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Cyclophosphamide is one of the most common causes of chemotherapyinduced menstrual difficulties and azoospermia (37Â45) acne 25 discount 10 mg accutane overnight delivery. Permanent secondary amenorrhea with evidence of primary ovarian damage has been observed after long-term (20 months) use of cyclophosphamide (45). In contrast, successful pregnancies have been reported following high-dose therapy (39,40,46Â50). Moreover, azoospermia appears to be reversible when the drug is stopped (41Â44,51). One report associated paternal use of cyclophosphamide and three other antineoplastics prior to conception with congenital anomalies in an infant (52). Defects in the infant included syndactyly of the first and second digits of the right foot and tetralogy of Fallot. Any relationship between these outcomes and paternal use of cyclophosphamide is doubtful because of the lack of experimental evidence and confirming reports. Cyclophosphamide-induced chromosomal abnormalities are also of doubtful clinical significance but have been described in some patients after use of the drug. A study published in 1974 reported chromosome abnormalities in patients treated with cyclophosphamide for rheumatoid arthritis and scleroderma (54). In contrast, chromosomal studies were normal in a mother and infant treated during the 2nd and 3rd trimesters in another report (16). Cyclophosphamide was administered three times between the 26th and 30th weeks of gestation. The clinical significance of these findings is unknown, but because these abnormalities may persist for several years, the potential existed for an increased risk of cancer as well as for a risk of genetic damage in the next generation (22). The long-term effects of cyclophosphamide on female and male reproductive function have been reported (55,56). In a 1988 publication, 40 women who had been treated with combination chemotherapy for malignant ovarian germ cell tumors (median age at diagnosis 15 years, range 6Â29 years) were evaluated approximately 10 years later (median age 25. Menstrual function in these women after chemotherapy was as follows: premenarchal (N = 1), regular menses (N = 27), irregular menses (N = 5), oligomenorrhea (N = 2), amenorrhea (N = 4), and premature menopause (N = 1). Of the 12 women with menstrual difficulties, only 3 of the difficulties were considered serious or persistent. Evaluation of the reproductive status after chemotherapy revealed that 24 had not attempted to become pregnant, 9 had problem-free conceptions, 3 had initial infertility followed by conceptions, and 4 had chronic infertility. A study published in 1985 examined 30 men to determine the effect of cyclophosphamide on male hormone levels and spermatogenesis (56). The mean age of the men at the time of the study was 22 years with a mean interval from end of treatment to evaluation of 12.
Warnera (Goldenseal). Accutane.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96906
Although the number of subjects using flunisolide was not mentioned acne 8 yr old girl 30 mg accutane sale, there were no significant relationships between the inhaled steroid users and low birth weight, small for gestational age, major malformations, gestational hypertension, or preterm birth (7). However, the one study (7) examining perinatal outcomes was too small to have identified an association with oral clefts, if it had existed. Systemic corticosteroids are known to be associated with a low risk for isolated, nonsyndromic oral clefts (cleft lip and/or palate) when used in the 1st trimester, as well as fetal growth restriction when used for long periods later in gestation. The molecular weights of the inhaled and nasal spray formulations (about 434 and 444) are low enough for excretion into breast milk, but the short elimination half-lives and extensive metabolism should limit the amount. Other corticosteroids are excreted into milk in low concentrations (see Prednisone), and the passage of flunisolide into milk should be expected. The effects of this exposure on a nursing infant are unknown, but the amounts excreted into milk should be low. Reproductive studies on flunisolide in rats: oral administration during the period of organogenesis. Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth. The limited pregnancy experience with fluocinolone does not appear to represent a risk, probably because the systemic amounts were insufficient to cause embryo or fetal toxicity. Because the amounts absorbed systemically from topical fluocinolone are unknown and probably highly variable, a less-potent agent should be considered for pregnant women requiring long-term topical corticosteroid therapy. Fluocinolone is not absorbed systemically in detectable amounts from the ocular implant, so the embryoÂfetal risks from this therapy appear to be negligible. It is available in various topical formulations as a cream, ointment, solution, shampoo, and oil in concentrations ranging from 0. Topical fluocinolone is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses (1,2). Systemic absorption of detectable amounts has not been observed after administration of the ocular implant (3). The degree of absorption is affected by inflammation, integrity of the epidermal barrier, and the use of occlusive dressings. Potent topical corticosteroids also can cause structural anomalies after dermal application (2,3). The molecular weight (about 453 as the acetonide) is low enough that exposure of the embryo and fetus should be expected from the amounts absorbed systemically. The use of fluocinolone for the treatment of pruritus vulvae in 17 pregnant women was described in a 1967 reference (4).
