Antimalarial drugs in pregnancy: a review.
In this review we examine the available information on the safety of antimalarials in pregnancy, from both animal and human studies. The antimalarials that can be used in pregnancy include (1) chloroquine, (2) amodiaquine, (3) quinine, (4) azithromycin, (5) sulfadoxine-pyrimethamine, (6) mefloquine, (7) dapsone-chlorproguanil, (8) artemisinin derivatives, (9) atovaquone-proguanil and (10) lumefantrine. Antimalarial drugs that should not be used in pregnancy including (1) halofantrine, (2) tetracycline/doxycycline, and (3) primaquine. There are few studies in humans on the pharmacokinetics, safety and efficacy of antimalarials in pregnancy. This is because pregnant women are systematically excluded from clinical trials. The absence of adequate safety data, especially in the first trimester, is an important obstacle to developing treatment strategies. The pharmacokinetics of most antimalarial drugs are also modified in pregnancy and dosages will need to be adapted. Other factors, including HIV status, drug interactions with antiretrovirals, the influence of haematinics and host genetic polymorphisms may influence safety and efficacy. For these reasons there is an urgent need to assess the safety and efficacy of antimalarial treatments in pregnancy, including artemisinin based combination therapies.
Nosten
François
F
Shoklo Malaria Research Unit, 63110 Mae Sot, Thailand. SMRU@tropmedres.ac
McGready
Rose
R
d'Alessandro
Umberto
U
Bonell
Ana
A
Verhoeff
Francine
F
Menendez
Clara
C
Mutabingwa
Thenonest
T
Brabin
Bernard
B
D000818:Animals; D000962:Antimalarials / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*
D000962:Antimalarials