Drug interactions at the human placenta: what is the evidence?

Pregnant women (and their fetuses) are treated with a significant number of prescription and nonprescription medications. Interactions among those drugs may affect their efficacy and toxicity in both mother and fetus. Whereas interactions that result in altered drug concentrations in maternal plasma...

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Main Authors: Miriam eRubinchik-Stern, Sara eEyal
Format: Article
Language:English
Published: Frontiers Media S.A. 2012-07-01
Series:Frontiers in Pharmacology
Subjects:
Online Access:http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00126/full
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author Miriam eRubinchik-Stern
Sara eEyal
author_facet Miriam eRubinchik-Stern
Sara eEyal
author_sort Miriam eRubinchik-Stern
collection DOAJ
description Pregnant women (and their fetuses) are treated with a significant number of prescription and nonprescription medications. Interactions among those drugs may affect their efficacy and toxicity in both mother and fetus. Whereas interactions that result in altered drug concentrations in maternal plasma are detectable, those involving modulation of placental transfer mechanisms are rarely reflected by altered drug concentrations in maternal plasma. Therefore, they are often overlooked. Placental-mediated interactions are possible because the placenta is not only a passive diffusional barrier, but also expresses a variety of influx and efflux transporters and drug metabolizing enzymes. Current data on placental-mediated drug interactions are limited. In rodents, pharmacological or genetic manipulations of placental transporters significantly affect fetal drug exposure. In contrast, studies in human placentae suggest that the magnitude of such interactions is modest in most cases. Nevertheless, under certain circumstances, such interactions may be of clinical significance. This review describes currently known mechanisms of placental-mediated drug interactions and the potential implications of such interactions in humans. Better understanding of those mechanisms is important for minimizing fetal toxicity from drugs while improving their efficacy when directed to treat the fetus.
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spelling doaj.art-6a30724217f64528ac61974d1e13f7b42022-12-21T19:20:12ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122012-07-01310.3389/fphar.2012.0012627396Drug interactions at the human placenta: what is the evidence?Miriam eRubinchik-Stern0Sara eEyal1Hebrew University of JerusalemHebrew University of JerusalemPregnant women (and their fetuses) are treated with a significant number of prescription and nonprescription medications. Interactions among those drugs may affect their efficacy and toxicity in both mother and fetus. Whereas interactions that result in altered drug concentrations in maternal plasma are detectable, those involving modulation of placental transfer mechanisms are rarely reflected by altered drug concentrations in maternal plasma. Therefore, they are often overlooked. Placental-mediated interactions are possible because the placenta is not only a passive diffusional barrier, but also expresses a variety of influx and efflux transporters and drug metabolizing enzymes. Current data on placental-mediated drug interactions are limited. In rodents, pharmacological or genetic manipulations of placental transporters significantly affect fetal drug exposure. In contrast, studies in human placentae suggest that the magnitude of such interactions is modest in most cases. Nevertheless, under certain circumstances, such interactions may be of clinical significance. This review describes currently known mechanisms of placental-mediated drug interactions and the potential implications of such interactions in humans. Better understanding of those mechanisms is important for minimizing fetal toxicity from drugs while improving their efficacy when directed to treat the fetus.http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00126/fullDrug InteractionsP-GlycoproteinPlacentaPregnancyBreast cancer resistance proteinMaternal-fetal pharmacology
spellingShingle Miriam eRubinchik-Stern
Sara eEyal
Drug interactions at the human placenta: what is the evidence?
Frontiers in Pharmacology
Drug Interactions
P-Glycoprotein
Placenta
Pregnancy
Breast cancer resistance protein
Maternal-fetal pharmacology
title Drug interactions at the human placenta: what is the evidence?
title_full Drug interactions at the human placenta: what is the evidence?
title_fullStr Drug interactions at the human placenta: what is the evidence?
title_full_unstemmed Drug interactions at the human placenta: what is the evidence?
title_short Drug interactions at the human placenta: what is the evidence?
title_sort drug interactions at the human placenta what is the evidence
topic Drug Interactions
P-Glycoprotein
Placenta
Pregnancy
Breast cancer resistance protein
Maternal-fetal pharmacology
url http://journal.frontiersin.org/Journal/10.3389/fphar.2012.00126/full
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