Farmacoterapia in sarcina
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Impactul farmacoterapiei in sarcina si lactatie
Prof. dr. Anca Dana BuzoianuDepartamentul de Farmacologie, Toxicologie si Farmacologie Clinica
Universitatea de Medicina si Farmacie “Iuliu Hatieganu”
Cluj-Napoca, Romania
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IntroducereSarcina – stare fiziologica cu multiple
particularitati farmacologice (embrion, fat, mama)
Medicatia in sarcina si lactatie – problema controversata
Implicatii medico-legale si emotionale
Responsabilitatea medicului – siguranta si eficienta farmacoterapiei indicate atat pentru mama cat si pentru fat
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IntroducereExperienta nefericita cu talidomida
a dus la multiple efecte:aparitia farmacologiei clinice ca disciplinatestarea preclinica a toxicitatii
medicamentelor nou introduse pe piatarevolutionarea modului in care
medicamentele sunt folosite in timpul sarcinii
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IntroducereIn timpul sarcinii si lactatiei
afectiuni acute controlul unor boli cronice medicatia putand fi necesara pentru a asigura starea
de sanatate optima a gravidei si fatului Andrade et al – 2004
unei gravide i se prescriu 3-5 medicamente in timpul sarcinii
64% din gravide primesc cel putin 1 medicament inaceasta perioada
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Mitchell et al -2011-70-80% din gravide folosesc cel putin 1
medicament in primul trimestru50% folosesc minim 4 medicamente pe periada
sarcinii
Concluzie: utilizarea medicatiei in sarcina - frecventa, necesitand monitorizare sistematica si continua, pre, intra si post-partum
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Topice prezentare Modificari farmacocinetice in sarcina Selectia medicamentelor in sarcina Recomandari generale privind administrarea
medicamentelor in boli acute Recomandari generale privind administrarea
medicamentelor in boli cronice Remediile din plante in sarcina
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Modificari farmacocinetice in sarcinaEvolutia sarcinii - modificari fiziologice care
influenteaza absorbtia, distributia si eliminarea medicamentelor
Pot afecta raspunsul la medicatie
Monitorizare si eventual ajustarea farmacoterapiei
Modificarile incep din trimestru I maximul in trimestrul II de sarcina
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Farmacocinetica - drumul parcurs de medicamente in organism
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Modificari farmacocinetice in sarcinaAbsorbtia
Greata, varsaturi - influenteaza absorbtia Scaderea motilitatii intestinale, golirii si aciditatii gastriceMedicatia seara, in doza unica
DistributiaGreutate totala crescutaCreste (cu aprox. 50%) volumul plasmatic, debitul
cardiac - scade concentratia plasmatica a unor medicamente
Albumina - concentratie scazuta in trimestrul III (risc de toxicitate - creste forma libere a medicamentelor)
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BARIERA PLACENTARA
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Bariera placentara - nu mai este “bariera” propriu zisaPermeabilitatea creste de 10 ori (scade grosimea)
pana la sfarsitul sarciniiMajoritatea medicamentelor – lipofile cu GM mica –
difuziune simpla
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Medicamente cu GM < 500 kDa – transfer rapid
cu GM > 500 kDa – transfer lent
cu GM > 1000 kDa (heparina, insulina) – nu
traverseaza bariera placentara in concentratie
semnificativa
Medicamentele liposolubile – opiacee, antibiotice –
transfer facil, comparativ cu cele hidrosolubile
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Metabolizarea hepaticaNivelul crescut de hormoni estrogeni si
progesteronModificarile enzimelor hepatice
Clearace-ul renalRata filtrarii glomerulare poate creste cu pana la
50%Poate fi necesara ajustarea dozelor
Modificari farmacocinetice in sarcina
