Article
Therapeutic monitoring of chloroquine in pregnant women with malaria.
Department of Pharmaceutical Microbiology & Clinical Pharmacy, College of Medicine, University of Ibadan, Nigeria.
West African journal of medicine
21(4):286-7.
Source: PubMed
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Citations (0)
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Article: Antimalarial drugs in pregnancy: a review.
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ABSTRACT: In this review we examine the available information on the safety of antimalarials in pregnancy, from both animal and human studies. The antimalarials that can be used in pregnancy include (1) chloroquine, (2) amodiaquine, (3) quinine, (4) azithromycin, (5) sulfadoxine-pyrimethamine, (6) mefloquine, (7) dapsone-chlorproguanil, (8) artemisinin derivatives, (9) atovaquone-proguanil and (10) lumefantrine. Antimalarial drugs that should not be used in pregnancy including (1) halofantrine, (2) tetracycline/doxycycline, and (3) primaquine. There are few studies in humans on the pharmacokinetics, safety and efficacy of antimalarials in pregnancy. This is because pregnant women are systematically excluded from clinical trials. The absence of adequate safety data, especially in the first trimester, is an important obstacle to developing treatment strategies. The pharmacokinetics of most antimalarial drugs are also modified in pregnancy and dosages will need to be adapted. Other factors, including HIV status, drug interactions with antiretrovirals, the influence of haematinics and host genetic polymorphisms may influence safety and efficacy. For these reasons there is an urgent need to assess the safety and efficacy of antimalarial treatments in pregnancy, including artemisinin based combination therapies.Current Drug Safety 02/2006; 1(1):1-15. -
Article: Severe embryotoxicity of artemisinin derivatives in experimental animals, but possibly safe in pregnant women.
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ABSTRACT: Preclinical studies in rodents have demonstrated that artemisinins, especially injectable artesunate, can induce fetal death and congenital malformations at a low dose range. The embryotoxicity can be induced in those animals only within a narrow window in early embryogenesis. Evidence was presented that the mechanism by which embryotoxicity of artemisinins occurs seems to be limited to fetal erythropoiesis and vasculogenesis/ angiogenesis on the very earliest developing red blood cells, causing severe anemia in the embryos with higher drug peak concentrations. However, this embryotoxicity has not been convincingly observed in clinical trials from 1,837 pregnant women, including 176 patients in the first trimester exposed to an artemisinin agent or artemisinin-based combination therapy (ACT) from 1989 to 2009. In the rodent, the sensitive early red cells are produced synchronously over one day with single or multiple exposures to the drug can result in a high proportion of cell deaths. In contrast, primates required a longer period of treatment of 12 days to induce such embryonic loss. In humans only limited information is available about this stage of red cell development; however, it is known to take place over a longer time period, and it may well be that a limited period of treatment of 2 to 3 days for malaria would not produce serious toxic effects. In addition, current oral intake, the most commonly used route of administration in pregnant women with an ACT, results in lower peak concentration and shorter exposure time of artemisinins that demonstrated that such a concentration-course profile is unlikely to induce the embryotoxicity. When relating the animal and human toxicity of artemisinins, the different drug sensitive period and pharmacokinetic profiles as reviewed in the present report may provide a great margin of safety in the pregnant women.Molecules 01/2010; 15(1):40-57. · 2.39 Impact Factor -
Article: Chloroquine pharmacokinetics in pregnant and nonpregnant women with vivax malaria
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ABSTRACT: PurposeWe compared the pharmacokinetics of chloroquine in pregnant and nonpregnant women treated for Plasmodium vivax malaria. MethodsTwelve pregnant women and 15 nonpregnant women of child-bearing age with acute P. vivax malaria were treated with 25mg chloroquine base/kg over 3days on the northwestern border of Thailand. Blood concentrations of chloroquine and desethylchloroquine were measured using hydrophilic interaction liquid chromatography coupled with fluorescence detection. Twenty-five women completed the pharmacokinetic study. ResultsAlthough increasing gestational age was associated with reduced chloroquine \textAUC0 ® ¥ {\text{AUC}}_{0 \to \infty } , there was no significant difference overall in the pharmacokinetics of chloroquine between pregnant and nonpregnant women. Fever was associated with lower chloroquine \textAUC0 ® ¥ {\text{AUC}}_{0 \to \infty } values. Desethylchloroquine area under the curve (AUC) values were not significantly affected by pregnancy. ConclusionsPregnancy did not significantly affect blood concentrations of chloroquine or its metabolite, desethylchloroquine, in women with P. vivax malaria.European Journal of Clinical Pharmacology 04/2012; 64(10):987-992. · 2.85 Impact Factor
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Keywords
10 mg/kg body weight
5 mg/kg body weight
chloroquine
clinical malaria
first dose
intervals
peak plasma concentration
peak plasma concentrations
Plasma chloroquine level
pregnant women
specific liquid chromatographic method