Monitoring topiramate concentrations at delivery and during lactation - 16/04/21
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Abstract |
Objective |
To determine transplacental passage of topiramate and its transport to colostrum, mature maternal milk and breastfed infants, we examined data from 27 women treated with topiramate from 2004 to 2020.
Methods |
In this cohort study, maternal serum, umbilical cord serum, milk and infant serum levels were measured by gas chromatography in the delivery subgroup, the colostrum subgroup (3–4 days postpartum) and the mature milk subgroup (7–30 days postpartum). Paired umbilical cord serum, maternal serum, breastfed infant serum, and milk levels were used to assess the ratios of umbilical cord/maternal serum, milk/maternal serum and infant/maternal serum levels.
Results |
Topiramate levels varied from 1.0 to 7.1 mg/L in maternal serum and from 0.8 to 6.2 mg/L in umbilical cord serum, and the mean umbilical cord/maternal serum ratio was 0.93 ± 0.11. At 3–4 days after delivery, topiramate concentrations were 1.4–8.4 mg/L in maternal serum, 1.5–8.6 mg/L in milk and 0.3–4.4 mg/L in infant serum. The mean milk/maternal serum ratio was 0.99 ± 0.45, and the mean infant/maternal serum ratio was 0.25 ± 0.15. At 7–30 days after delivery, maternal serum levels varied from 1.9 to 9.7 mg/L, milk levels ranged from 2.3 to 10.6 mg/L and infant serum levels ranged from 0.3 to 6.5 mg/L. The mean milk/maternal serum ratio was 1.07 ± 0.31, and the mean infant/maternal serum ratio was 0.51 ± 0.27.
Conclusions |
We extended information about free transplacental passage of topiramate and its extensive transport to maternal milk with lower serum concentrations in breastfed infants in the largest group of patients ever reported to our knowledge.
Data availability statement |
Authors declare that take full responsibility for the data, the analyses and interpretation, and the conduct of the research; that they have full access to all of the data; and that they have the right to publish all data. Authors were not participations in industry-sponsored research and corporate activities for evaluation of a manuscript.
El texto completo de este artículo está disponible en PDF.Highlights |
• | The mean umbilical cord/maternal serum ratio was found to be close to one. |
• | Significant correlation between umbilical cord and maternal serum levels was found. |
• | Paired milk and maternal serum levels were not significantly different. |
• | The mean infant serum levels reached approximately a quarter of the maternal value. |
Abbreviations : CBZ, CYP, I, LLoQ, N, M, Mi, TDM, TPM, UC
Keywords : Topiramate, Delivery, Breastfeeding, Therapeutic drug monitoring
Esquema
Vol 138
Artículo 111446- juin 2021 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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