Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics.

Details

Serval ID
serval:BIB_29716
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics.
Journal
Journal of the American College of Cardiology
Author(s)
Oudijk M.A., Ruskamp J.M., Ververs F.F., Ambachtsheer E.B., Stoutenbeek P., Visser G.H., Meijboom E.J.
ISSN
0735-1097
Publication state
Published
Issued date
2003
Volume
42
Number
4
Pages
765-770
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
OBJECTIVES: The aim of this study was to investigate the pharmacokinetics and pharmacodynamics of sotalol in the treatment of fetal tachycardia. BACKGROUND: Maternally administered, intrauterine therapy of fetal tachycardia is dependent on the transplacental passage of the antiarrhythmic agent. METHODS: In a prospective study of patients treated for fetal tachycardia with sotalol, concentrations of sotalol were determined in maternal and umbilical blood and in amniotic fluid, and the relationship between these concentrations and the occurrence of conversion to sinus rhythm was investigated. RESULTS: Eighteen fetal patients were studied, nine with atrial flutter and nine with supraventricular tachycardia. Fourteen were treated with sotalol; 13 converted to sinus rhythm, of whom 2 relapsed. There was one intrauterine death. Four patients were treated with sotalol and digoxin, of whom two were treated successfully. Mean birth weight was 3,266 g. The daily maternal sotalol dose was linearly related to the maternal plasma concentration. The mean fetal/maternal sotalol plasma concentration was 1.1 (range 0.67 to 2.87, SD 0.63), and the mean amniotic fluid/fetal blood ratio of sotalol was 3.2 (range 1.28 to 5.8, SD 1.4). The effectiveness of sotalol therapy could not be extrapolated from maternal blood levels. CONCLUSIONS: Sotalol is a potent antiarrhythmic agent in the treatment of fetal tachycardia. The placental transfer is excellent. Sotalol accumulates in amniotic fluid but not in the fetus itself. Therefore it seems that renal excretion in the fetus is efficient and greater than the oral absorption by fetal swallowing. The maternal blood level is not a reliable predictor of the chances of success of therapy. Sotalol is not associated with fetal growth restriction.
Keywords
Amniotic Fluid/chemistry, Anti-Arrhythmia Agents/therapeutic use, Dose-Response Relationship, Drug, Female, Fetal Blood/chemistry, Fetal Diseases/drug therapy, Humans, Maternal-Fetal Exchange, Placenta/physiology, Pregnancy, Prospective Studies, Sotalol/therapeutic use, Tachycardia/complications, Tachycardia/drug therapy
Pubmed
Web of science
Create date
19/11/2007 12:27
Last modification date
20/08/2019 13:09
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