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Özen B, Us Z, Toplu A, Vizdiklar C, Selalmaz Y, Çulpan Y, Aşik ZT, Kaşkal M, Açikgöz BN, Gülçebi Idriz Oğlu M, Karaalp A, Onat F, Yananli HR, Gülhan R. Favipiravir does not appear to be a major teratogen: Case series from Türkiye. J Gynecol Obstet Hum Reprod 2024; 53:102693. [PMID: 37984519 DOI: 10.1016/j.jogoh.2023.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Favipiravir has gained attention during the Coronavirus Disease-2019 pandemic due to its potential antiviral effect against Severe Acute Respiratory Syndrome Coronavirus-2. Favipiravir has been identified as a teratogen in animal studies, but there is limited human data. We aimed to evaluate the pregnancy outcomes of women exposed to favipiravir during the pandemic. MATERIAL AND METHODS Pregnant women who were exposed to favipiravir and applied to Marmara University School of Medicine Medical Pharmacology Outpatient Clinic Teratology Information Service between December 2020-September 2021 are included in the study. The demographic information, medical and obstetric histories of patients were acquired during admission, the outcomes of the pregnancies and the characteristics of the infants were gathered by regular phone calls. The infants whose parents consented were evaluated by a pediatrician for general well-being and congenital anomalies. RESULTS 22 pregnant women were included in this study. 81.8 % received the recommended favipiravir dose (8000 mg in 5 days), in the first trimester. Two patients were lost to follow-up, there was one elective termination and 19 live births. Congenital anomalies were found in 2 infants, one of whom had 9q34 duplication syndrome. Except for these, all newborns examined by the pediatrician were healthy. DISCUSSION Within a limited case series, a subset of the infants exposed to favipiravir prenatally were followed up to 1 year of age. Two infants exhibited congenital malformations that cannot be directly linked to favipiravir due to confounding variables. Considering the limited data published, favipiravir does not appear to be a major teratogen.
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Affiliation(s)
- Berna Özen
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Zeynep Us
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Aylin Toplu
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Caner Vizdiklar
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | | | - Yekta Çulpan
- Turkish Medicines and Medical Devices Agency, Ankara, Türkiye; Department of Medical Biology and Genetic, Institute of Health Sciences, Marmara University, Istanbul, Türkiye
| | - Zehranur Turgan Aşik
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Mert Kaşkal
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Büşra Nazli Açikgöz
- Unit of Pediatric Genetics, Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Türkiye
| | - Medine Gülçebi Idriz Oğlu
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Atila Karaalp
- Department of Medical Pharmacology, School of Medicine, Biruni University, Istanbul, Türkiye
| | - Filiz Onat
- Department of Medical Pharmacology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Hasan Raci Yananli
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Rezzan Gülhan
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye.
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Çulpan Y, Keçeci İ, Sandıkçı İ, Gökçe Ş, Göker H, Özyılmaz Yay N, Ergelen R, Akakın D, Gülhan R. Duration of Ciprofloxacin Use Is Important in the Development of Abdominal Aortic Aneurysm in a Rat Model. Anatol J Cardiol 2022; 26:810-817. [PMID: 35949127 PMCID: PMC9682552 DOI: 10.5152/anatoljcardiol.2022.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Recent findings suggest that fluoroquinolones, most prescribed antibiotic to treat various infections, have increased abdominal aortic aneurysm formation. We aimed to investigate the relation of the development of abdominal aortic aneurysm and the duration of ciprofloxacin use. METHODS Male Sprague-Dawley rats were divided into 2 groups to administer saline to the control groups and CaCl2 to the aneurysm groups. These groups were then divided into 3 subgroups: intraperitoneal saline, ciprofloxacin for 2 weeks, and ciprofloxacin for 4 weeks. At the end of 4 weeks, the diameter of abdominal aorta was determined by ultrasonography and animals were sacrificed to obtain abdominal aorta specimens. Elastic fiber fracture, tunica media layer thickness, and aortic tissue damage were evaluated histologically. RESULTS Aortic diameter of control-saline (2.15 mm ± 0.06), control-2 weeks (2.25 mm ± 0.06), and control-4 weeks (3.31 mm ± 0.09) ciprofloxacin groups was significantly different (P < .0001). Also, aortic diameter of aneurysm-saline (2.07mm ± 0.02), aneurysm-2 weeks ciprofloxacin (3.33 mm ± 0.64), and aneurysm-4 weeks ciprofloxacin (8.55 mm ± 1.70) groups showed significant increase in aortic diameter with increasing duration of ciprofloxacin use (P < .01). A significant difference was found between the control-saline (0.00 ± 0.00), control-2 weeks (1.50 ± 0.33), and control-4 weeks ciprofloxacin groups (1.57 ± 0.20) in the histological aneurysm scores (P < .001). Aortic tunica media thickness did not change between control-saline and control-ciprofloxaci n groups (P > .05). CONCLUSION The study showed that ciprofloxacin caused injury in the aortic wall but not a significant change in the thickness of the aortic tunica media layer. The duration of ciprofloxacin use was important in the development of aneurysm and aneurysm severity.
