EPILEPSY - PPP + Pregnancy and breastfeeding Flashcards
Which drug is safest in pregnancy?
Lamotrigine + levetiracetam
LL
If pt is planning on getting pregnant
Refer to specialist if planning a pregnancy
Notify the UK epilepsy and pregnancy register
Pregnancy Prevention Programme (PPP)
- ONE highly effective method of contraception (e.g. IUD or implant) or
- TWO complementary forms of contraception
including a barrier method. - Fully informed of the risks of use in pregnancy, and a signed risk acknowledgement form.
- Seen annually by specialist for review.
PPP - Pharmacists role
Provide valproate patient card.
Remind pt. of risks in pregnancy/need for highly effective contraception.
Remind of need for annual specialist review
Dispense as whole pack - always give PIL
Refer/contact GP if pt.not taking highly effective contraception.
Sodium Valproate in pregnancy
HIGHLY TERATOGENIC
- can lead to congenital malformations and neurodevelopmental disorders
- prescribers should NOT prescribe SV to females of childbearing potential
Contraindicated in pregnant women for BPD and only considered in epilepsy if no alternative.
PPP - Which contraception is highly effective?
1) male and female sterilisation
2) copper IUDs 3) levonorgestrel intrauterine device
4) progestogen-only implant
What would you advise a patient who is on sodium valproate and becomes pregnant?
ADVISE TO SEE GP ASAP
- Too late to make med changes
- Do NOT stop meds
- Folate supplementation to reduce risks of neural tube defects
What drug should be given to patients taking AEDs when pregnant?
Folic acid 5mg should be taken until the 12th week of pregnancy
reduces the risk of neural tube defects in 1st trimester
What vitamin should be injected
Vitamin K
can minimise the risk of neonatal haemorrhage when the mother is taking AEDs
Teratogenicity - highest risk
Valproate/valproic acid
Minor and major congenital malformation + long-term developmental disorders.
What antiepileptics cause increased risk of congenital malformations?
Carbamazepine, phenobarbital, phenytoin and topiramate
Which antiepileptics may have their plasma concentrations effected by pregnancy?
Adjust dose based on plasma-drug concentration.
* Phenytoin
* Carbamazepine
* Lamotrigine
For other drugs, dose adjustments are made based on clinical judgement.
What if a pregant woman gets a seizure during the second half of pregancy
- Assess eclampsia before any changes to meds
Can pregabalin be used in pregnancy?
AVOID
Slight increased risk of major birth defects - congenital malformations
Topiramate
Risk of cleft palate if used in 1st trimester
Monitor foetal growth