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Selectia medicamentelor in sarcinaUnele medicamente – potential teratogenMajoritatea medicamentelor necesare in
sarcina – utilizare siguraExpunerea la medicamente – responsabila de
malformatii congenitale in <1% din cazuri (Brent RL, 2003)
Nu orice expunere determina malformatii congenitale!Medicatia doar la indicatia medicului curantAutomedicatia poate avea consecinte severe
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Selectia medicamentelor in sarcinaFactorii care influenteaza efectul asupra fatului
varsta sarciniicalea de administraredoza
Uneori – necesare medicamente
cu efect negativ asupra fatului
pentru tratarea mamei
Primele 2 saptamani dupa conceptie – efect “totul sau
nimic”Zilele 18-60 dupa conceptie- anomalii structurale (etapa
de organogeneza)
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Saptamana de sarcina
3 4 5 6 7 8 12 16 20 38
SNC
Cord
Mb sup
Ochi
Mb inf
Dinti
Palat
Org genit ext
UrechiPerioada cu risc crescut pentru efecte teratogene
Perioada cu risc mai redus pentru efecte teratogene
Dupa Krauer et al (1984)
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Selectia medicamentelor in sarcinaFDA – reglementari specifice
privind administrarea medicamentelor
in sarcina si lactatie – 1979Raspuns la cazurile de anomalii
induse de talidomida (1962)Revizuire – 1997Reglementari noi propuse in 2008,
urmeaza
sa fie introduse in practica medicala curenta
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Selectia medicamentelor in sarcina
Medicamentele - clasificate in 5 grupe in functie de:Prezenta sau absenta datelor privind efectul
medicamentelor in sarcinaSursa datelor (animale sau om)Rezultatele studiilor (prezenta sau absenta
efectelor teratogene)
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Grupele de medicamente in sarcinaCategoria A – studii controlate la femei gravide care nu au
demonstrat efect nociv asupra fatuluiCategoria B
studiile pe animale reproductive nu au demonstrat risc fetal si nu exista studii controlate la femeile gravide
studiile pe animale au relevat un risc potential si nu s-au efectuat studii pe femei gravide
Categoria C
studiile pe animalele au relevat un posibil risc, dar nu
exista studii controlate la om; beneficiu>risc
nu exista studii la animale sau la om
65-70% dintre medicamentele existente
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Categoria D
studiile pe femei gravide au evidentiat risc pentru fat
folosite doar daca beneficiul potential poate fi acceptabil
comparativ cu riscul
Categoria X
studiile pe animale si om au demonstrat anomalii fetale
evidente certe privind riscul fetal raportate in cadrul
studiilor pre sau post-marketing
contraindicate in sarcina!
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Selectia medicamentelor in sarcinaClasificarea – numeroase critici
Incadrarea medicamentelor intr-o anumita categorie, fara ca riscul, incidenta si severitatea reactiilor adverse produse de acestea sa fie similar
Ex: categoria B – nu exista o diferenta clara intre datele obtinulte de la om si cele de la animal
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Selectia medicamentelor in sarcina1997 FDA a propus revizuirea
In 2008 un nou set de reglementari - care urmeaza a fi puse in practicaSepararea informatiilor clinice de datele privind
riscul la animalePrecizarea in prospect a urmatoarelor
datele privind riscul fetalconsideratii clinicedate provenite din studii clinice
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Mitchell et al -2011
Medicatia cel mai frecvent utilizata in timpul sarcinii
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Cele mai prescrise medicamente cu risc teratogen minim sau necunoscut
Medicament Clasificare FDA
Analgezice (aspirina, paracetamol, ibuprofen) B-D
Antibiotice (Penicilina G, tetraciclina, ciprofloxacina, metronidazol, nitrofurantoin, azitromicina)
B-D
Anticolinergice (atropina, dimenhidrinat) beta mimetic (salbutamol)
B-C
AntiHTA (metildopa, hidralazina, labetalol, propranolol) B-C