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Affiliation(s)
- Yekta Çulpan
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - İrem Keçeci
- Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - İrem Sandıkçı
- Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Şeyda Gökçe
- Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Hande Göker
- Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Nagehan Özyılmaz Yay
- Department of Histology and Embryology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Rabia Ergelen
- Department of Radiology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Dilek Akakın
- Department of Histology and Embryology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Rezzan Gülhan
- Department of Medical Pharmacology, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Kaşkal M, Aşık ZNT, Kale BY, Günal D, İdrisoğlu MG, Akdaş S, Gülhan R. Brief communication: A case of cyclophosphamide exposure in the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 2022; 272:262-263. [PMID: 35341650 DOI: 10.1016/j.ejogrb.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Mert Kaşkal
- Department of Pharmacology, Marmara University School of Medicine, Istanbul, Turkey.
| | | | - Burçin Yorgancı Kale
- Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Günal
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Sena Akdaş
- Cumhuriyet Family Medicine Center, Çanakkale, Turkey
| | - Rezzan Gülhan
- Department of Pharmacology, Marmara University School of Medicine, Istanbul, Turkey.
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Gülhan R, Eryüksel E, Gülçebi İdriz Oğlu M, Çulpan Y, Toplu A, Kocakaya D, Tigen E, Ertürk Şengel B, Sili U, Olgun Yıldızeli Ş, Balcan MB, Elçi A, Bulut C, Karaalp A, Yananlı HR, Güner AE, Hatipoğlu M, Karakurt S, Korten V, Ratnaraj N, Patsalos P, Ay P, Onat F. Pharmacokinetic characterization of favipiravir in patients with COVID-19. Br J Clin Pharmacol 2022; 88:3516-3522. [PMID: 35014080 DOI: 10.1111/bcp.15227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/17/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day-2 and Day-4 of the therapy. Laboratory findings of the patients (n=21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C0-trough ) on Day-2 was 21.26 (IQR, 8.37-30.78) μg/mL whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) μg/mL on Day-4, the area under the concentration versus time curve decreased by 68.5%. Day-2-C0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.
