Schaefer / Peters / Miller Drugs During Pregnancy and Lactation

Treatment Options and Risk Assessment
3. Auflage 2014
ISBN: 978-0-12-407901-4
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 918 Seiten

Drugs During Pregnancy and Lactation, Third Edition is a quick and reliable reference for all those working in disciplines related to fertility, pregnancy, lactation, child health and human genetics who prescribe or deliver medicinal products, and to those who evaluate health and safety risks. Each chapter contains twofold information regarding drugs that are appropriate for prescription during pregnancy and an assessment of the risk of a drug when exposure during pregnancy has already occurred. Thoroughly updated with current regulations, references to the latest pharmacological data, and new medicinal products, this edition is a comprehensive resource covering latest knowledge and findings related to drugs during lactation and pregnancy. - Provides evidence-based recommendations to help clinicians make appropriate recommendations - Uniquely organized and structured according to drug class and treatment indications to offer authoritative clinical content on potential adverse effects - Highlights new research developments from primary source about working mechanism of substances that cause developmental disorders

Autoren/Hrsg.

Schaefer, Christof

Peters, Paul W. J.

Miller, Richard K

Inhaltsverzeichnis

1;Cover
;1
2;Drugs During Pregnancy and Lactation;4
3;Copyright;5
4;Contents;6
5;List of Contributors;20
6;Preface;24
7;Disclaimer;26
8;1 - General commentary on drug therapy and drug risks in ­pregnancy;28
8.1;1.1 Introduction;28
8.2;1.2 Development and health;29
8.3;1.3 Reproductive stages;30
8.4;1.4 Reproductive and developmental toxicology;31
8.5;1.5 Basic principles of drug-induced reproductive and developmental toxicology;35
8.6;1.6 Effects and manifestations;37
8.7;1.7 Pharmacokinetics of drugs in pregnancy;38
8.8;1.8 Mechanisms of developmental toxic agents;40
8.9;1.9 Causes of developmental disorders;41
8.10;1.10 Embryo/fetotoxic risk assessment and plausibility;42
8.11;1.11 Classification of drugs used in pregnancy;44
8.12;1.12 Paternal use of medicinal products;45
8.13;1.13 Communicating the risk of drug use in pregnancy;46
8.14;1.14 Risk communication prior to pharmacotherapeutic choice;47
8.15;1.15 Risk communication regarding the safety of drugs already used in pregnancy;48
8.16;1.16 Teratology information centers;48
8.17;References;49
9;2 - Specific drug therapies
during pregnancy;52
9.1;2.1 - Analgesics, non-steroidal anti-­inflammatory drugs (NSAIDs), muscle relaxants, and antigout medications;54
9.1.1;2.1.1 Paracetamol (acetaminophen);54
9.1.2;2.1.2 Acetylsalicylic acid;56
9.1.3;2.1.3 Pyrazolone compounds and phenylbutazone;59
9.1.4;2.1.4 Analgesic drug combination products and drugs used for osteoarthritis;60
9.1.5;2.1.5 Opioid agonists and antagonists and other centrally acting analgesics;61
9.1.6;2.1.6 Non-steroidal anti-inflammatory and antirheumatic drugs;68
9.1.7;2.1.7 Migraine therapy;73
9.1.8;2.1.8 Muscle relaxants and other analgesics;75
9.1.9;2.1.9 Antigout preparations;76
9.1.10;References;78
9.2;2.2 - Allergy and hyposensitization therapy;86
9.2.1;2.2.1 Antihistamines (H1-blocker);86
9.2.2;2.2.2 Hyposensitization therapy;88
9.2.3;2.2.3 C1-Esterase inhibitor deficiency;88
9.2.4;References;89
9.3;2.3 - Antiasthmatic and cough ­medication;92
9.3.1;2.3.1 Selective ß2-adrenergic agonists;93
9.3.2;2.3.2 Inhaled corticosteroids (ICSs);94
9.3.3;2.3.3 Theophylline;95
9.3.4;2.3.4 Leukotriene antagonists;96
9.3.5;2.3.5 Mast cell stabilizers (inhibitors);96
9.3.6;2.3.6 Anticholinergics;97
9.3.7;2.3.7 Omalizumab and roflumilast;97
9.3.8;2.3.8 Expectorants and mucolytic agents;97
9.3.9;2.3.9 Antitussives;98
9.3.10;2.3.10 Non-selective ß-adrenergic agonists;99
9.3.11;References;100
9.4;2.4 - Nausea and vomiting in pregnancy;102
9.4.1;2.4.1 Treatment options;103
9.4.2;2.4.2 Complementary treatment options;103
9.4.3;2.4.3 Pharmacological treatment options;105
9.4.4;2.4.4 Dopamine antagonists;108
9.4.5;2.4.5 Pyridoxine (vitamin B6);110
9.4.6;2.4.6 Vitamin B1;111
9.4.7;2.4.7 Serotonin antagonists;112
9.4.8;2.4.8 Glucocorticoids;113
9.4.9;2.4.9 Other antiemetics;113
9.4.10;Summary;114
9.4.11;References;114
9.5;2.5 - Gastro-intestinal medications, hypolipidemic agents and ­spasmolytics;120
9.5.1;2.5.1 Antacids;121
9.5.2;2.5.2 Sucralfate and pirenzepine;122
9.5.3;2.5.3 H2 receptor antagonists;122
9.5.4;2.5.4 Proton pump inhibitors;123
9.5.5;2.5.5 Bismuth salts;124