Antihistaminice (cetirizina, difenhidramina) B
Antivirale - aciclovir B
Corticosteroizi (prednison, betametazona, dexametazona)
B
Buhimschi si Weiner, Obstet Gynecol, 2009
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Cele mai prescrise medicamente cu risc teratogen minim sau necunoscut
Medicament Clasificare FDA
Antiacide (Aluminum hidroxide, Magnesium hidroxid , Magnesium trisilicat, Calcium carbonate, salicilat de bismut )
B-C
Laxative: metilceluloza, bisacodil B-D
Antisecretorii: omeprazol, ranitidina, famotidina, cimetidina B-C
Antidiareice: loperamida, B-C
Antiflatulente: simeticona, B
Antitusive: dextrometorfan, guaiafenesina B
Antimicotice (miconazol) B
Altele: calciu, cofeina, pseudoefedrina B
Dupa Buhimschi si Weiner, Obstet Gynecol, 2009
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Medicamente Efecte teratogene
Thalidomida Focomelie, malformatii cardiace
Penicilamina Pierdere tegumentara
Anticoagulantele orale
Anomalii SNC, ochi, membre
Estrogeni Atrofie testiculara la baieti
Androgeni Masculinizare la fete
Stilbestrol Cancer vaginal, col uterin
IECA, sartani Insuficienta renala, oligohidramnios
Medicamente cu potential teratogen
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Medicament Efecte teratogene
Fenitoina Anomalii de palat, microcefalie, retard mental
Acid valproic Defecte de tub neural
Carbamazepina Retard al cresterii extremitatii cefalice
Citotoxice chimioterapice
Hidrocefalie, anomalii de palat, defecte de tub neural
Tetracicline Anomalii dentare
Etanol Sindrom alcoolic fetal
Retinoizii Hidrocefalie
Medicamente cu potential teratogen
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Medicatia uzuala in cursul sarcinii
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Antibiotice. Beta lactamice Penicilina G si celelalte beta lactamice
(ampicilina, amoxicilina, cefalosporinele) –
sigure, cele mai utilizate in sarcinaConsiderate prima linie de tratament in infectiile cu
germeni sensibiliTraverseaza placentaNu s-au demonstrat efecte teratogene – la animale si omExperienta clinica foarte mareConcentratii mici in lapte – nu influenteaza copilul
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Antibiotice. Beta lactamice
Combinatia amoxicilina-acid clavulanic – putine dateStudiul Oracle – utilizarea combinatiei la pacientele
cu ruptura prematura de membrane nu a prelungit durata sarcinii
Imipenem + cilastatina – combinatie sigura in sarcina
(Briggs et al, Lippincot 2008)
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Antibiotice. MacrolideEritromicina
traverseaza bariera placentaranu s-a observat o crestere a riscului de malformatii fetale
Claritromicina, azitromicina, roxitromicina– date mai putineTelitromicina (Ketek) – evitare, cazuri severe de
hepatotoxicitate la gravidaAzitromicina – tratamentul de electie in infectia cu
chlamydia (Buhimschi et al - Obstet Gynecol, 2009)Fara efecte adverse asupra fatului raportate pana in
prezentSe excreta prin lapte – fara afectarea copilului
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Antibiotice. QuinoloneStudiile pe animale – artropatii la toate speciile studiateNu sunt indicate de rutina la gravide si copiiNu s-au observat condropatii sau alte modificari musculo-
scheletale la copii (Briggs si Freeman - Lippincot 2008– numar redus de paciente care au primit fluoroquinolone in primul trimestru de sarcina)
Ciprofloxacina - se indica la pacientele cu infectii cu gram negativi si ca linia II de tratament in TBC
Trovafloxacina – risc crescut de malformatii
musculo-scheletale la animale si om
(Casey et al, 2000)
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Sulfamidele si trimetoprimulSulfamidele
Risc potential in sarcinaAdministrate in trim I – nu determina malformatiile fetale
observate in studiile pe animale (palat)Nu se administreaza in trim III – risc de icter
neonatal!Trimetoprim
Efect teratogen la animaleStudiile la om – date putine, cresterea incidentei
malformatiilor (defecte de tub neural, cardiovasculare, palat)
