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Lecturer Department of Pharmacy Practice SRM College of Pharmacy

This document discusses pharmacokinetic changes during pregnancy that may require medication dosage adjustments. It notes increased total body water, cardiac output, liver metabolism, plasma volume, glomerular filtration, and fat stores during pregnancy. These physiological changes can reduce drug concentrations through haemodilution and increased distribution, metabolism, and excretion. Specific changes discussed are slowed gastrointestinal motility, increased renal clearance up to 150% of normal range, increased hepatic clearance, expanded plasma volume and volume of distribution up to 150% by 24-28 weeks, and decreased protein binding. The document provides guidelines for safer antibiotic and analgesic use during pregnancy and notes risks of some drugs for breastfeeding.

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227 views12 pages

Lecturer Department of Pharmacy Practice SRM College of Pharmacy

This document discusses pharmacokinetic changes during pregnancy that may require medication dosage adjustments. It notes increased total body water, cardiac output, liver metabolism, plasma volume, glomerular filtration, and fat stores during pregnancy. These physiological changes can reduce drug concentrations through haemodilution and increased distribution, metabolism, and excretion. Specific changes discussed are slowed gastrointestinal motility, increased renal clearance up to 150% of normal range, increased hepatic clearance, expanded plasma volume and volume of distribution up to 150% by 24-28 weeks, and decreased protein binding. The document provides guidelines for safer antibiotic and analgesic use during pregnancy and notes risks of some drugs for breastfeeding.

Uploaded by

Robert Selvin M
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BY:

J. jayasutha
lecturer
department of pharmacy practice
Srm college of pharmacy
SRM UNIVERSITY
INTRODUCTION
During the 40 weeks of pregnancy total body water is
increased by approximately 8 liters, leading to altered drug
distribution. Pregnancy also increases cardiac output, the rate
of liver metabolism, plasma volume, glomerular filtration and
fat stores. These physiological changes cause drug
concentrations to be reduced in pregnancy through a
combination of haemodilution and increased distribution,
metabolism and excretion.
Pharmacokinetic changes in pregnancy that may
require adjustments in medication dosing or
frequency
y Absorption
Slowed gastrointestinal motility may delay absorption of oral
agents.

y Renal clearance
Glomerular filtration rates increase in pregnancy to 150% of
normal range; many medications that are renally cleared require
dosage alterations in pregnancy. For example, digoxin doses
may need to be increased to as much as 1.0 mg by the end of the
second trimester.

y Hepatic clearance
An increase in hepatic clearance of pharmacologic agents is
often seen during pregnancy.
y Volume of distribution
y Plasma volume increases to 150% of normal by 24 to 28 weeks’
gestation, increasing the volume of distribution. Drugs may
require dosage adjustments.

y Protein binding
Dilution of serum proteins—caused by the increase in free
water that is responsible for most of the increase in blood
volume during pregnancy—may lead to increased free drug
levels for a particular total serum level.
Safer drugs during Pregnancy

y Some medications are commonly used in pregnancy. A daily


dose of 400 microgram folic acid should ideally be started pre-
conceptually and continued through the first 12 weeks of
pregnancy to reduce the risk of neural tube defects.
y Women with gastro-oesophageal reflux should be advised to
eat smaller amounts of food more frequently and avoid
aggravating, rich foods. However, antacids are often required
and can be used at any stage of pregnancy.
y Ferrous sulphate is commonly prescribed for iron deficiency
anaemia in pregnancy but alternative salt formulations can be
tried if there is poor gastrointestinal tolerance. If the response
to oral treatment is poor then women may need to be referred
for parenteral iron.
y Reduced gastrointestinal motility in pregnancy can lead to
constipation. Lifestyle changes are again first-line management,
with emphasis on increasing fluids and dietary fiber. A bulk
laxative such as ispaghula and/or an osmotic laxative such as
lacunose can be safely prescribed, but stimulant laxatives
should be avoided.
y Penicillin's and cephalosporin's are considered safe to use in
pregnancy.
y Vaginal candidacies is more common in pregnancy and can be
treated with topical antifungal such as clotrimazole, but oral
antifungal agents including fluconazole, itraconazole and
terbinafine should be avoided.
Antibiotics that can be used in 
pregnancy
Infection Suggested treatment

Urinary tract infection Cephalosporin (e.g.cefalexin).


Amoxicillin (if sensitive).
Nitrofurantoin (avoid near term).

Acute pyelonephritis Cephalosporin.


Co-amoxiclav

Chest infection Amoxicillin.


Erythromycin

Skin infection Flucloxacillin.


Penicillin V.
Erythromycin

Pelvic inflammatory disease Erythromycin plus metronidazole

Bacterial vaginosis Metronidazole.


Topical clindamycin.
y Paracetamol is considered a safe analgesic throughout
pregnancy. For more powerful analgesia opiates such as
codeine can be prescribed, but it should be remembered that if
they are used towards term then they run the risk of inducing
neonatal respiratory depression and withdrawal syndrome.
y Low dose ibuprofen may be the safest option but generally
NSAIDs should not be prescribed.
y Lithium use is a particular concern because of the association
with congenital cardiac defects.
y Sodium cromoglycate eye drops and nasal corticosteroids can
be safely prescribed in pregnancy for hay fever.
Chorphenamine has a good safety record in pregnancy and
should be prescribed ahead of non-sedating second generation
antihistamines, such as cetirizine, on which there is less data.
y Women with asthma should be strongly encouraged to
continue their medications when pregnant. Shortand
long‐acting beta‐2 agonists and inhaled steroids all
appear safe, although leukotriene receptor antagonists
such as montelukast should be continued only if they
are essential. Oral steroids should not be withheld in
cases of severe asthma.
Breastfeeding

y A woman's physiology returns close to within normal parameters


within days of delivery, and drug doses are usually returned to
baseline within the first three days after childbirth. Breast feeding
provides many short and long term benefits to mother and baby.
Even though many drugs pass into breast milk, few are present in
sufficient quantity to cause any adverse effects.
y Some drugs are actively secreted and concentrated into breast milk
(for example, Phenobarbital), however. Some drugs have undesirable
pharmacodynamic effects on the baby (for example, iodine in
amiodarone may cause neonatal hypothyroidism, and cytotoxics may
cause bone marrow suppression), and the immature neonatal liver
may be unable to breakdown drugs. Drug accumulation can have
undesirable effects in the baby (for example, benzodiazepines can
lead to drowsiness).
THANK YOU

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