9.5.6;2.5.6 Helicobacter pylori therapy;124
9.5.7;2.5.7 Digestives and carminatives;125
9.5.8;2.5.8 Atropine and other anticholinergic spasmolytics;125
9.5.9;2.5.9 Cholinergics;126
9.5.10;2.5.10 Constipation during pregnancy;126
9.5.11;2.5.11 Antidiarrheal agents;129
9.5.12;2.5.12 Medications for inflammatory bowel disease;130
9.5.13;2.5.13 Chenodeoxycholic acid and ursodeoxycholic acid;131
9.5.14;2.5.14 Lipid lowering agents;132
9.5.15;2.5.15 Appetite suppressants, weight loss medications, and obesity;135
9.5.16;References;136
9.6;2.6 - Anti-infective Agents;142
9.6.1;2.6.1 Penicillins and ß-lactamase inhibitors;143
9.6.2;2.6.2 Cephalosporins;144
9.6.3;2.6.3 Carbapenems and monobactams;144
9.6.4;2.6.4 Erythromycin and other macrolides;145
9.6.5;2.6.5 Clindamycin and lincomycin;146
9.6.6;2.6.6 Tetracyclines;147
9.6.7;2.6.7 Sulfonamides and trimethoprim;148
9.6.8;2.6.8 Quinolones;149
9.6.9;2.6.9 Nitrofurans and drugs for urinary tract infections;150
9.6.10;2.6.10 Nitroimidazole antibiotics;152
9.6.11;2.6.11 Aminoglycosides;152
9.6.12;2.6.12 Glycopeptide and polypeptide antibiotics;153
9.6.13;2.6.13 Other antibiotics;154
9.6.14;2.6.14 Tuberculosis and pregnancy;156
9.6.15;2.6.15 Local antibiotics;159
9.6.16;2.6.16 Malaria prophylaxis and treatment in pregnancy;159
9.6.17;2.6.17 Azole antifungals;166
9.6.18;2.6.18 Amphotericin B;168
9.6.19;2.6.19 Echinocandins;168
9.6.20;2.6.20 Flucytosine;169
9.6.21;2.6.21 Griseofulvin;169
9.6.22;2.6.22 Terbinafine;170
9.6.23;2.6.23 Topical antifungal agents;170
9.6.24;2.6.24 Anthelmintics;171
9.6.25;2.6.25 Herpes medications;174
9.6.26;2.6.26 Antiviral drugs for hepatitis;175
9.6.27;2.6.27 Antiviral drugs for influenza;177
9.6.28;2.6.28 Antiretroviral agents;178
9.6.29;2.6.29 Overview of the antiretroviral medications;179
9.6.30;2.6.30 Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs);180
9.6.31;2.6.31 Non-nucleoside reverse transcriptase inhibitors (NNRTIs);182
9.6.32;2.6.32 Protease inhibitors (PIs);184
9.6.33;2.6.33 Entry inhibitors;187
9.6.34;2.6.34 Integrase inhibitors;188
9.6.35;2.6.35 Hyperthermia;189
9.6.36;2.6.36 Long-distance travel and flights;189
9.6.37;References;190
9.7;2.7 - Vaccines and immunoglobulins;204
9.7.1;2.7.1 Thiomersal as a preservative for vaccines;205
9.7.2;2.7.2 Cholera vaccination;206
9.7.3;2.7.3 Diphtheria and tetanus vaccination;206
9.7.4;2.7.4 Haemophilus influenza B (HIB) vaccination;207
9.7.5;2.7.5 Hepatitis A and hepatitis B vaccination;207
9.7.6;2.7.6 HPV vaccination;207
9.7.7;2.7.7 Influenza vaccination;208
9.7.8;2.7.8 Measles and mumps vaccination;210
9.7.9;2.7.9 Meningococcal vaccination;210
9.7.10;2.7.10 Pertussis vaccination;211
9.7.11;2.7.11 Pneumococcal vaccination;211
9.7.12;2.7.12 Poliomyelitis vaccination;211
9.7.13;2.7.13 Rabies vaccination;212
9.7.14;2.7.14 Rubella vaccination;212
9.7.15;2.7.15 Tick-borne encephalitis vaccination;213
9.7.16;2.7.16 Typhoid vaccination;213
9.7.17;2.7.17 Varicella vaccination;214
9.7.18;2.7.18 Yellow fever vaccination;214
9.7.19;2.7.19 Immunoglobulins;215
9.7.20;References;216
9.8;2.8 - Heart and blood medications;220
9.8.1;2.8.1 Arterial hypertension and pregnancy;221
9.8.2;2.8.2 a-Methyldopa;222
9.8.3;2.8.3 ß-Receptor blockers;223
9.8.4;2.8.4 Calcium channel blockers;225
9.8.5;2.8.5 ACE inhibitors;226
9.8.6;2.8.6 Angiotensin II receptor blockers (ARBs; Sartans);227
9.8.7;2.8.7 Dihydralazine;229
9.8.8;2.8.8 a-1 Blockers (peripherally acting adrenergic antagonists);229
9.8.9;2.8.9 a-2 Blockers (centrally acting adrenergic antagonists);230
9.8.10;2.8.10 Other antihypertensive medications;231
9.8.11;2.8.11 Pulmonary hypertension and pregnancy;232
9.8.12;2.8.12 Hypotension and antihypotensive drugs;234
9.8.13;2.8.13 Adrenergic agents;235
9.8.14;2.8.14 Cardiac glycosides;235
9.8.15;2.8.15 Antiarrhythmic medications;235
9.8.16;2.8.16 Coronary therapeutic drugs (cardiac vasodilators);240
9.8.17;2.8.17 Vasocirculatory drugs and peripheral vasodilators;241
9.8.18;2.8.18 Diuretics;242
9.8.19;References;244
9.9;2.9 - Anticoagulants, thrombocyte aggregation inhibitors, fibrinolytics and volume replacement agents;252
9.9.1;2.9.1 Indications for anticoagulation;253
9.9.2;2.9.2 Heparins and danaparoid;254
9.9.3;2.9.3 Protamines;256
9.9.4;2.9.5 Factor Xa inhibitors;258
9.9.5;2.9.6 Inhibitors of thrombocyte aggregation;258
9.9.6;2.9.7 Vitamin K antagonists;260
9.9.7;2.9.8 Vitamin K;264
9.9.8;2.9.9 Fibrinolysis;265
9.9.9;2.9.10 Streptokinase;266
9.9.10;2.9.11 Antihemorrhagics;266
9.9.11;2.9.12 Other antihemorrhagics;267
9.9.12;2.9.13 Volume replacement substances and rheologics;268