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Tetraciclinele
Contraindicate in sarcina –
in special in trimestrul II si IIIMalformatii osoase si dentare ale fatului
Doxiciclina risc redus de malformatii fetale, daca se
administreaza in trim II si III (Czeizel et al, 1997)utilizata la nevoie – antibiotic de rezerva
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Tetraciclinele
Oxitetraciclina - incidenta crescuta a defectelor de
tub neural
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AminoglicozideleMalformatii fetale – descrise la copiii ai caror mame au fost tratate cu kanamicina si streptomicinaRisc de nefrotoxicitate – asocierea cu cefalosporineGentamicina si neomicina oral – fara risc teratogenic
fetal (Czeizel et al. 2000)Gentamicina
utilizata in infectiile urinare in sarcinaexcretata in lapte la 1h dupa administrare (Celiloglu et al. 1994)nu exista dovezi privind efectele adverse asupra
copilului
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MetronidazolulUtilizat in sarcina pentru tratamentul vaginitei
trichomoniazice, amebiaza Colegiul American de Obstetrica si Ginecologie –
utilizare limitata numai in amoebiaza, in trimestrul IIn dozele recomandate – fara risc teratogenicAdministrarea metronidazolului se asociaza cu un
risc crescut de nastere prematura (studiul Premet, 2006)
Evitarea administrarii inainte de nastere!Poate fi utilizat in perioada de alaptare
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Nitrofurantoinul
Date limitateNu se stie daca traverseaza placentaNu exista raportari legate de un posibil efect
teratogenContraindicata administrarea prenatala si la nou
nascut – reactii hemolitice la NNSe excreta in lapte – nu sunt raporate efecte
adverse la copil
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AciclovirulNu s-a observat o crestere a incidentei
malformatiilor fetale la copiii mamelor tratate cu aciclovir in trim I si nici efecte adverse la NN din mame tratate in trim III de sarcina
I.v. pentru infectia herpetica diseminata-
reduce mortalitatea materna si fetalaOral in infectiile genitale primare-
previne complicatiileValaciclovir, famciclovir – date limitate
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AINS. Acidul acetilsalicilic (Aspirina) AINS larg utilizate in sarcina- peste 20% din
greavide in trimestrul I (Hernandez RK et al. 2011)
Traverseaza placenta – anomalii raportate la animale
Studii ample – nu au confirmat aparitia anomaliilor fetale - Slone et al (Lancet 1976), Jick et al (Jama 1981) Norgard B (2005)
Kozer et al (Am J Obstet Gynecol 2002) – administrarea aspirinei se asociaza cu un risc fetal crescut de aparitie a anomaliilor, in special gastroschisis, atrezie intestinala
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Acidul acetilsalicilic (Aspirina)Evitarea administrarii in primul trimestru de sarcina!Prescrisa pentru a reduce riscul de tromboza la
mama - poate produce hemoragii la nastere – nu se recomanda in trim III
In alaptare – utilizarea dozelor cele mai mici eficiente, administrate imediat dupa alaptare
Daca sunt necesare doze mari (RAA, PAR) – evitarea alaptarii, risc de efecte toxice la copil
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ParacetamolulUtilizat frecvent in sarcina- antipiretic, in infectiiAfectare materna – datorita abuzului cronic, sau
supradozaNu are efect antiagregant plachetar – fara risc de
hemoragii la fatPoate fi administrat si in timpul alaptarii
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Ibuprofen (Advil, Nurofen)
Medicamentul de electie in durerile acute
postpartum sau postoperatorii
Traverseaza placenta- concentratia la nivelul fatului
dependenta de cea materna
Poate fi utilizat si in perioada de lactatie – doze mici,
perioade scurte de timp
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AINS (cu efect antiinflamator marcat) Indometacin, naproxen, ketoprofen, piroxicam,
diclofenac Diclofenacul- risc de insuficienta renala la NN (Phadke et al.
