Page 1 of 1: Pharmacology:Safest antiepileptic drug in pregnancy

Akil · Credits: 28114 My Scrapbook

The safest antiepileptic drug in pregnancy is....

Diazepam
Phenytoin
Carbamazepine
Valproate

carbamazepine?

drsmita_s · Credits: 18649 My Scrapbook

you are right, of the options given, answer should be carbamazepine. i read harri and kdt. diazepam and phenytoin are definitely not given during pregnancy. kdt says, valproate should be substituted in case of pregnancy. so, this leaves us with carbamazepine. if phenobarbitone was one of the choices given, it would have been the best answer.

Akil · Credits: 28114 My Scrapbook

Harri's reference is based on the most recent consensus that there are NOT safest antiepileptic in pregnancy...

Lamotrigine is a new drug which has proportionately least major malformation of the common AEDs.

The article I found interesting now after your answer about phenobarbital was:

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Reported major malformation rates vary among phenobarbital (PB), 4.7% to 6.5%; phenytoin (PHT), 0.7 to 9.1%; CBZ, 2.3% to 5.7%; and lamotrigine (LTG), 2.0% to 2.9%.

At the same time another article at:
BMJ 2006;333:615-616 (23 September), doi:10.1136/bmj.38961.437639.BE

Teratogenicity of antiepileptic drugs

says: Carbamezine has the lowest incidence of major malformation (2.9% for monotherapy)

But considering that lamotrigine is relatively new and there is still long term studies lacking!

But the final verdict that all agree is monotherapy with lowest dose that controls an epileptic attack should be decided on case by case basis and a judicious choice must be made along with folic acid supplementation!

The question was from one of the old books and I think the question now is best considered obsolete... what do you feel?

Another aspect is that NICE guidelines, I think, suggests avoidance of carbamazepine and lamotrigine when a woman is known to be pregnant (risk of neural tube defects) and alternative drug like an antipsychotic should be considered.

I remember some book which I do not remember (curse my memory!) that carbamazepine is C/I in first trimester... perhaps katzung?. It was a table with a list of many drugs and their C/I in different trimesters. I did not see about phenobarbital.

Another thing I remember from katzung is that it says "phenobarbital was considered safest antiepileptic drug" but it is effective only in controlling seizures in infants.

I agree with the answer that of the choices given... carbamazepine is safest...

Perhaps, I am adding more to the confusion?

Akil · Credits: 28114 My Scrapbook

Akil · Credits: 28114 My Scrapbook

Some facts that I got here and there related to pregnancy and drug therapy is:

1. ACE inhibitors are C/I in 2nd and 3rd trimester.... so a woman may take it until she knows she is pregnant and then stop it as soon as pregnancy is confirmed!

2. Aspirin may be valuable in preeclampsia-eclampsia treatment!

Ref: Katzung

Akil · Credits: 28114 My Scrapbook

drjanak · Credits: 3151 My Scrapbook

Williams Obstetrics 22nd Ed Ch 14 - Teratology Etc
Valproic acid (Depakene) and carbamazepine (Tegretol) each carry approximately a 1 percent risk of NTDs and possibly other anomalies
Phenytoin (Dilantin) decreases folate absorption and lowers the serum folate, which has been implicated in birth defects. (Risk of anomalies of 5-11%). It causes the fetal hydantoin syndrome.
Phenobarbital causes Clefts, cardiac anomalies, urinary tract malformations and affects 10-20% cases.
Ch.55- Neurological & Psychiatric Disorders
Management - Preconceptional Counseling

For a number of reasons, women with epilepsy may benefit from preconceptional counseling (see Chap. 7, Epilepsy). This discussion should address the optimal anticonvulsant management, including a switch to the least teratogenic drug if possible or a reduction in the number of anticonvulsant types prescribed. Although some clinicians recommend that medications be limited if possible to the older, more traditional anticonvulsants, namely, phenytoin, carbamazepine, and phenobarbital, some newer drugs may actually have less teratogenic potential.

Gabbe Obstetrics- Normal & Problem Pregnancies 5th Ed
Most authorities agree that the benefits of anticonvulsant therapy during pregnancy outweigh the risks of discontinuation of the drug if the patient is first seen during pregnancy.The greater the number of anticonvulsants, the higher the risk of malformation

As per both the above references the least teratogenic is carbamazepine.

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