9.9.13;References;269
9.10;2.10 - Epilepsy and antiepileptic medications;278
9.10.1;2.10.1 Antiepileptic therapy;279
9.10.2;2.10.2 Antiepileptic and contraceptive drugs;280
9.10.3;2.10.3 Epilepsy and fertility;280
9.10.4;2.10.4 Frequency of seizures in pregnancy;281
9.10.5;2.10.5 Risk of malformations;281
9.10.6;2.10.6 Typical malformations and other anomalies;283
9.10.7;2.10.7 Pregnancy complications;283
9.10.8;2.10.8 Mental development dysfunction;284
9.10.9;2.10.9 “Damage mechanisms”;285
9.10.10;2.10.10 Folic acid and antiepileptic drugs;286
9.10.11;2.10.11 Vitamin K and antiepileptic drugs;286
9.10.12;2.10.12 Is epilepsy teratogenic?;287
9.10.13;2.10.13 Carbamazepine;287
9.10.14;2.10.14 Clobazam and clonazepam;290
9.10.15;2.10.15 Eslicarbazepine;291
9.10.16;2.10.16 Ethosuximide and other succinimides;291
9.10.17;2.10.17 Felbamate;292
9.10.18;2.10.18 Gabapentin;292
9.10.19;2.10.19 Lacosamide;293
9.10.20;2.10.20 Lamotrigine;294
9.10.21;2.10.21 Levetiracetam;295
9.10.22;2.10.22 Oxcarbazepine;296
9.10.23;2.10.23 Phenobarbital and primidone;297
9.10.24;2.10.24 Phenytoin;300
9.10.25;2.10.25 Pregabalin;301
9.10.26;2.10.26 Rufinamide;302
9.10.27;2.10.27 Sultiame;302
9.10.28;2.10.28 Tiagabine;302
9.10.29;2.10.29 Topiramate;303
9.10.30;2.10.30 Valnoctamide;304
9.10.31;2.10.31 Valproic acid;305
9.10.32;2.10.32 Vigabatrin;309
9.10.33;2.10.33 Zonisamide;310
9.10.34;References;311
9.11;2.11 - Psychotropic drugs;320
9.11.1;2.11.1 Psychiatric disorder during pregnancy;321
9.11.2;2.11.2 Antidepressant treatment;321
9.11.3;2.11.3 Selective serotonin-reuptake-inhibitors (SSRI);322
9.11.4;2.11.4 Tri- and tetracyclic antidepressants;329
9.11.5;2.11.5 Individual antidepressants;330
9.11.6;2.11.6 Antipsychotic treatment;340
9.11.7;2.11.7 Individual antipsychotic drugs;343
9.11.8;2.11.8 Lithium and other anti-manic agents;349
9.11.9;2.11.9 Anxiolytics, hypnotics, sedatives in general;351
9.11.10;2.11.10 Benzodiazepines;352
9.11.11;2.11.11 Zaleplon, zolpidem and zopiclone;354
9.11.12;2.11.12 Other anxiolytics and hypnotics;355
9.11.13;2.11.13 Psychoanaleptics;355
9.11.14;2.11.14 Anti-Parkinson drugs and restless legs syndrome;356
9.11.15;References;357
9.12;2.12 - Immunosuppression, rheumatic diseases, multiple ­sclerosis, and Wilson’s disease;368
9.12.1;2.12.1 Azathioprine/6-mercaptopurine;368
9.12.2;2.12.2 Selective immunosuppressants;369
9.12.3;2.12.3 Biologics;372
9.12.4;2.12.4 Multiple sclerosis;379
9.12.5;2.12.5 Interferons;381
9.12.6;2.12.6 Other immunostimulatory drugs;383
9.12.7;2.12.7 Transplantation;385
9.12.8;2.12.8 Drugs for rheumatic diseases;385
9.12.9;2.12.9 Drugs for Wilson’s disease;390
9.12.10;References;392
9.13;2.13 - Antineoplastic drugs;400
9.13.1;2.13.1 Malignancy and pregnancy;401
9.13.2;2.13.2 Breast cancer;403
9.13.3;2.13.3 Vinca alkaloids and analogs;404
9.13.4;2.13.4 Podophyllotoxin derivatives;404
9.13.5;2.13.5 Nitrosourea alkylators;405
9.13.6;2.13.6 Nitrogen mustard analog alkylators;405
9.13.7;2.13.7 Other alkylating agents;406
9.13.8;2.13.8 Cytotoxic anthracycline antibiotics;407
9.13.9;2.13.9 Other cytotoxic antibiotics;408
9.13.10;2.13.10 Folate antagonists;409
9.13.11;2.13.11 Purine antagonists;410
9.13.12;2.13.12 Pyrimidine antagonists;410
9.13.13;2.13.13 Taxanes and other cytostatic agents;412
9.13.14;2.13.14 Monoclonal antibodies;412
9.13.15;2.13.15 Platin compounds;413
9.13.16;2.13.16 Thalidomide and its analogs;414
9.13.17;2.13.17 Tyrosine kinase inhibitors;415
9.13.18;2.13.18 Antineoplastic drugs with endocrine effects;416
9.13.19;2.13.19 Other antineoplastic agents;417
9.13.20;References;419
9.14;2.14 - Uterine contraction agents, tocolytics, vaginal therapeutics and local contraceptives;428
9.14.1;2.14.1 Prostaglandins;428
9.14.2;2.14.2 Oxytocin;430
9.14.3;2.14.3 Ergot alkaloids;431
9.14.4;2.14.4 Tocolytics in general;432
9.14.5;2.14.5 ß2-Sympathomimetics;433
9.14.6;2.14.6 Calcium antagonists;434
9.14.7;2.14.7 Magnesium sulfate;434
9.14.8;2.14.8 Oxytocin receptor antagonists;435
9.14.9;2.14.9 Prostaglandin antagonists;435
9.14.10;2.14.10 Other tocolytics;436
9.14.11;2.14.11 Vaginal therapeutics;436
9.14.12;2.14.12 Spermicide contraceptives;437
9.14.13;2.14.13 Intrauterine devices;437
9.14.14;References;438
9.15;2.15 - Hormones;440
9.15.1;2.15.1 Hypothalamic releasing hormones;441
9.15.2;2.15.2 Anterior pituitary hormones;442
9.15.3;2.15.3 Prolactin antagonists/dopamine agonists;443
9.15.4;2.15.4 Posterior pituitary hormones;444
9.15.5;2.15.5 Thyroid function and iodine supply during pregnancy;444
