Uporaba benzodiazepina u trudnoći i dojenju s naglaskom na toksični učinak na dijete

master's thesis

• Title (english): Use of benzodiazepines during pregnancy and breastfeeding with emphasis on toxic effects on child
• Author: Tea Vojta
• Mentor: Irena Žuntar (mentor)
• Committee member: Irena Žuntar
• Committee member: Suzana Inić
• Committee member: Jasna Jablan
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; Zagreb
• Defense date and country: 2015-06-18, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj ovog rada je proučiti potencijalni toksični učinak benzodiazepina na dijete ukoliko ih majka koristi u razdoblju trudnoće i dojenja. Benzodiazepini su jedna od najčešće propisivanih skupina lijekova i često upotrebljavani u trudnoći, a prema FDA klasifikaciji spadaju u kategorije ''D'' i ''X'' što pokreće brojna pitanja vezana za sigurnost njihove uporabe u tim razdobljima. Pri pregledu istraživanja u razmatranje su uzimana samo ona o kliničkim slučajevima. Trudnice su osjetljiva skupina pacijenata čije je tijelo zahvaćeno brojnim promjenama koje mogu utjecati na farmakokinetiku lijekova. Ključni čimbenici odgovorni za prolazak lijeka kroz placentu i njegov utjecaj na fetus su slijedeći: (1) fizikalno-kemijska svojstva lijeka; (2) stopa prolaska lijeka i količina koja dođe do fetusa; (3) vrijeme trajanja izloženosti lijeku; (4) značajke distribucije lijeka u fetalna tkiva; (5) stupanj razvoja posteljice i fetusa u vrijeme izloženosti lijeku i (6) učinak kombinacija lijekova. Brojne studije pokazuju sigurnost uporabe benzodiazepina u trudnoći, no manji broj slučajeva u kojima je uporaba ovih lijekova povezana s problemima kod djeteta izaziva sumnju i ponovno postavlja pitanje njihove kompatibilnosti s trudnoćom. Benzodiazepini prelaze u majčino mlijeko i mogu ostvariti učinak na dijete stoga se ne preporuča njihova uporaba. Ipak, istraživanja pokazuju da je uporaba tih lijekova kompatibilna s dojenjem i da se eventualne poteškoće mogu izbjeći pomnijim izborom lijeka, npr. kraćeg poluvremena eliminacije ili ograničavanjem broja depresora SŽS koje majka koristi. Potrebno je dakako pratiti dijete. Uporaba bilo kojeg lijeka u trudnoći i dojenju je dozvoljena ako korist za majku nadilazi rizik za dijete. Nekada za dijete može biti pogubnije neliječeno stanje majke nego korištenje lijeka. Znanje, iskustvo i neprestano informiranje u smislu najnovijih znanstvenih spoznaja, stvorit će povjerenje između liječnika/farmaceuta i pacijentice te omogućiti sretan završetak trudnoće i uspješan razvoj djeteta.

Abstract (english)

The objective of this study was to examine potential toxic effects which benzodiazepines have on child, if used during pregnancy and breastfeeding. Benzodiazepines are one of the most frequently prescribed drug groups and often used during pregnancy. FDA classified them as ''D'' and ''X'' which brings up many questions pertaining to the safety of their usage in these periods. The literature overview encompassed exclusively a research on clinical cases. Pregnant women are considered to be a sensitive group of patients as their bodies undergo a number of changes that may affect the drug pharmacokinetics. Key factors responsible for the diffusion of a drug through the placenta and its impact on the fetus are following: physical and chemical properties of a drug, the passage rate of a drug and the amount which reaches the fetus, duration of exposure to a drug, characteristics of a drug distribution into fetal tissue, development degree of both fetus and placenta at the time of exposure to a drug, and the effect of drug combinations. Numerous studies indicate that the usage of benzodiazepines during pregnancy is safe; however, a number of cases where the adverse effects were noticed causes doubts and again raises the question of their compatibility with pregnancy. Their usage during breastfeeding is also not recommended because it can affect the baby. Nevertheless, studies show compatibility between benzodiazepines and breastfeeding and that any difficulties can be avoided with a careful choice of drugs; for example, drugs with a short half-life or by limiting the number of CNS depressants used by mother. Of course it is necessary to monitor the child. The use of any drug during pregnancy and breastfeeding is permitted if the benefit for the mother outweighs the risks for the child. Sometimes the untreated condition of the mother can be more dangerous for the child than the exposure to a drug. Knowledge, experience and being up to date with the latest scientific findings will create trust between doctors/pharmacists and patients and provide a happy ending pregnancy and successful development of the child.

• Keywords: trudnoća; laktacija; dojenje; teratogenost; urođene anomalije; anksioznost; sedacija; benzodiazepini; diazepam; alprazolam; bromazepam; flurazepam; klonazepam; lorazepam; midazolam; nitrazepam; oksazepam
• Keywords (english): pregnancy; lactation; breastfeeding; teratogenicity; congenital abnormalities; anxiety; sedation; benzodiazepines; diazepam; alprazolam; bromazepam; flurazepam; clonazepam; lorazepam; midazolam; nitrazepam; oxazepam
• Language: croatian
• URN:NBN: urn:nbn:hr:163:471180
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-01-15 14:22:40