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Affiliation(s)
- Rezzan Gülhan
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Emel Eryüksel
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Yekta Çulpan
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aylin Toplu
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Derya Kocakaya
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tigen
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Buket Ertürk Şengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uluhan Sili
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Şehnaz Olgun Yıldızeli
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Mehmet Baran Balcan
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Abdullah Elçi
- Istanbul Health Directorate Public Health Laboratory-3, Istanbul, Turkey
| | - Cenk Bulut
- Istanbul Health Directorate Public Health Laboratory-3, Istanbul, Turkey
| | - Atila Karaalp
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hasan Raci Yananlı
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | - Sait Karakurt
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Neville Ratnaraj
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Philip Patsalos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Pınar Ay
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Filiz Onat
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Medical Pharmacology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Tezcan K, Yananli HR, Demirkapu MJ, Gören MZ, Sakalli HE, Colombo G, Gülhan R. The effect of telmisartan, an angiotensin receptor blocker, on alcohol consumption and alcohol-induced dopamine release in the nucleus accumbens. Alcohol 2021; 96:73-81. [PMID: 34419631 DOI: 10.1016/j.alcohol.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
Alcohol use disorder remains a major health problem. The mesocorticolimbic dopaminergic system, including the nucleus accumbens region and multiple neural circuits, is involved in its complex underlying mechanism. For instance, alcohol intake stimulates the central and peripheral renin-angiotensin system and increases angiotensin II levels, which predominantly affect angiotensin 1 receptors both in the periphery and in the brain. In this study, we aimed to investigate the effects of the intracerebroventricularly-administered angiotensin 1 receptor blocker telmisartan on the alcohol consumption of male Sardinian alcohol-preferring (sP) rats and on the alcohol-induced dopamine levels in the nucleus accumbens region in Wistar rats. Acute intracerebroventricular administration of telmisartan (100 nM) reduced the alcohol intake for 24 hours without affecting food and water consumption in sP rats. Acute intracerebroventricular injection of the opioid receptor antagonist naloxone (75 nM), tested as a reference compound, also reduced the alcohol consumption in sP rats; however, naloxone's effect lasted only for 30 minutes. In microdialysis experiments, telmisartan administered intracerebroventricularly did not change dopamine levels in the nucleus accumbens that had been induced by acute intraperitoneal alcohol administration in Wistar rats. According to these results, further studies are needed to elucidate the role of the renin-angiotensin system on alcohol use disorder pathophysiology.
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Yananli HR, Demirkapu MJ, Sakallı HE, Gülhan R, Onat FY. Effect of U-92032, T-Type Ca2+ Channel Blocker, on Rats with Genetic Absence Epilepsy. Pharmacology 2020; 105:561-567. [PMID: 32101873 DOI: 10.1159/000505215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Absence epilepsy is associated with diffuse spike-and-wave discharges (SWD) on the electroencephalogram (EEG). Recent studies have demonstrated that the primary somatosensory cortex is also implicated in the generation of the SWDs. OBJECTIVE This study investigated the effects of systemic and local administrations of U-92032 into the brain of Genetic Absence Epilepsy Rats from Strasbourg (GAERS). METHODS GAERS animals underwent stereotaxic surgery for the placement of EEG recording electrodes and guide cannulas for U-92032 administration into the lateral ventricle (intracerebroventricular [i.c.v.]), upper lips area (S1Ulp) or barrel field area (S1B) of primary somatosensory cortex. Following 7 days of recovery, electrical activity was recorded continuously for 1 h before and 6 h after intraperitoneal (0.25; 1; 5 mg/kg i.p.) or local U-92032 or dimethyl sulfoxide (DMSO) injections. RESULTS No changes were detected in the cumulative duration, mean duration, and number of SWDs following i.p. U-92032 injections. Local i.c.v. injections of U-92032 caused a significant decrease in the cumulative duration (i.c.v., 50 and 100 nmol/L), mean duration (i.c.v., 50, 100, and 250 nmol/L), and the number (i.c.v., 250 nmol/L) of SWDs compared to DMSO groups. Intra-cortical (S1Ulp and S1B) U-92032 injections caused a significant decrease in all 3 parameters compared to DMSO groups, as well. CONCLUSION Intra-cortical injection of U-92032 caused almost complete removal of SWDs in GAERS and i.c.v. administration resulted in a significant reduction. However, systemic i.p. administration did not cause a significant change with the applied -doses.
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Affiliation(s)
- Hasan Raci Yananli
- Department of Pharmacology, Marmara University School of Medicine, Istanbul, Turkey,
| | | | - Halil Eren Sakallı
- Department of Pharmacology, Eastern Mediterranean University Faculty of Medicine, Famagusta, Cyprus
| | - Rezzan Gülhan
- Department of Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Filiz Yılmaz Onat
- Department of Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
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Gören MZ, Tekin N, Gülhan R, Bebitoglu BT. The analysis of plasma acitretin and etretinate levels in patients treated with acitretin. Reprod Toxicol 2018. [DOI: 10.1016/j.reprotox.2018.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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