首页> 外文期刊>Neurology: Official Journal of the American Academy of Neurology >Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency.
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Lamotrigine in pregnancy: clearance, therapeutic drug monitoring, and seizure frequency.

机译:拉莫三嗪在怀孕:间隙,治疗药物监测,发作频率。

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摘要

OBJECTIVE: To characterize the magnitude and course of alterations in total and free lamotrigine (LTG) clearance (Cl) during pregnancy and the postpartum period, to assess the impact of therapeutic drug monitoring (TDM) on seizure frequency, to determine the ratio to individual target LTG concentration that is associated with increased seizure risk, and to evaluate maternal postpartum toxicity. METHODS: A cohort of women were enrolled before conception or during pregnancy in this prospective, observational study. Visits occurred every 1 to 3 months with review of seizure and medication diaries, examination, and blood sampling. Total and free LTG Cls were calculated. Individualized target concentrations were used for TDM. The ratio to target concentration (RTC) was compared between patients with and without increased seizures. A receiver operating characteristic curve determined the threshold RTC that best predicts increased seizure frequency. RESULTS: Analysis of 305 samples in 53 pregnancies demonstrated increased total and free LTG Cl in all trimesters above nonpregnant baseline (p < 0.001), with peak increases of 94% and 89% in the third trimester. Free LTG Cl was higher in white compared with black women (p < 0.05). Increased seizure frequency (n = 36 women with epilepsy) in the second trimester was associated with a lower RTC (p < 0.001), and RTC < 0.65 was a significant predictor of seizure worsening. An empiric postpartum taper reduced the likelihood of maternal LTG toxicity (p < 0.05) (n = 27). Newborn outcomes were similar to the general population (n = 52). CONCLUSIONS: These novel data contribute to a rational treatment plan and dosing paradigm for lamotrigine use during pregnancy, parturition, and the postpartum period.
机译:目的:描述大小和的改变和自由拉莫三嗪(LTG)间隙(Cl)怀孕期间和产后阶段,评估的影响在癫痫的治疗药物监测(TDM)频率,来确定个体的比率目标LTG浓度相关联增加发作风险,评估孕产妇产后毒性。为在怀孕前或期间怀孕在这个前瞻性观察研究。癫痫和药物治疗日志评论,检查和血液样本。LTG Cls计算。用于TDM浓度。目标浓度(RTC)之间的比较并没有增加癫痫患者。接受者操作特性曲线确定阈值RTC,最好的预测发作频率增加。305个样本在53个怀孕了增加总在所有三学期制和自由LTG Cl妊娠超过基线(p < 0.001),峰值怀孕后期增加94%和89%。免费的LTG Cl在白色相比更高黑人女性(p < 0.05)。频率(n = 36女性癫痫)怀孕中期RTC较低有关(p < 0.001), RTC < 0.65显著预测癫痫发作恶化。产后锥度的可能性减少孕产妇LTG毒性(p < 0.05) (n = 27)。新生的结果类似于一般人口(n = 52)。有助于合理治疗方案和数据拉莫三嗪剂量范例中使用妊娠、分娩和产后时期。

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