phgenomicsФармакогенетика и фармакогеномикаPharmacogenetics and Pharmacogenomics2588-05272686-8849LLC "Izdatelstvo OKI"10.37489/2588-0527-2022-1-6-14phgenomics-241Research ArticleФАРМАКОКИНЕТИЧЕСКИЕ ИССЛЕДОВАНИЯPHARMACOKINETICS STUDYГенетические и физиологические предпосылки к индивидуальному воздействию селективных ингибиторов обратного захвата серотонина во время беременности и грудного вскармливанияGenetic and physiological factors predisposing to individual selective serotonine reuptake inhibitors exposure during pregnancy and breast feedinghttps://orcid.org/0000-0002-5251-5319ЗагородниковаК. А.ZagorodnikovaK. A.

к. м. н., зав. отделом клинической фармакологии

Санкт-Петербург

Cand. Sci. (Med.), PhD, Head of the Department of ClinicalPharmacology

St. Petersburg

ksenia.zagorodnikova@gmail.comНовиковаС. Ю.NovikovaS. Yu.

студент

Санкт-Петербург

Student

St. Petersburg

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution “V. A. Almazov National Medical Research Center” of the Ministry of Health of the Russian FederationRussian Federation20222702202301614Copyright © Загородникова К.А., Новикова С.Ю., 20232023Загородникова К.А., Новикова С.Ю.Zagorodnikova K.A., Novikova S.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmacogenetics-pharmacogenomics.ru/jour/article/view/241

Тревожные и депрессивные расстройства очень широко распространены во время беременности. В послеродовом периоде они могут усугубляться в результате гормональных изменений, происходящих с женщиной, и приводить к фатальным последствиям, перерастая в большую депрессию. Наиболее распространённой группой лекарственных средств для амбулаторного лечения расстройств тревожно-депрессивного спектра являются селективные ингибиторы обратного захвата серотонина. В связи с отсутствием клинических исследований, которые бы проводились с участием беременных и кормящих, об эффективности и безопасности этой группы можно судить только на основании данных, полученных в реальной жизни. Ввиду того, что, очевидно, все представители группы имеют приблизительно схожий профиль эффективности и безопасности, выбор одного из представителей может вызывать затруднения. В нашей статье мы провели анализ влияния генетических факторов, влияющих на фармакокинетику этих препаратов, с целью выявления наиболее значимых из них и указания на тех представителей, которые могут характеризоваться большей фармакокинетической стабильностью и, с точки зрения фармакокинетики, могут оказаться сравнительно более клинически надёжными и безопасными для женщины и плода или новорождённого. Среди факторов, которые мы описываем, важное значение имеют данные об ожидаемых изменениях концентраций препаратов по мере прогрессирования беременности, вероятность предсуществующих, генетически обусловленных, индивидуальных особенностей фармакокинетики, потенциал межлекарственных взаимодействий, а также известные сведения о проникновении лекарств в организм ребёнка при полном грудном вскармливании.

Anxiety and depression are very common during pregnancy. Post-partum period may frequently be complicated by more pro found depression due to hormonal changes, which may lead to fatal consequences for both — the mother and the child. The most commonly prescribed group of drugs for ambulatory patient care is the group of selective serotonine reuptake inhibitors (SSRIs). Absence of clinical trials where pregnant or breast-feeding women were among the participants has led to the situation when we can rule out effectiveness and safety of this drug class for pregnant and breastfeeding women based only on real-life studies. Current know ledge let us conclude that all individual group representatives have comparable efficacy and safety profile. The choice of a single agent to use may be difficult. In our paper we analyzed genetic and non-genetic factors, that may be important for individual pharmacokinetics of various SSRIs in order to reveal the most relevant for each group representative, and to determine those drugs with the most stable pharmacokinetic parameters in pregnancy. We also tried to define the drugs that may theoretically be more clinically reliable and safe for the fetus and the newborn. We considered such factors as expected changes in drug concentration during various periods in pregnancy, probable impact of pre-existing pharmacogenetic factors of individual drug exposure, potential for drug-drug interactions, and current knowledge about the extent of drug distribution in the blood of the newborns during breastfeeding

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The authors declare that there are no conflicts of interest present.