6
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Comment on the case report “Possible association between acetazolamide administration during pregnancy and multiple congenital malformations”

      1 , 2 , 1 , 2

      Drug Design, Development and Therapy

      Dove Medical Press

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Dear editor We read with interest the case report in the April 2016 issue of Drug Design Development and Therapy by Al-Saleem and Al-Jobair.1 The authors have presented a boy with oligodontia, ectrodactyly, and syndactyly who was exposed to acetazolamide in utero. Although the discussion was well balanced with a mention to possible confounders such as family and obstetric history and lack of a genetic analysis, two important papers regarding prenatal exposure to acetazolamide were not cited by the authors. In this letter, we would like to mention these studies in order to expand the current context provided by Al-Saleem and Al-Jobair.1 Scott et al suggested that non-rodent species such as monkeys2 were shown to be resistant to the forelimb reduction inducing effect of acetazolamide that was seen in the offspring of rodents3,4 (mice, rat, hamster) which were prenatally exposed to this agent. Low carbonic anhydrase enzyme activity in this species during the sensitive period of development or poor bioavailability/passage of the drug was proposed as the mechanism of resistance to the aforementioned effects.2 Heinonen et al5 have evaluated and presented the outcomes of the largest number of pregnant women exposed to acetazolamide during their pregnancies. The authors included 1,024 mothers who used acetazolamide anytime during pregnancy and reported 18 infants with a malformation, a result that was not higher than the expected value (18.06) (relative risk 1.00, 95% confidence interval 0.59−1.57). However, the number of the exposures in the sensitive period of development was low; there were only 13 mother and child pairs who were exposed to carbonic anhydrase inhibitors (12 pairs to acetazolamide and one pair to ethoxyzolamide) during 1−4 gestation months and none of them had any malformation. Finally, we are in agreement with the suggestion of Al-Saleem and Al-Jobair1 regarding the verification of the absence of pregnancy before initiating acetazolamide to women of reproductive age. Nevertheless, the successful use of acetazolamide has been described in a limited number of pregnant women with intracranial hypertension.6,7 As previously remarked by Falardeau et al, clinicians should be aware that “The avoidance of acetazolamide during the first trimester has very little medical justification and is mainly guided by medical–legal rationale”.7 Therefore, each pregnant patient should be counseled individually with a careful risk−benefit assessment regarding the necessity of acetazolamide treatment during pregnancy in order to ensure the appropriate management of their diseases.

          Related collections

          Most cited references 7

          • Record: found
          • Abstract: found
          • Article: not found

          The use of acetazolamide during pregnancy in intracranial hypertension patients.

          Acetazolamide is the mainstay of medical therapy for idiopathic intracranial hypertension (IIH). Its use in pregnant women has not been recommended because of reported teratogenic effects in rodents and rabbits. However, the safety of acetazolamide use during human pregnancy remains unclear. We report the pregnancy and offspring outcomes in women with intracranial hypertension (IH) treated with acetazolamide during pregnancy.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Effects of maternal acetazolamide treatment on body weights and incisor development of the fetal rat.

             N Kojima,  M Naya,  T Makita (1999)
            The incisor development of fetal rats on gestation day 19 was well correlated with their fetal weights. The number of odontoblasts in the mandibular incisors, an index of incisor development, increased more than that of the maxillary incisors with increase in fetal body weights. Maternal acetazolamide treatments were observed to suppress the mean fetal weight and to retard incisor development. A smaller incisor size, a thinner predentin layer, and fewer odontoblasts were characteristic of the acetazolamide group. There was also a good correlation between the fetal weights and the number of odontoblasts in the acetazolamide group. From these results, we postulated that the retarded incisor development of the fetal rats caused by the maternal acetazolamide treatment was related to their suppressed fetal weights. However, the regression coefficient of the fetal weights and the number of odontoblasts in the acetazolamide group was smaller than that of the vehicle control group. It may indicate that retarded incisor development in response to maternal acetazolamide treatment is to some extent independent of suppressed fetal weight.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Acetazolamide: maternal toxicity, pattern of malformations, and litter effect

                Bookmark

                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2016
                10 November 2016
                : 10
                : 3681-3683
                Affiliations
                [1 ]Department of Pharmacology, School of Medicine, Izmir Katip Celebi University
                [2 ]Terafar – Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
                [1 ]Dental Department, Prince Sultan Military Medical City
                [2 ]Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
                Author notes
                Correspondence: Yusuf Cem Kaplan, Izmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi, Klinik Farmakoloji ve Toksikoloji Birimi, 35360, Karabağlar, Izmir, Turkey, Tel +90 232 244 4444 ext 1798, Fax +90 232 245 0438, Email seawise@ 123456gmail.com
                Correspondence: Asma M Al-Jobair, Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia, Tel +96 611 467 6648, Email aaljobair@ 123456ksu.edu.sa
                Article
                dddt-10-3681
                10.2147/DDDT.S122748
                5108495
                © 2016 Keskin-Arslan and Kaplan. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Letter

                Pharmacology & Pharmaceutical medicine

                Comments

                Comment on this article