Optimizing Therapeutic Drug Monitoring in Pregnant Women: A Critical Literature Review

Autor(es)

Moreira, Fernanda de Lima ; Benzi, Jhohann Richard de Lima ; Pinto, Leonardo ; Thomaz, Matheus de Lucca ; Duarte, Geraldo ; Lanchote, Vera Lucia

• Tipo de documento: Artigo Científico
• Fonte: THERAPEUTIC DRUG MONITORING; v. 45, n. 2, p. 14-pg., 2023-04-01.

Resumo

Background:More than 90% of pregnant women take at least one drug during pregnancy. Drug dose adjustments during pregnancy are sometimes necessary due to various pregnancy-induced physiological alterations frequently associated with lower plasma concentrations. However, the clinical relevance or benefits of therapeutic drug monitoring (TDM) in pregnant women have not been specifically studied. Clinical pharmacokinetic studies in pregnant women are incredibly challenging for many reasons. Despite this, regulatory agencies have made efforts to encourage the inclusion of this population in clinical trials to achieve more information on the pharmacotherapy of pregnant women. This review aims to provide support for TDM recommendations and dose adjustments in pregnant women.Methods:The search was conducted after a predetermined strategy on PubMed and Scopus databases using the MeSH term "pregnancy" alongside other terms such as "Pregnancy and dose adjustment," "Pregnancy and therapeutic drug monitoring," "Pregnancy and PBPK," "Pregnancy and pharmacokinetics," and "Pregnancy and physiological changes."Results:The main information on TDM in pregnant women is available for antiepileptics, antipsychotics, antidepressants, antibiotics, antimalarials, and oncologic and immunosuppressive drugs.Conclusions:More data are needed to support informed benefit-risk decision making for the administration of drugs to pregnant women. TDM and/or pharmacokinetic studies could ensure that pregnant women receive an adequate dosage of an active drug. Mechanistic modeling approaches potentially could increase our knowledge about the pharmacotherapy of this special population, and they could be used to better design dosage regimens. (AU)

• Processo FAPESP: 16/23938-2 - Influência da gravidez associada com HIV na atividade do transportador OATP em pacientes em tratamento com Efavirenz
• Beneficiário: Fernanda de Lima Moreira
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 18/05616-3 - Farmacocinética clínica em doenças infecciosas
• Beneficiário: Vera Lúcia Lanchote
• Modalidade de apoio: Auxílio à Pesquisa - Temático