2012)
Nakhai-Pour HR et al. 2011- risc de avort spontan pentru diclofenac, naproxen, celecoxib, ibuprofen
Se intrerupe tratamentul cu 6-8 saptamani ant. nasteriiprelungirea sarcinii si travaliului, hemoragii la nastereafectarea fatului – hemoragii cerebrale, inchiderea
prematura a canalului arterial, hipertensiune pulmonara, afectare renala
Administrate in doza minim eficienta, intermitent
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Antihistaminice
Nu exista studii adecvate in sarcina, nu
se cunosc efectele asupra fatuluiCetirizina Loratadina (efect teratogen pe animale, dar
experienta clinica mare, fara efecte teratogene raportate)
In timpul alaptarii – iritabilitate la copil
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Beta mimetice. SalbutamolFolosit inhalator pentru controlul astmului
(Wendel 1996)Utilizat ca si tocolitic, p.o. Nu afecteaza TA si FC a mamei<10% din doza administrata inhalator se absoarbeDatele existente - fara teratogenitate daca se
utilizeaza in primul trimestru de sarcina
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CorticosteoriziiRisc matern
riscul infectiilor in ruptura prematura de membrane cresterea tranzitorie a glicemiei, agravarea DZ prednisonul – rata mai mare avortului spontan
(administrat concomitent cu aspirina in sdr antifosfolipidic)
Risc fetal risc teratogen redus nu se recomanda administrarea repetata a
corticosteroizilor- creste incidenta G mici la nastere (Wapner 2006)
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Recomandari generale privind
administrarea
medicamentelor in boli acute
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Tratamentul infectiilor urinareCea mai frecventa infectie bacteriana in timpul sarciniiTratamentul bacteriuriei asimptomatice – reduce riscul de
aparitie a pielonefritei si a nasterii premature95% determinate de E coli De electie : penicilineAmoxicilina p.o. 3 g de 2 ori / zi
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Incidenta crescuta a tulpinilor rezistente la ampicilina, amoxicilina si sulfamide-trimetoprim
Cefalexina – eficienta si siguraDurata optima de tratament –
7-10 zile, desi unele studii au aratat
eficienta a 3 zile de tratamentCistita acuta – acelasi tratament si durata ca si in
bacteriuria asimptomatica
Tratamentul infectiilor urinare
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Tratamentul infectiilor urinarePielonefrita acuta –
complicatie in 1-2% din sarciniSpitalizare – ceftriaxona i.v.
sau cefazolina + gentamicina, Durata tratamentului – 10-14
zile23% din femei – recidiveSe recomanda nitrofurantoin
100 mg/zi, seara pe durata sarcinii, pana in sapt 37
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Boli cu transmitere sexuala (BTS)
Sifilis – tratamentul de electie – penicilina eficienta in prevenirea transmiterii infectiei si
tratamentul acesteia la fat doza si calea de administrare – dependente de
stadiul bolii tratamentul in a doua parte a sarcinii – asociere
cu risc crescut de nastere prematura
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Sifilis congenital
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Boli cu transmitere sexuala (BTS)Gonoree
Ceftriaxona 125 mg im sau cefixima 400 mg oral in doza unica
Spectinomicina 2 g doza unica – alternativa pentru cefalosporine
Infectie cu Chlamydia la NN – conjunctivita Azitromicina 1 g doza unica Amoxicilina 500 mgx3/zi, 7 zile alternativa - eritromicina
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Herpes genitalinfectarea in timpul sarcinii –
risc de transmitere la nastere (30-50%)infectii recurente – risc de
transmitere de 1%leziuni prezente la termen
nastere prin cezarianaAciclovir oral
Boli cu transmitere sexuala (BTS)
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Cefaleea si migrena60-70% din paciente – ameliorarea simptomelor in
timpul sarcinii, in special in trim II si IIIParacetamol ± cofeina, codeinaAINS – de evitat in trim IIIUtilizarea sumatriptanului (imigran) – controversata,
numai la pacientele care nu raspund la antialgice uzuale