9.15.6;2.15.6 Hypothyroidism, triiodothyronine (T3) and thyroxin (T4);445
9.15.7;2.15.7 Hyperthyroidism and thyrostatics;446
9.15.8;2.15.8 Glucocorticoids;450
9.15.9;2.15.9 Diabetes mellitus and pregnancy;453
9.15.10;2.15.10 Insulin;455
9.15.11;2.15.11 Oral antidiabetics (OAD);457
9.15.12;2.15.12 Estrogens;461
9.15.13;2.15.13 Gestagens;462
9.15.14;2.15.14 Duogynon®;464
9.15.15;2.15.15 Diethylstilbestrol;464
9.15.16;2.15.16 Androgens and anabolics;465
9.15.17;2.15.17 Cyproterone and danazol;466
9.15.18;2.15.18 Mifepristone (RU486);467
9.15.19;2.15.19 Clomiphene;467
9.15.20;2.15.20 Erythropoietin;468
9.15.21;References;469
9.16;2.16 - General and local anesthetics and muscle relaxants;478
9.16.1;2.16.1 Halogenated inhalational anesthetic agents;479
9.16.2;2.16.2 Ether (diethyl ether);481
9.16.3;2.16.3 Nitrous oxide;481
9.16.4;2.16.4 Xenon;481
9.16.5;2.16.5 Occupational exposure to anesthetic gases;481
9.16.6;2.16.6 Injection anesthetics;482
9.16.7;2.16.7 Local anesthetics;484
9.16.8;2.16.8 Muscle relaxants;487
9.16.9;References;489
9.17;2.17 - Dermatological medications and local therapeutics;494
9.17.1;2.17.1 Typical skin changes during pregnancy;495
9.17.2;2.17.2 Antiseptics and disinfectants;495
9.17.3;2.17.3 Glucocorticoids and non-steroid antiphlogistics;498
9.17.4;2.17.4 Astringents;498
9.17.5;2.17.5 Antipruritics and essential oils;499
9.17.6;2.17.6 Coal tar and slate oil preparations;499
9.17.7;2.17.7 Local immunomodulators as therapy for atopic eczema;500
9.17.8;2.17.8 Keratolytics;500
9.17.9;2.17.9 Retinoids for acne and psoriasis therapy;502
9.17.10;2.17.10 Ultraviolet light;506
9.17.11;2.17.11 Fumaric acid preparations;506
9.17.12;2.17.12 Biologicals;507
9.17.13;2.17.13 Wart therapeutics;507
9.17.14;2.17.14 Lithium;508
9.17.15;2.17.15 Lice medications;508
9.17.16;2.17.16 Anti-scabies;509
9.17.17;2.17.17 Vein therapeutics;510
9.17.18;2.17.18 Antihidrotica;510
9.17.19;2.17.19 Eflornithine, finasteride and minoxidil;511
9.17.20;2.17.20 Repellents;512
9.17.21;2.17.21 Cosmetics;512
9.17.22;2.17.22 Eye, nose and ear drops;513
9.17.23;2.17.23 Hemorrhoid medications;515
9.17.24;2.17.24 Vaginal therapeutics;515
9.17.25;References;515
9.18;2.18 - Vitamins, minerals and trace elements;520
9.18.1;2.18.1 Vitamin A (retinol);521
9.18.2;2.18.2 Vitamin B1 (thiamine);523
9.18.3;2.18.3 Vitamin B2 (riboflavin);523
9.18.4;2.18.4 Vitamin B3 (nicotinamide);524
9.18.5;2.18.5 Vitamin B6 (pyridoxine);524
9.18.6;2.18.6 Vitamin B12 (cyanocobalamin);524
9.18.7;2.18.7 Vitamin C (ascorbic acid);525
9.18.8;2.18.8 Folic acid;525
9.18.9;2.18.9 Vitamin D group;528
9.18.10;2.18.10 Vitamin E (tocopherol);529
9.18.11;2.18.11 Vitamin K;530
9.18.12;2.18.12 Multivitamin preparations;530
9.18.13;2.18.13 Iron;530
9.18.14;2.18.14 Calcium;531
9.18.15;2.18.15 Fluoride;532
9.18.16;2.18.16 Strontium;533
9.18.17;2.18.17 Biphosphonates and other osteoporosis drugs;533
9.18.18;2.18.18 Iodide;534
9.18.19;2.18.19 Trace elements;534
9.18.20;References;534
9.19;2.19 - Herbs during pregnancy;538
9.19.1;2.19.1 The safety of herbs during pregnancy;538
9.19.2;2.19.2 Counseling a pregnant woman about herbs;539
9.19.3;2.19.3 General concepts regarding the use of herbs during pregnancy;540
9.19.4;2.19.4 Herbs used as foods;541
9.19.5;2.19.5 Essential oils that are safe during pregnancy;541
9.19.6;2.19.6 Herbs frequently used during pregnancy;541
9.19.7;2.19.7 Herbs controversially used during pregnancy;542
9.19.8;2.19.8 Herbs contraindicated during pregnancy;547
9.19.9;References;550
9.20;2.20 - Diagnostic agents;554
9.20.1;2.20.1 Diagnostic imaging;554
9.20.2;2.20.2 Contrast media;558
9.20.3;2.20.3 Radioactive isotopes;561
9.20.4;2.20.4 Stable isotopes;563
9.20.5;2.20.5 Dyes;564
9.20.6;2.20.6 Other diagnostic agents;565
9.20.7;References;565
9.21;2.21 - Recreational drugs;568
9.21.1;Introduction;568
9.21.2;2.21.1 Alcohol;569
9.21.3;2.21.2 Caffeine and other xanthines;574
9.21.4;2.21.3 Tobacco and smoking;576
9.21.5;2.21.4 Drugs of abuse in general (excluding caffeine);582
9.21.6;2.21.5 Sedating drugs;589
9.21.7;References;592
9.22;2.22 - Poisonings and toxins;602
9.22.1;2.22.1 The general risk of poisoning in pregnancy;602
9.22.2;2.22.2 Treatment of poisoning in pregnancy;603
9.22.3;2.22.3 Medicines;609
9.22.4;2.22.4 Animal toxins;617
9.22.5;2.22.5 Mushrooms;619
9.22.6;2.22.6 Other plant toxins;619
9.22.7;2.22.7 Bacterial endotoxins;619
9.22.8;References;620
9.23;2.23 - Occupational, industrial and environmental agents;626
9.23.1;2.23.1 Solvent exposure in general;628
9.23.2;2.23.2 Formaldehyde and formalin;634
9.23.3;2.23.3 Photographic/printing chemicals;634
