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Lamotrigine in pregnancytherapeutic drug monitoring in maternal blood, amniotic fluid, and cord blood

Paulzen, Michaela; Lammertz, Sarah E.a; Veselinovic, Tanjaa; Goecke, Tamme W.b; Hiemke, Christophc; Gründer, Gerharda

International Clinical Psychopharmacology: September 2015 - Volume 30 - Issue 5 - p 249–254
doi: 10.1097/YIC.0000000000000088
ORIGINAL ARTICLES
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This study is the first to measure and correlate lamotrigine concentrations in maternal blood, amniotic fluid, and umbilical cord blood and account for distribution of the drug between these three compartments. Concentrations of lamotrigine were measured in six mother–infant pairs at the time of delivery. Daily doses of lamotrigine ranged between 200 and 650 mg. Daily doses were correlated with maternal serum and umbilical cord blood concentrations, and serum levels were correlated with levels in amniotic fluid. Lamotrigine levels in serum correlated strongly with the lamotrigine levels in amniotic fluid (r=+0.986, P<0.001) and cord blood (r=+0.928, P=0.008). The penetration ratio into amniotic fluid was in a range between 0.31 and 0.75 (mean 0.58, SD 0.17); the penetration ratio into the fetal circulation, calculated on the basis of umbilical cord blood levels, was found to be in a range between 0.48 and 1.27 (mean 0.81, SD 0.28). Lamotrigine concentrations in amniotic fluid provided evidence that maternally administered lamotrigine is accessible to the fetus in a manner not previously appreciated. Furthermore, the penetration ratio into umbilical cord blood calculated here is in line with the largest study carried out so far to explore transplacental transfer.

aDepartment of Psychiatry, Psychotherapy and Psychosomatics and JARA – Translational Brain Medicine

bDepartment of Gynaecology and Obstetrics, RWTH Aachen University, Aachen

cDepartment of Psychiatry and Psychotherapy, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Mainz, Germany

Correspondence to Michael Paulzen, MD, Department of Psychiatry, Psychotherapy and Psychosomatics and JARA – Translational Brain Medicine, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany Tel: +49 241 80 89508; fax: +49 241 80 82401; e-mail: mpaulzen@ukaachen.de

Received March 25, 2015

Accepted May 19, 2015

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