Asocierea simptomelor digestive – metoclopramidTratament profilactic – la pacientele care prezinta 3-4
episoade severe/luna (propranolol)
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Recomandari generale privind
administrarea medicamentelor
in boli cronice
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Rinita alergica si astmul bronsicRinita alergica – diminuarea calitatii vietiiAstmul bronsic – consecinte negative asupra fatului si
mameiAstmul netratat
risc matern - cu placenta praevia, oligohidramnios, nastere prematura, HTA, preeclampsie, hemoragii uterine
risc fetal – greutate mica la nastere, nastere prematura
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Tratamentul astmului in treptesalbutamol – in exacerbaritratament de fond – corticoizi inhalatori – prima liniecromone (cromoglicat de sodiu) – eficienta redusaantileucotriene (Singulair) – date insuficientexantine (miofilin) – toxicitate crescuta
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Rinita alergica si astmul bronsicTratamentul rinitei
imunoterapie specifica – poate fi continuata
pe durata sarciniicorticosteroizii intranazali – eficienta cea mai mare,
risc sistemic scazut (beclometazona, budesonid)antihistaminice H1 (cetirizina, loratadina) dupa sapt 12evitarea decongestionantelor nazale in primul
trimestru – risc crescut de gastroschisis!
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Diabet zaharatSarcina – in conditiile unui control bun al boliiControl inadecvat – creste riscul de avort spontan si
malformatii fetaleAgravarea retinopatiei, HTA, functiei renale in timpul
sarciniiInsulina – tratamentul de electie pentru DZ tip 1 si 2Gliburid – alternativa dupa sapt 11Metformin- sigur si eficient dupa ultimele studii
(Gandhi et al. 2012)
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Hipertensiunea arteriala3% din femei urmeaza tratament antihipertensiv in
timpul sarciniiACOG – tratament daca TAS>170 mmHg si/sau
TAD>109 mmHgNu exista un consens privind tratamentul formelor
usoare si moderate de HTASe utilizeaza – metildopa, hidralazina, labetalol,
BCC(nifedipina), propranolol, alfa-blocante
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Metildopa (Dopegyt)Cel mai studiat antihipertensiv in sarcinaSigur in primul trim de sarcina (Podymow et al. 2011)
Tratamentul formelor moderate si usoareSe elimina prin lapte – NN sunt normotensiviCreste incidenta hipoglicemiei la NN – formule de
lapte praf cu supliment de glucoza
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NifedipinaEficace in tratamentul HTA de sarcinaSe prefera forma retardNu exista date suficiente – grupa de risc C
HidralazinaUtilizat in tratamentul urgentelor hipertensive din
sarcinaSigur in primul trimestruStudiul PIVOT (2007) – eficienta si siguranta in
tratamentul urgentelor hipertensive in sarcina si postpartum
Se excreta prin lapte – NN normotensiv
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LabetalolIn sarcina - tratamentul urgentelor acuteDoze mari IV – bradicardie, hipoglicemie,
hipotensiune, hipertrofie miocardica, moarte fetala (Olsen 1992, Crooks 1998)
Se excreta in lapte – NN sunt normotensivi
PropranololUtilizat in sarcina: HTA, aritmii, migrenaSigur in doza ce nu afecteaza debitul cardiac maternStudiile privind tratamentul cronic al HTA in sarcina –
numar redus de pacienteEficienta similara cu metildopa, asociat cu hidralazina
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Epilepsia1% din sarcini, majoritatea – agravarea simptomelorMalformatii majore – 4-6% din paciente care
utilizeaza benzodiazepine, carbamazepina, fenobarbital, acid valproic, fenitoina
Lamotrigina chielopalatoschisis (1%)malformatiile minore – frecventa
dubla fata de populatia generala
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EpilepsiaMalformatiile – se datoreaza expunerii fetale, mai
putin epilepsiei materneTerapiile combinate – risc mai mare de malformatiiToate pacientele – acid folic 5 mg/ziCorectarea deficitului de vitamina K la NN