9.23.4;2.23.4 Pesticides;635
9.23.5;2.23.5 Phenoxyacetic acid derivatives and polychlorinated dibenzo-dioxins;639
9.23.6;2.23.6 Polychlorinated biphenyls;641
9.23.7;2.23.7 Chlorinated drinking water by-products;641
9.23.8;2.23.8 Metals;643
9.23.9;2.23.9 Hazardous waste landfill sites and waste incinerators;649
9.23.10;2.23.10 Radiation associated with the nuclear industry;650
9.23.11;2.23.11 Cell/mobile phones;652
9.23.12;2.23.12 Other sources of electromagnetic radiation;652
9.23.13;2.23.13 Electric shocks and lightning strikes;654
9.23.14;References;655
9.24;3 - General commentary on drug therapy and drug risk during lactation;666
9.24.1;3.1 The advantages of breastfeeding versus the risks of maternal medication;666
9.24.2;3.2 The passage of medications into the mother’s milk;668
9.24.3;3.3 Infant characteristics;669
9.24.4;3.4 Milk plasma ratio;670
9.24.5;3.5 Amount of medication in the milk and relative dose;671
9.24.6;3.6 Toxicity of medications in the mother’s milk;672
9.24.7;3.7 Medications that affect lactation;674
9.24.8;3.8 Breastfeeding support;675
9.24.9;References;676
10;4 - Specific drug therapies during lactation;678
10.1;4.1 - Analgesics, antiphlogistics and anesthetics;680
10.1.1;4.1.1 Paracetamol;680
10.1.2;4.1.2 Acetylsalisylic acid;681
10.1.3;4.1.3 Pyrazolone and phenylbutazone derivatives;682
10.1.4;4.1.4 Non-steroidal anti-inflammatory drugs (NSAID);682
10.1.5;4.1.5 Selective COX-2 inhibitors;684
10.1.6;4.1.6 Other antirheumatics;685
10.1.7;4.1.7 Migraine medications;686
10.1.8;4.1.8 Opioids and opioid derivatives;687
10.1.9;4.1.9 Local anesthetics;691
10.1.10;4.1.10 Other medications used in connection with anesthesia;692
10.1.11;4.1.11 Myotonolytics and other analgesics;693
10.1.12;4.1.12 Gout therapy;693
10.1.13;References;694
10.2;4.2 - Antiallergics, antiasthmatics and antitussives;698
10.2.1;4.2.1 Antihistamines (H1-blocker);698
10.2.2;4.2.2 Selective effective ß2-sympathomimetics;699
10.2.3;4.2.3 Inhalable corticosteroids (ICS);700
10.2.4;4.2.4 Leukotrien-receptor antagonists;700
10.2.5;4.2.5 Theophylline;701
10.2.6;4.2.6 Mast cell inhibitors;701
10.2.7;4.2.7 Anticholinergics for asthma treatment;701
10.2.8;4.2.8 Omalizumab;702
10.2.9;4.2.9 Mucolytics, expectorants and cold remedies;702
10.2.10;4.2.10 Antitussives;702
10.2.11;References;703
10.3;4.3 - Gastrointestinal drugs;704
10.3.1;4.3.1 Gastritis and ulcer medications;704
10.3.2;4.3.2 Peristaltic stimulators;706
10.3.3;4.3.3 Cholinergics;707
10.3.4;4.3.4 Anticholinergic spasmolytics;708
10.3.5;4.3.5 Laxatives;708
10.3.6;4.3.6 Agents used for chronic inflammatory bowel diseases;709
10.3.7;4.3.7 Antidiarrheals for acute diarrhea;710
10.3.8;4.3.8 Digestives and carminatives;710
10.3.9;4.3.9 Lipid reducers;710
10.3.10;4.3.10 Chenodeoxycholic acid and ursodeoxycholic acid;711
10.3.11;4.3.11 Appetite suppressants;711
10.3.12;4.3.12 Antiemetics;711
10.3.13;References;712
10.4;4.4 - Anti-infectives;714
10.4.1;4.4.1 Penicillins, cephalosporins and other ß-lactam antibiotics;715
10.4.2;4.4.2 Erythromycin and other macrolides;715
10.4.3;4.4.3 Tetracyclines;716
10.4.4;4.4.4 Sulfonamides and trimethoprim;716
10.4.5;4.4.5 Quinolones;717
10.4.6;4.4.6 Nitrofurans and drugs for urinary tract infections;717
10.4.7;4.4.7 Nitroimidazole antibiotics;718
10.4.8;4.4.8 Aminoglycosides;719
10.4.9;4.4.9 Glycopeptide and polypeptide antibiotics;719
10.4.10;4.4.10 Other antibiotics;719
10.4.11;4.4.11 Tuberculostatics;720
10.4.12;4.4.12 Local antibiotics;721
10.4.13;4.4.13 Antimalarial medication;722
10.4.14;4.4.14 Systemic antifungal agents;723
10.4.15;4.4.15 Topical antifungal agents;723
10.4.16;4.4.16 Anthelmintics;724
10.4.17;4.4.17 Antiviral agents;724
10.4.18;References;727
10.5;4.5 - Vaccines and immunoglobulins;732
10.5.1;4.5.1 Maternal immunization;732
10.5.2;4.5.2 Efficacy of immunization in breastfed infants;733
10.5.3;4.5.3 Hepatitis A vaccine;733
10.5.4;4.5.4 Hepatitis B vaccine;733
10.5.5;4.5.5 Human papillomavirus vaccine;734
10.5.6;4.5.6 Influenza vaccine;734
10.5.7;4.5.7 Polio vaccine;734
10.5.8;4.5.8 Rabies vaccine;735
10.5.9;4.5.9 Rubella vaccine;735
10.5.10;4.5.10 Smallpox vaccine;735
10.5.11;4.5.11 Typhoid vaccine;735
10.5.12;4.5.12 Immunoglobulins;736
10.5.13;4.5.13 CDC recommendations;736
10.5.14;References;737
10.6;4.6 - Cardiovascular drugs and ­diuretics;738
10.6.1;4.6.1 ß-Receptor blockers;738
10.6.2;4.6.2 Hydralazine;740
10.6.3;4.6.3 a-Methyldopa;740
10.6.4;4.6.4 Calcium antagonists;741
10.6.5;4.6.5 ACE inhibitors;742
10.6.6;4.6.6 Angiotensin-II receptor-antagonists (sartan);742
