@article{477c84be9fa14446a3b312951197725b,
title = "The teratogenesis risk associated with antiseizure medication duotherapy in women with epilepsy",
abstract = "Purpose: To investigate rates of occurrence of pregnancies associated with a foetal malformation (FM pregnancy rates) following simultaneous intrauterine exposure to two antiseizure medications in 524 pregnancies in women with epilepsy from the Australian Pregnancy Register who were treated simultaneously with various combinations and dosages of two antiseizure medications (duotherapy). Results: FM pregnancy rates tended to be higher in those exposed simultaneously to two antiseizure medications, each of which was a statistically significant teratogen (valproate, topiramate, or carbamazepine), than when there was exposure to only one such teratogen. When there was exposure to only one such teratogen together with clonazepam or levetiracetam, for neither of which there was statistically significant evidence of heightened teratogenicity, the FM pregnancy rates also tended to be higher, but less so. When lamotrigine was the other component of the duotherapy with an established teratogen, FM pregnancy rates tended to be lower than that for the teratogen used as monotherapy. Conclusion: Leaving aside issues in relation to seizure control, our data suggest that it would be best to avoid using established teratogenic antiseizure medications (carbamazepine, valproate and topiramate) in combination with each other due to the increased FM risks. When combining an established teratogenic medication with a less teratogenic one, i.e. lamotrigine, levetiracetam or clonazepam, lamotrigine appears to be the safer option.",
keywords = "Carbamazepine, Drug pairs, Foetal malformation, Lamotrigine, Pregnancy, Topiramate, Valprote",
author = "Vajda, {Frank J.E.} and O'Brien, {Terence J.} and Graham, {Janet E.} and Hitchcock, {Alison A.} and Piero Perucca and Lander, {Cecilie M.} and Eadie, {Mervyn J.}",
note = "Funding Information: We are grateful to professional and lay colleagues and bodies for referring patients to the Australian Pregnancy Register, and to the Scientific Advisory Board and the Ethical Research Committees of St. Vincent's Hospital, Monash Medical Centre, the Royal Melbourne Hospital and other institutions for their successive ethics oversight of the Australian Pregnancy Register. The Epilepsy Society of Australia, at various stages of its existence, the Royal Melbourne Hospital Neuroscience Foundation, Epilepsy Action Australia, the Australian NHMRC and the pharmaceutical companies Sanofi-Aventis, UCB Pharma, Janssen-Cilag, Novartis, Sci-Gen, Eisai and Genzyme have provided financial support for the Australian Pregnancy Register. Funding Information: We are grateful to professional and lay colleagues and bodies for referring patients to the Australian Pregnancy Register, and to the Scientific Advisory Board and the Ethical Research Committees of St. Vincent{\textquoteright}s Hospital, Monash Medical Centre, the Royal Melbourne Hospital and other institutions for their successive ethics oversight of the Australian Pregnancy Register. The Epilepsy Society of Australia , at various stages of its existence, the Royal Melbourne Hospital Neuroscience Foundation , Epilepsy Action Australia , the Australian NHMRC and the pharmaceutical companies Sanofi-Aventis, UCB Pharma, Janssen-Cilag, Novartis , Sci-Gen, Eisai and Genzyme have provided financial support for the Australian Pregnancy Register. Publisher Copyright: {\textcopyright} 2024 Elsevier B.V.",
year = "2024",
month = feb,
doi = "10.1016/j.eplepsyres.2024.107316",
language = "English",
volume = "200",
journal = "Epilepsy Research",
issn = "0920-1211",
publisher = "Elsevier",
}