Anticonvulsants and pregnancy

• 25-30% of patients have an increase in seizures during pregnancy even with medications

  • there are changes in metabolism: Increased drug clearance and Increased volume

• Suggestions for use during pregnancy

  • folate supplements

  • dosage alterations—as low as possible during 1^st trimester and monotherapy if possible

  • get more frequent lab values

    • especially during 1^st trimester (toxicity) and 3^rd (make sure levels are therapeutic)

• Fetal hydantoin syndrome—due to phenytoin, carbamazepine, and valproic acid

  • cleft lip/palate

  • congenital heart disease

  • slowed growth and mental deficiencies

• BUT, if you don’t medicate

  • Increase frequency of seizures ==> anoxia

  • higher birth defects (77%)

• Malformations common in multiple drug tx

Category: Pharmacology Notes