10.6.7;4.6.7 Other antihypertensives;743
10.6.8;4.6.8 Antihypotensives;744
10.6.9;4.6.9 Digitalis;744
10.6.10;4.6.10 Antiarrhythmics;744
10.6.11;4.6.11 Vasodilators and circulatory drugs;746
10.6.12;4.6.12 Diuretics;747
10.6.13;References;748
10.7;4.7 - Anticoagulants, thrombocyte aggregation inhibitors and fibrinolytics;752
10.7.1;4.7.1 Heparin and danaparoid;752
10.7.2;4.7.2 Thrombin- and factor Xa-inhibitors;753
10.7.3;4.7.3 Thrombocyte aggregation inhibitors;753
10.7.4;4.7.4 Vitamin K-antagonists;754
10.7.5;4.7.5 Fibrinolytics;755
10.7.6;4.7.6 Antihemorrhagics;755
10.7.7;4.7.7 Volume expanders;755
10.7.8;References;756
10.8;4.8 - Antiepileptics;758
10.8.1;4.8.1 Introduction;758
10.8.2;4.8.2 Individual antiepileptics;759
10.8.3;References;766
10.9;4.9 - Psychotropic drugs;770
10.9.1;4.9.1 Introduction;770
10.9.2;4.9.2 Antidepressants;770
10.9.3;4.9.3 Individual antidepressants;772
10.9.4;4.9.4 Antipsychotic;782
10.9.5;4.9.5 Individual antipsychotic drugs;783
10.9.6;4.9.6 Lithium and other antimanic drugs;789
10.9.7;4.9.7 Anxiolytics, hypnotics and sedatives;791
10.9.8;4.9.8 Benzodiazepines;791
10.9.9;4.9.9 Zaleplon, zolpidem and zopiclone;794
10.9.10;4.9.10 Other anxiolytics, hypnotics and sedatives;794
10.9.11;4.9.11 Psychoanaleptics;795
10.9.12;4.9.12 Anti-Parkinson drugs;796
10.9.13;References;796
10.10;4.10 - Immunomodulating and antineoplastic agents;802
10.10.1;4.10.1 Azathioprine and 6-mercaptopurine;802
10.10.2;4.10.2 Selective immune suppressants;803
10.10.3;4.10.3 Monoclonal antibodies (mAb) and other biologicals;804
10.10.4;4.10.4 Interferons;805
10.10.5;4.10.5 Other immune stimulants;806
10.10.6;4.10.6 Antineoplastics;806
10.10.7;References;807
10.11;4.11 - Hormones and hormone antagonists;810
10.11.1;4.11.1 Pituitary and hypothalamic hormones;810
10.11.2;4.11.2 Methylergometrine (methylergonovine);811
10.11.3;4.11.3 Bromocriptine and other prolactin inhibitors;812
10.11.4;4.11.4 Thyroid hormones and thyroid receptor antibodies (TRAb);812
10.11.5;4.11.5 Thyrostatics;813
10.11.6;4.11.6 Iodine;814
10.11.7;4.11.7 Corticosteroids;815
10.11.8;4.11.8 Adrenaline;816
10.11.9;4.11.9 Insulin and oral antidiabetics;816
10.11.10;4.11.10 Estrogens, gestagens, and hormonal contraceptives;817
10.11.11;4.11.11 Androgens and anabolics;819
10.11.12;4.11.12 Cyproterone acetate and other sex-hormone inhibitors;819
10.11.13;4.11.13 Prostaglandins;820
10.11.14;References;820
10.12;4.12 - Dermatological medication and local therapeutics;824
10.12.1;4.12.1 Topical applications and cosmetics;824
10.12.2;4.12.2 Essential oils;825
10.12.3;4.12.3 Retinoids and topicals for psoriasis, dermatitis and acne;825
10.12.4;4.12.4 Photochemotherapy and fumaric acid preparations;826
10.12.5;4.12.5 Wart removal medications;826
10.12.6;4.12.6 Medications for lice and scabies;826
10.12.7;4.12.7 Eye, nose and ear drops;827
10.12.8;4.12.8 Vein therapeutics and other local therapeutics;828
10.12.9;4.12.9 Vaginal therapeutics;828
10.12.10;References;829
10.13;4.13 - Alternative remedies, vitamins, and minerals;830
10.13.1;4.13.1 Alternative remedies and phytotherapeutics;830
10.13.2;4.13.2 Herbal galactogogues and antigalactogogues;832
10.13.3;4.13.3 Topical treatment for breast problems;834
10.13.4;4.13.4 Vitamins, minerals, and trace elements;835
10.13.5;4.13.5 Biphosphonates;835
10.13.6;4.13.6 Exercise;836
10.13.7;4.13.7 Glucose 6-phosphate-dehydrogenase deficiency;836
10.13.8;References;837
10.14;4.14 - Contrast media, radionuclides and diagnostics;840
10.14.1;4.14.1 X-ray studies, ultrasound, and magnetic resonance imaging;840
10.14.2;4.14.2 Iodine-containing contrast media;840
10.14.3;4.14.3 Magnetic resonance contrast agents;842
10.14.4;4.14.4 Ultrasound contrast media;843
10.14.5;4.14.5 Radionuclides;843
10.14.6;4.14.6 Dyes;844
10.14.7;4.14.7 Other diagnostics;845
10.14.8;References;845
10.15;4.15 - Infections during breastfeeding;848
10.15.1;4.15.1 Common infections;849
10.15.2;4.15.2 Cytomegaly;849
10.15.3;4.15.3 Dengue virus;850
10.15.4;4.15.4 Hepatitis A;850
10.15.5;4.15.5 Hepatitis B;851
10.15.6;4.15.6 Hepatitis C;851
10.15.7;4.15.7 Hepatitis E;851
10.15.8;4.15.8 Herpes simplex;852
10.15.9;4.15.9 Herpes zoster (shingles), chicken pox (varicella);852
10.15.10;4.15.10 HIV infection;853
10.15.11;4.15.11 Human T-lymphotropic virus (HTLV);854
10.15.12;4.15.12 Influenza;854
10.15.13;4.15.13 Lyme disease;855
10.15.14;4.15.14 Methicillin-resistant Staphylococcus aureus (MRSA);855
10.15.15;4.15.15 Rotavirus;855
10.15.16;4.15.16 Tuberculosis;856
10.15.17;4.15.17 West Nile virus;857
