Pregnancy valproic acid

The miscellaneous anticonvulsants are contraindicated in patients with known hypersensitivity to any of the dru. Carbamazepine is contraindicated in patients with bone marrow depression or hepatic or renal impairment and during pregnancy (Category D). Valproic acid is not administered to patients with renal impairment or during pregnancy (Category D). Oxcarbazepine (Trileptal), a miscellaneous anticonvulsant, may exacerbate dementia... 

The answer is d. (Katzung, pp 411, 1029.) An increased incidence of spina bifida may occur with the use of valproic acid during pregnancy Cardiovascular, orofacial, and digital abnormalities may also occur. The main issue with the use of phenobarbital or primidone (metabolite is phe-nobarbital) for the fetus is neonatal dependence on barbiturates. 

Adverse effects include anorexia, nausea, vomiting, diarrhoea and/or constipation, weight gain, skin rash hair loss, neutropenia, tremors and ataxia are occasionally reported. Valproic acid is contraindicated in liver disease, especially cirrhosis, pregnancy and hypersensitivity. 

It is best to avoid concomitant use of ivermectin and other drugs that enhance GABA activity, eg, barbiturates, benzodiazepines, and valproic acid. Ivermectin should not be used during pregnancy. Safety in children younger than 5 years has not been established. 

Iqbal MM, Sohhan T, Mahmud SZ The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation. J Toxicol Clin Toxicol 2001 39 381. [PMID 11527233]... 

Rodriguez-Pinilla E, Arroyo I, FondeviUa J, Garcia MJ, Martinez-Frias ML. Prenatal exposure to valproic acid during pregnancy and limb deficiencies a case-control study. Am J Med Genet 2000 90(5) 376-81. 

Valproic acid is associated with a 2- to 3-fold increase in the frequency of congenital anomalies. A 10- to 20-fold increase in the risk of spina bifida in infants born to women treated with valproic acid compared with the general population has been reported. The absolute risk of spina bifida in exposed infants appears to be 1% to 2%. Other problems associated with use in pregnancy include intrauterine growth retardation, hypoglycemia, and coagulopathy. Some investigators have reported developmental delays in up to 90% of children with prenatal exposure to valproic acid. ... 

Partial—simple or complex Valproic acid, phenytoin, carbarn azepine Phenobarbital in pregnancy most newer drugs are also effective... 

Valproic acid, carbamazepine, and in pregnancy clonazepam or gabapentin. 

The use ofLt in early pregnancy may be associated with an increase in the incidence of cardiovascular anomalies of the newborn, especially Ebstein s malformation. The antimanic anticonvulsants valproic acid and probably carbamazepine have an associated risk of irreversible spina bifida that may exceed 1/100, and so do not represent a rational alternative for pregnant women. In balancing the risk versus benefit of using LG in pregnancy, it is important to evaluate the risk of untreated manic-depressive disorder and to consider conservative measures, such as deferring intervention until symptoms arise or using a safer treatment, such as a neuroleptic or ECT... 

Valproic acid often causes gastrointestinal distress and is potentially hepatotoxic. The use of this drug in pregnancy has been associated with teratogenicity (neural tube defects). Valproic acid inhibits the metabolism of barbiturates marked CNS depression may result if such drugs are given concomitantly. Peripheral neuropathy, in the form of diminished deep tendon reflexes in the lower extremities, is associated with chronic use of phenytoin. The answer is (C). 

---