Premium
Nicardipine in pre‐eclamptic patients: placental transfer and disposition in breast milk
Author(s) -
Bartels PA,
Hanff LM,
Mathot RAA,
Steegers EAP,
Vulto AG,
Visser W
Publication year - 2007
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.01200.x
Subject(s) - nicardipine , medicine , umbilical cord , breast milk , fetus , dose , anesthesia , venous blood , placenta , endocrinology , pregnancy , chemistry , blood pressure , biology , anatomy , biochemistry , genetics
To assess the safety risks to the fetus and neonate caused by maternal use of nicardipine in pre‐eclamptic patients, we evaluated the placental transfer and the transfer to breast milk after maternal intravenous administration of nicardipine. In ten pre‐eclamptic subjects, nicardipine concentrations of maternal blood (P) and both arterial and venous umbilical cord blood samples (U arterial and U venous ) were assessed, and the U/P ratio was calculated as an indication of placental transfer. We found a median transfer of 0.15 (U arterial /P, range 0.05–0.22) and 0.17 (U venous /P, range 0.023–0.22). The highest umbilical cord concentration found after maternal dosage of 4.5 mg/hour was 18 ng/ml, which can be considered as subtherapeutic. Therefore, adverse fetal reactions caused by a direct pharmacological effect of nicardipine are unlikely to occur. Nicardipine levels were determined in 34 breast milk samples of seven women, and were found to be undetectable in 82% of the samples. In six breast milk samples of four different women, nicardipine levels (ranging from 5.1 to 18.5 ng/ml) were detectable during maternal nicardipine dosages ranging from 1 to 6.5 mg/hour. The maximum possible exposure of a neonate to nicardipine was calculated to be less than 300 ng/day, which is an insignificant fraction of therapeutic dosages used in neonates. In conclusion, the exposure of a fetus and neonate to nicardipine through placental transfer and disposition in breast milk expression is low.