10.15.18;4.15.18 Other infectious diseases;857
10.15.19;References;857
10.16;4.16 - Recreational drugs;862
10.16.1;4.16.1 Alcohol;862
10.16.2;4.16.2 Amphetamines;863
10.16.3;4.16.3 Caffeine;863
10.16.4;4.16.4 Cannabis;864
10.16.5;4.16.5 Cocaine;864
10.16.6;4.16.6 Nicotine;865
10.16.7;4.16.7 Opiates, including methadone;866
10.16.8;4.16.8 Other drugs;868
10.16.9;References;868
10.17;4.17 - Plant toxins;872
10.17.1;References
;872
10.18;4.18 - Industrial chemicals and environmental contaminants;874
10.18.1;4.18.1 Persistent organochlorine compounds (pesticides, polychlorinated biphenyls and dioxins);874
10.18.2;4.18.2 Mercury;878
10.18.3;4.18.3 Lead;880
10.18.4;4.18.4 Cadmium;882
10.18.5;4.18.5 Other contaminants;882
10.18.6;4.18.6 Breastfeeding despite environmental contaminants?;884
10.18.7;4.18.7 Breastfeeding and the workplace;885
10.18.8;References;886
11;Index;890

Leseproben

1 General commentary on drug therapy and drug risks in pregnancy
Paul Peters, Richard K. Miller,  and Christof Schaefer Abstract
This introduction describes the fundamentals necessary to interpret therapeutic and other exposures during pregnancy that may adversely affect mother, embryo and baby. Of note is the discussion of the science involved with Reproductive and Developmental Pharmacology/Toxicology and its use in developing risk assessments for women who desire to become pregnant or are pregnant. Specific examples are presented from a historical perspective, which continue to have application today in counseling patients. Risk Communication is discussed focusing on women who are pregnant. Teratogen information services around the world are discussed as additional opportunities for assisting with specific risk assessments taking into account not only the therapy but also the disease process so associated. Pregnancy Registries are also presented as an opportunity to participate in developing new information concerning specific therapeutic exposures during pregnancy. Keywords
Dysmorphology; birth defect; risk communication; epidemiology; teratogen information services; ENTIS; OTIS; mothertobaby; pregnancy registries; thalidomide; teratology 1.1 Introduction 1 1.2 Development and health 2 1.3 Reproductive stages 3 1.4 Reproductive and developmental toxicology 4 1.5 Basic principles of drug-induced reproductive and developmental toxicology 8 1.6 Effects and manifestations 10 1.7 Pharmacokinetics of drugs in pregnancy 11 1.8 Mechanisms of developmental toxic agents 13 1.9 Causes of developmental disorders 14 1.10 Embryo/fetotoxic risk assessment and plausibility 15 1.11 Classification of drugs used in pregnancy 17 1.12 Paternal use of medicinal products 18 1.13 Communicating the risk of drug use in pregnancy 19 1.14 Risk communication prior to pharmacotherapeutic choice 20 1.15 Risk communication regarding the safety of drugs already used in pregnancy 21 1.16 Teratology information centers 21 1.1. Introduction
Most prescribers and users of drugs are familiar with the precautions given concerning drug use during the first trimester of pregnancy. These warnings were introduced after the thalidomide disaster in the early 1960s. However, limiting the exercise of caution to the first 3 months of pregnancy is both shortsighted and effectively impossible – firstly, because chemicals can affect any stage of pre- or postnatal development; and secondly, because when a woman first learns that she is pregnant, the process of organogenesis has already long since begun (for example, the neural tube has closed). Hence, the unborn could already be inadvertently exposed to maternal drug treatment during the early embryonic period (Figure 1.1). This book is intended for practicing clinicians, who prescribe medicinal products, evaluate environmental or occupational exposures in women who are or may become pregnant. Understanding the risks of drug use in pregnancy has lagged behind the advances in other areas of pharmacotherapy. Epidemiologic difficulties in establishing causality and the ethical barriers to randomized clinical trials with pregnant women are the major reasons for our collective deficiencies. Nevertheless, since the recognition of prenatal vulnerability in the early 1960s, much has been accomplished to identify potential developmental toxicants such as medicinal products and to regulate human exposure to them. The adverse developmental effects of pharmaceutical products are now recognized to include not only malformations, but also growth restriction, fetal death and functional defects in the newborn.