The mean caffeine content in the usual servings of some common beverages was reported as caffeinated coffee (66 146 mg) skin care 27 year old female generic accutane 30 mg mastercard, nonherbal tea (20Â46 mg), and caffeinated soft drinks (47 mg) (2), but these amounts may vary widely. The mutagenicity and carcinogenicity of caffeine have been evaluated in more than 50 studies involving laboratory animals, human and animal cell tissue cultures, and human lymphocytes in vivo (1,3). The significance of mutagenic and carcinogenic effects found in nonmammalian systems has not been established in man. The drug is an animal teratogen only when doses high enough to cause toxicity in the mother have been given (1). In this group, slightly increased relative risks were found for musculoskeletal defects, hydronephrosis, adrenal anomalies, and hemangiomas or granulomas, but the results are not interpretable without independent confirmation (7, pp. Other reports have also found no association between the use of caffeine during pregnancy and congenital malformations (9Â12). However, a few of these studies have isolated the effects of caffeine from cigarette or alcohol use, both of which are positively associated with caffeine consumption (3). One German study has observed that high coffee use alone is associated with low birth weights (18). In an American study of more than 12,400 women, low birth weights and short gestations occurred more often among offspring of women who drank four or more cups of coffee/day and who smoked (12). No relationship between low birth weights or short gestation and caffeine was found after controlling for smoking, alcohol intake, and demographic characteristics. However, other investigators have questioned whether this study has accurately assessed the total caffeine intake of the women (19,20). A Canadian study retrospectively investigated 913 newborn infants for the effects of caffeine and cigarette smoking on birth weight and placental weight (21). Significant caffeine cigarette interactions were found when daily consumption of caffeine was 300 mg. Compared with nonsmokers, cigarette smoking significantly lowered mean birth weight. When caffeine use was considered, daily consumption of 300 mg combined with smoking 15 cigarettes caused an additional significant reduction in weight. Head circumference and body length were not affected by any level of caffeine consumption. Placental weight, which normally increases with cigarette smoking, an effect hypothesized to be due to compensatory hypertrophy induced by chronic fetal hypoxia, was found to decrease significantly in women smoking 15 cigarettes/day and ingesting 300 mg of caffeine/day (21). Caffeine consumption was calculated based on the intake of coffee (107 mg/serving), tea (34 mg/serving), colas (47 mg/serving), and drugs. The data were adjusted for factors such as demographic characteristics, obstetric and medical histories, contraceptive use, smoking, and alcohol exposure. The mean 1st trimester caffeine consumption was statistically similar in those who aborted compared with those who delivered liveborn infants, 125.
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Armon, 57 years: In a multicenter, prospective controlled study, the pregnancy outcomes of three groups of women were evaluated: (a) paroxetine 330 (286 in the 1st trimester), (b) fluoxetine 230 (206 in the 1st trimester), and (c) 1141 exposures not known to cause birth defects (41). Taken in sum, however, the evidence suggests that the maternal benefit of treatment outweighs the potential risk to the fetus and newborn.
Corwyn, 30 years: The outcomes of the 289 pregnancies included 178 infants (5 sets of twins), 39 (13. Persistent pulmonary hypertension of the newborn may occur if these agents are used in the 3rd trimester close to delivery (2,3).
Vasco, 35 years: Moreover, calcium supplementation did not reduce the number of preterm births (<37 weeks; 10. Neonatal neurologic and electroencephalographic effects of intrauterine cocaine exposure.
Lee, 34 years: However, the maternal benefit, and indirect embryoÂfetal benefit, appears to far outweigh the unknown embryoÂfetal risk. A similar risk for orofacial clefts was observed with inhaled budesonide, but the number of exposed infants was too small for statistical significance.
Ramirez, 31 years: The molecular weight of the parent compound (about 416) and its long plasma elimination half-life (about 70 hours) suggest that donepezil, and possible the active metabolites, will be excreted into breast milk. Thus, chelation by the calcium in milk might prevent clinically significant amounts from being absorbed.
Pavel, 50 years: A sensory panel of 11 judges, all screened for normal olfactory function, were able consistently to detect the odor of garlic from paired samples of expressed milk (treated and untreated) with a peak effect at 2 hours. Other medications used were prednisone (5 mg/day), diphenoxylate-atropine (2 tablets/day), tacrolimus (12 mg/day), ferrous sulfate (650 mg/day), ascorbic acid (1 g/day), prenatal vitamins (1/day), and magnesium supplementation.