10 mg/zi, in ultima luna de sarcina
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Afectiuni psihiatriceDepresia – cea mai studiata
incidenta – 10-60% la gravide risc de nastere prematura si greutate mica la nastere antidepresivele – utilizate timp de 40 de ani ISRS – utilizare pe scara larga la gravide studii recente – hipertensiune pulmonara, sindrom de
abstinenta la NN Paroxetina (Seroxat) – utilizarea in trim I se asociaza cu
malformatii cardiace gravidele care intrerup tratamentul risc de 5 ori mai
mare de recaderi
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Reactii adverse produse de ISRS la gravide
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Afectiuni psihiatriceTulburari anxioase
cele mai frecvente afectiuni
psihiatricebenzodiazepinele – risc de aparitie a palatoschizisului
(0.01%)utilizarea in trim III – sedare, sindrom de abstinenta la
NN, mai sever decat cel indus de ISRS“flopy baby syndrome” – scor Apgar scazut,
hipotermie, hipotonie musculara
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Afectiuni psihiatriceSchizofrenia
asociata cu risc crescut: deces perinatal, greutate mica la nastere, prematuritate
clorpromazina, haloperidolul - utilizare indelungata nu se asociaza cu cresterea incidentei malformatiilor
fetaleantipsihoticele atipice – controversate in sarcinanu sunt mai sigure decat agentii clasici
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Utilizarea medicamentelor “naturale” -din plante- in sarcinaNumeroase remedii din plante - sigureUnele – periculoasePlantele pot contine alcaloizi
avorturi spontane, nastere prematura, contractii, malformatii fetale
Exista putine studii asupra efectului remediilor din plante asupra gravidei si fatului
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Pot induce contractii uterine –interzise la gravide!
Limba mielului (boranta) - favorizeaza metabolismul
Lemn dulce (licviritie) - antitusiv Vasc, smirna, salvia, AloeGinseng Ulei de primula – reglator hormonal Spilcuta (iarba fetei) - antiinflamatorKava Kava - calmantSenna - laxativ
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Saw Palmetto - Serenoa repens (palmier pitic) – activitate hormonala
Goldenseal – imunostimulantDong Quai – tonic feminin cu actiune
polivalenta Ephedra - efedrinaFloarea pasiunii Cohos negru si albastru – induce
contractii uterine si nastere prematuraBusuioc - oral, in doze medicinaleRozmarin
Pot induce contractii uterine –interzise la gravide!
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Plante considerate sigure in sarcinaFrunze de zmeura: stimuleaza lactatia,
antiemeticMenta: combate greata, flatulentaGhimbirul: antiemeticScoarta de ulm (greata, pirozis, arsuri vaginale)Psyllium: laxativ Tarate de ovaz: laxativeUsturoi: hipolipemiant, antiinflamatorCapsaicina (ardei iute) - topic
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Concluzii
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Prescrierea medicamentelor la femeile gravide sau care alapteaza reprezinta o decizie importanta, dependenta de mai multi factori:varsta sarcinii necesitatea administrarii medicamentuluicalea de administrareproprietatile farmacocinetice
Evaluarea raportului risc/beneficiu in timpul sarcinii este un proces complex si individualizat
Ameliorarea starii de sanatate a mamei poate influenta benefic cresterea embrionului/fatului
Absenta tratamentului poate afecta negativ starea de sanatate a mamei si copilului
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Medicul trebuie sa cunoasca particularitatile de prescriere a medicamentelor in sarcina si alaptare in ideea promovarii unor recomandari sigure pentru mama si copil
Clasificarea medicamentelor in functie de riscul lor de administrare in sarcina si perioada de alaptare nu reprezinta o certitudine
Gravidele si femeile care alapteaza nu pot reprezenta subiecti pentru studii clinice controlate, datorita riscului de teratogenitate al medicamentelor
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Va multumesc pentru atentie