Title:Hepatic Elimination of Drugs in Gestational Diabetes
Volume: 13
Issue: 1
Author(s): Claudio Daniel Gonzalez, Jorge Alvarinas, Ricardo Bolanos and Guillermo Di Girolamo*
Affiliation:
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Farmacología y Toxicología, Centro de Vigilancia y Seguridad de Medicamentos, 1053 Buenos Aires,Argentina
Keywords:
Hepatic clearance, drugs, gestational diabetes, intestinal microbiome, exogenous chemical agents, hepatocytes.
Abstract: Background: The liver is the major metabolic clearance organ for chemical agents from
the human body.
Pregnancy is associated with several physiological changes that may affect one or more of these
factors, and also induces changes in the hepatic clearance of certain drugs. The aim of this paper
was to review some of the currently available information in the field to provide some insights
about the relevance of these changes on the clearance of some drugs.
Methods: A comprehensive literature search was carried out to identify eligible studies from
MEDLINE/PubMed, EMBASE and SCIELO databases through 1970 first semester.
Results: Gestational Diabetes Mellitus (GDM) is a frequent disease commonly associated with
other entities as obesity, hypertension, dyslipidemia, non-alcoholic fatty liver disease, prothrombotic
conditions, changes in intestinal microbiome. These entities, together with the glycemic
fluctuations associated with GDM might affect the determinants of the hepatic clearance (hepatic
blood flow, the unbound fraction of drugs, and the hepatic intrinsic clearance).
GDM is frequently associated with multi-drug treatments. While many of these drugs are cleared
by the liver, little is known about the clinical relevance of these GDM associated pharmacokinetic
changes.
Conclusion: Considering the frequency of the disease and the effects that these pharmacokinetic
changes might have on the mother and child, the need for further research seems advisable. In the
meantime, cautious clinical judgment in the management of drug administration in women affected
by this disease is recommended.