Figure 1 Timetable of early human development. The evaluation of human case reports and epidemiological investigations provide the primary sources of information. However, for many drugs and certainly new drugs (even more so in the case of chemicals) experience with human exposure is scarce, and animal experiments, in vitro tests, or information on related congeners provide the only basis for risk assessment. Registration authorities in different continents have mandated that medications potentially used in pregnant women must now be followed via pregnancy registries. This book presents the current state of knowledge about the use of drugs during pregnancy. In each chapter, the information is presented separately for two different aspects of the problem: firstly, seeking a drug appropriate for prescription during pregnancy; and secondly, assessing the risk of a drug when exposure during pregnancy has already occurred. 1.2. Development and health
The care of pregnant women presents one of the paradoxes of modern medicine. Women usually require little medical intervention during a (uneventful) pregnancy. Conversely, those at high risk of damage to their own health, or that of their unborn, require the assistance of appropriate medical technology, including drugs. Accordingly, there are two classes of pregnant women; the larger group requires support but little intervention, while the other requires the full range of diagnostic and therapeutic measures applied in any other branch of medicine (Chamberlain 1991). Maternal illness demands treatment tolerated by the unborn. However, a normal pregnancy needs to avoid harmful drugs – both prescribed and over-the-counter, and drugs of abuse, including smoking and alcohol – as well as occupational and environmental exposure to potentially harmful chemicals. Obviously, sufficient and well-balanced nutrition is also essential. Currently, this set of positive preventive measures is by no means broadly guaranteed in either developing or industrial countries. When such primary preventive measures are neglected, complications of pregnancy and developmental disorders can result. Furthermore, nutritional deficiencies and toxic effects during prenatal life predispose the future adult to some diseases, such as schizophrenia (St Clair 2005), fertility disorders (Elias 2005), metabolic imbalances (Painter 2005), hypertension, non-insulin-dependent diabetes, and cardiovascular illnesses, as demonstrated by Barker (1998) and based upon epidemiological and experimental data. Studies of programming in fetal life are now on the agenda for medical research. 1.3. Reproductive stages
The different stages of reproduction are, in fact, highlights of a continuum. These stages concern a specific developmental time-span, each with its own sensitivity to a given toxic agent. ? Primordial germ cells are present in the embryo at about 1 month after the first day of the last menstruation. They originate from the yolksac-entoderm outside the embryo, and migrate into the undifferentiated primordia of gonads located at the medio-ventral surface of the urogenital ridges. They subsequently differentiate into oogonia and oocytes, or into spermatogonia. Toxic effects on primordial germ cells may cause infertility or mutagenic harm. ? Oocytes in postnatal life are at an arrested stage of the meiotic division. This division is reinitiated much later following birth, shortly before ovulation, and is finalized after fertilization with the expulsion of the polar bodies. Thus, all-female germ cells develop prenatally and no germ cells are formed after birth. Moreover, during a female lifespan approximately 400 oocytes undergo ovulation. All these facts make it possible to state that an 8-week pregnant mother of an unborn female is already prepared to be a grandmother! This implies that the oocytes are not only older than the female but also that they are being exposed to substances from prenatal time forward. As we have seen in Section 1.2, fetal programming during early stages of pregnancy might induce diseases in later adult life; such programming for toxicity might also be possibly focused upon oocytes. ? The embryonal spermatogenic epithelium, on the contrary, divides slowly by repeated mitoses, and these cells do not differentiate into spermatocytes and do not undergo meiosis in the prenatal period. Gonocytes exist in the neonatal testis and represent a transient population of male germ-line stem cells. It has been demonstrated that stem cell self-renewal and progeny production are probably controlled by the neighboring differentiated cells and extracellular matrix known as niches. The onset of meiosis in the male begins at puberty. Spermatogenesis continues throughout (reproductive) life. Even after chemotherapeutic treatment for example with anticancer drugs or radiation with destruction of spermatogonia, repopulation of the epithelium is possible with even a complete functional restitution. This is in contrast with oogonia after such chemotherapeutic treatment. When the complexity of sexual development and female and male gametogenesis is considered, it becomes apparent that pre- and postnatal drug exposures are special toxicological problems having different outcomes. The specificity of the male and female developmental processes also accounts for unique reactions to toxic agents, such as drugs, in both sexes. ? After fertilization of the oocyte by one of the spermatozoa in the oviduct, there is the stage of cell division and transport of the blastocyst into the...