期刊
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
卷 34, 期 2, 页码 244-255出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JCP.0000000000000087
关键词
pharmacokinetics; antidepressants; mood stabilizers; pregnancy
资金
- UMass Medical School [NIHUL1RR031982]
- NIH [NIMH 1K23MH097794]
- Worcester Foundation for Biomedical Research
- Forest Research Institute
- Massachusetts Department of Mental Health for the Massachusetts Child Psychiatry Access Program for Moms
- Meyers Primary Care Institute
- Rosalie Wolf Interdisciplinary Geriatric Healthcare Research Center Small Grants Initiative
- National Center for Research Resources
- National Center for Advancing Translational Sciences of the National Institutes of Health [KL2TR000160]
- GlaxoSmithKline
- Lilly
- Forest
Objective Pharmacotherapy for mood disorders during pregnancy is often complicated by pregnancy-related pharmacokinetic changes and the need for dose adjustments. The objectives of this review are to summarize the evidence for change in perinatal pharmacokinetics of commonly used pharmacotherapies for mood disorders, discuss the implications for clinical and therapeutic drug monitoring (TDM), and make clinical recommendations. Methods The English-language literature indexed on MEDLINE/PubMed was searched for original observational studies (controlled and uncontrolled, prospective and retrospective), case reports, and case series that evaluated or described pharmacokinetic changes or TDM during pregnancy or the postpartum period. Results Pregnancy-associated changes in absorption, distribution, metabolism, and elimination may result in lowered psychotropic drug levels and possible treatment effects, particularly in late pregnancy. Mechanisms include changes in both phase 1 hepatic cytochrome P450 and phase 2 uridine diphosphate glucuronosyltransferase enzyme activities, changes in hepatic and renal blood flow, and glomerular filtration rate. Therapeutic drug monitoring, in combination with clinical monitoring, is indicated for tricyclic antidepressants and mood stabilizers during the perinatal period. Conclusions Substantial pharmacokinetic changes can occur during pregnancy in a number of commonly used antidepressants and mood stabilizers. Dose increases may be indicated for antidepressants including citalopram, clomipramine, imipramine, fluoxetine, fluvoxamine, nortriptyline, paroxetine, and sertraline, especially late in pregnancy. Antenatal dose increases may also be needed for lithium, lamotrigine, and valproic acid because of perinatal changes in metabolism. Close clinical monitoring of perinatal mood disorders and TDM of tricyclic antidepressants and mood stabilizers are recommended.
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