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Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Xanthines and methylxanthines have unusual pharmacokinetics during pregnancy, and it important to note their unusual behavior. Xanthines tend to increase their steady-state concentration during pregnancy, and this effect is magnified during the third trimester. Accordingly, maintaining desired plasma concentrations requires different doses throughout pregnancy, and physicians should anticipate a decrease in doses required as the pregnancy advances because plasma concentrations increases.
Neonatal diseases I
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Since the 1970s, methylxanthines have been used to treat apnea of prematurity. Over the years, various methylxanthines have been used including theophylline, amino-phylline, and caffeine. Currently, caffeine is most commonly used due to a wide therapeutic window with fewer risks of side effects. We do not have to draw levels with caffeine compared with theophylline and aminophylline. The mechanism of action of methylxanthines is unknown, but they have been shown to decrease apneic events, increase minute volumes, improve respiratory system compliance, reduce diaphragmatic fatigue, and act as a diuretic (6,12,14). In fact those infants treated with caffeine required mechanical ventilation, noninvasive ventilation, and/or supplemental oxygen therapy for 1 week less on average compared with those infants treated with placebo. Those infants treated with caffeine, however, did show slower weight gain compared with the placebo group at least initially (7,13,14).
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The most frequent adverse effects observed with methylxanthines are: irritability, tachycardia, high blood pressure, increased gastric aspiration and gastrooesophageal reflux, polyuria and excessive natriuria [8,14–17]. They usually only require a dose reduction. The role of methylxanthines in the occurrence of necrotising enterocolitis remains controversial [18]. Dramatic adverse effects have been reported with overdoses (plasma drug concentrations ranging from 26 to 346 mg/1): tachypnoea, opisthotonos and seizures [19–21]. The question of potential long-term adverse effects on cerebral and neuronal development remains open, since these drugs are known to reduce cerebral blood flow in animals and adult humans [22,23] and to antagonise adenosine, which is cerebro-protective against hypoxic insult [1]. Studies on cerebral blood flow in infants given theophylline or caffeine have resulted in conflicting conclusions [24,25]. A prospective controlled study of 21 children treated for apnoeas in the neonatal period has shown that caffeine given at conventional doses had no apparent harmful effects 18 months to 3 years later, in term of growth and psychomotor development.
Sleep-promoting activity of lotus (Nelumbo nucifera) rhizome water extract via GABAA receptors
Published in Pharmaceutical Biology, 2022
Yejin Ahn, Singeun Kim, Chunwoong Park, Jung Eun Kim, Hyung Joo Suh, Kyungae Jo
Furthermore, to evaluate the sleep-promoting activity of LE, caffeine was administered to rats to develop the insomnia model. Caffeine has been used with methylxanthine compounds to increase arousal and induce cortical activation (Bonnet and Arand 1992; Nehlig et al. 1992). Caffeine has been reported to induce arousal by blocking the action of adenosine receptors and lead to insomnia by reducing slow waves (Bonnet and Arand 1992; Panagiotou et al. 2020). In this study, the delta power in NREM corresponding to the slow wave was significantly decreased in the group treated with caffeine alone compared to the NC group (Figure 5). However, administration of 120 and 150 mg/kg LE significantly increased the NREM sleep time in the respective LE-group compared to the caffeine control group. In the caffeine-induced insomnia model, oral administration of LE increased sleep time, which can be attributed to an increase in NREM sleep time.
Is there a role for phosphodiesterase inhibitors in the treatment of male subfertility?
Published in Human Fertility, 2022
Abigail Sharpe, Harish Bhandari, David Miller
Notwithstanding the obvious disadvantages of unwanted systemic effects, oral supplementation with methylxanthines has been shown to improve semen parameters (Merino et al., 1997; Safarinejad, 2011) (see below). PF administration at 800 mg to 1200 mg per day improved sperm motility, with results lasting up to 12 weeks after cessation of the drug (Merino et al., 1997; Safarinejad, 2011). There is no data on reproductive outcomes or impact on sperm DNA damage with oral supplementation or any comparison of the advantages and disadvantages of oral supplementation compared with direct stimulation of sperm. Potential adverse side-effects of oral supplementation with non-selective PDEI such as PF include hypotension, arrhythmias, headaches, nausea and diarrhoea (British National Formulary, 2019). Reassuringly, although some nausea, vomiting and dyspepsia were reported, no participants on a randomised control trial of PF administration (n = 127) discontinued their medication due to these side effects (Safarinejad, 2011).
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Aminophylline, due to its low therapeutic index, may induce seizure activity in even non-epilepsy patients. Experimental data indicate that, when given in subconvulsive doses, aminophylline reduced the anticonvulsant activity of a great number of AEDs, and generally, this negative effect was present after chronic administration of the methylxanthine. Moreover, chronic administration resulted in the further reduction in the anticonvulsant action of some AEDs. Only gabapentin was found resistant to the untoward activity of aminophylline. It is thus extremely important to note that administration of methylxanthines in patients with epilepsy may result in an increased seizure frequency. Perhaps, some alternative drugs for obturatory lung diseases should be considered in epilepsy patients.