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Maternal and Infant Pharmacokinetics of Psychotropic Medications During Pregnancy and Lactation

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Book cover Perinatal Psychopharmacology

Abstract

During the last decades, there is a trend for increased consumption of over-the-counter or prescribed medications by pregnant women. Although the use of psychotropic medications during pregnancy and lactation is likely, limited evidence regarding their safe use exists. In this chapter, we summarize the current available evidence on the pharmacokinetics of anxiolytics, antidepressants, antipsychotics, mood stabilizers, and opioids in the pregnant woman, the fetus, and the lactating infant. Dynamic changes in the female physiology during pregnancy affect several pharmacokinetic parameters of psychotropics and amplify the already present sex differences in drug absorption, distribution, metabolism, and elimination. Characteristics of psychotropic compounds that minimize the exposure of the fetus are higher protein binding, smaller distribution volume, shorter half-life, and, ideally, good affinity with efflux transporters. Regarding breastfeeding, drug levels in the infant of less than 10% of the maternal levels are considered safe, and many common psychotropics fall well below that limit. Therefore, breastfeeding should often be encouraged based on the available evidence. Importantly, interventions that reduce exposure of the infant should be chosen. Ideally, for drugs frequently used in pregnancy and lactation, better designed studies should be conducted, in order to assist clinicians and patients to take better-informed decisions.

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Authors and Affiliations

  1. Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Nikolaos Kokras, Marinos G. Sotiropoulos, Eleni Poulogiannopoulou & Christina Dalla

  2. First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Nikolaos Kokras

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  1. Nikolaos Kokras
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  2. Marinos G. Sotiropoulos
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  3. Eleni Poulogiannopoulou
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  4. Christina Dalla
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Correspondence to Christina Dalla .

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Editors and Affiliations

  1. Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

    Faruk Uguz

  2. Psychopharmacological, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hatfield, UK

    Laura Orsolini

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Kokras, N., Sotiropoulos, M.G., Poulogiannopoulou, E., Dalla, C. (2019). Maternal and Infant Pharmacokinetics of Psychotropic Medications During Pregnancy and Lactation. In: Uguz, F., Orsolini, L. (eds) Perinatal Psychopharmacology. Springer, Cham. https://doi.org/10.1007/978-3-319-92919-4_2

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  • DOI: https://doi.org/10.1007/978-3-319-92919-4_2

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