Trabalhos

Available online at www.sciencedirect.com

Epilepsy & Behavior 11 (2007) 263–269 www.elsevier.com/locate/yebeh

Pharmacology of antiepileptic drugs during pregnancy and lactation
Page B. Pennell a,*, Barry E. Gidal b, Anne Sabers c, Jacki Gordon d, Emilio Perucca e, for the International AED Pharmacology Work Group for the Health Outcomes in Pregnancy and Epilepsy Forum a Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA School of Pharmacy and Department of Neurology, University of Wisconsin, Madison, WI, USA c The Epilepsy Clinic, Glostrup University Hospital, Glostrup, Denmark d Epilepsy Therapy Development Project, Reston, VA, USA Clinical Pharmacology Unit, University of Pavia, and Institute of Neurology IRCCS C Mondino Foundation, Pavia, Italy b

e

Received 22 August 2007; accepted 23 August 2007

Abstract Most women with epilepsy require continuous treatment during pregnancy, making antiepileptic drugs (AEDs) one of the most frequent chronic teratogen exposures. Therapeutic decisions should balance the risks to the developing fetus of AED exposure and of not treating or undertreating the epilepsy. The International AED Pharmacology Work Group of the Health Outcomes in Pregnancy and Epilepsy (HOPE) Forum identified four pharmacology topics critical to enhancing maternal and fetal outcomes for pregnancies exposed to AEDs: (1) hormonal therapies and endogenous changes: bidirectional interactions with AEDs; (2) pharmacokinetic alterations during pregnancy, the role of therapeutic drug monitoring, and the influence on seizure control and maternal and fetal outcomes; (3) multidrug transporters and their various roles during pregnancy; (4) breastfeeding in mothers taking AEDs. The report provides an overview of these key topics, highlights gaps in the current knowledge, and provides future directions for needed research. Ó 2007 Elsevier Inc. All rights reserved.
Keywords: Epilepsy; Antiepileptic drugs; Pregnancy; Puerperium;