 5:3:1, during days 8-14 of gestation in three different doses. Dose S1 - 3.5 mg/kg acetaminophen, 2.14 mg/kg isopropylantipyrine, 0.7 mg/kg caffeine. Dose S2 was 10 times higher, and S3 100 times higher than dose S1. On day 21 of gestation, the dams were sacrificed and the fetuses were removed. The corpora lutea, resorptions, live and dead fetuses were counted. The pre- and postimplantation mortality were calculated. The weight of fetuses and placentas, and the length of fetuses and their tails were measured. Two-thirds of each litter was processed for Alizarin Red S staining. The remaining third was fixed in Bouin's solution for subsequent visceral examination by using modified Wilson's technique. A significant decrease in body weight in S1 group, and fetal length and placental weight in group S3 were recorded. A significant increase in tail length in group S2 was observed. The number of corpora lutea, fetuses, resorptions, preimplantation and postimplantation mortality did not exhibit any significant difference. Nonsignificant incidence of fetal anomalies was found.