Document Detail

Pharmacokinetics of anticonvulsants in pregnancy: alterations in plasma protein binding.
MedLine Citation:
PMID:  2384078     Owner:  NLM     Status:  MEDLINE    
Anticonvulsant levels decline as pregnancy progresses, even in the face of constant and, in some cases, increased dosages of medications. It has been suggested that this decline is responsible for the increase in seizure frequency seen in approximately one-third of the women with epilepsy who become pregnant. Changes in plasma protein binding may explain the declines in anticonvulsant concentrations during pregnancy. A prospective cohort study was designed to test this hypothesis. Carbamazepine, phenytoin and phenobarbital were studied. The mean total concentrations of all 3 drugs declined as pregnancy progressed, rising in the postpartum period. Free concentrations also declined, but did so significantly only for phenobarbital. The free fraction for all anticonvulsants studied rose significantly throughout pregnancy. Protein binding is significantly altered during pregnancy for all 3 drugs studied and appears to account for much of the decline in anticonvulsant concentrations seen in this condition. It is suggested that free rather than total drug concentrations be monitored in pregnant women with epilepsy.
M S Yerby; P N Friel; K McCormick; M Koerner; M Van Allen; A M Leavitt; C J Sells; J A Yerby
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Epilepsy research     Volume:  5     ISSN:  0920-1211     ISO Abbreviation:  Epilepsy Res.     Publication Date:  1990 Apr 
Date Detail:
Created Date:  1990-09-20     Completed Date:  1990-09-20     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8703089     Medline TA:  Epilepsy Res     Country:  NETHERLANDS    
Other Details:
Languages:  eng     Pagination:  223-8     Citation Subset:  IM    
Epilepsy Research Center, Department of Neurology, University of Minnesota, Minneapolis 55414.
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MeSH Terms
Anticonvulsants / pharmacokinetics*,  therapeutic use
Blood Proteins / metabolism*
Carbamazepine / pharmacokinetics*,  therapeutic use
Epilepsy / blood,  drug therapy*
Maternal-Fetal Exchange*
Phenobarbital / pharmacokinetics*,  therapeutic use
Phenytoin / pharmacokinetics*,  therapeutic use
Pregnancy Complications / metabolism*
Grant Support
Reg. No./Substance:
0/Anticonvulsants; 0/Blood Proteins; 298-46-4/Carbamazepine; 50-06-6/Phenobarbital; 57-41-0/Phenytoin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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