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Antivirali: mancano studi adeguati per una valutazione definitiva per la somministrazione in gravidanza e allattamento. La scarsa letteratura disponibile segnala la presenza di varie malformazioni di feti le cui madri avevano assunto antivirali per cui la sooministrazione di antivirali in gravidanza deve essere limitata ai casi veramente indispensabili e sotto il diretto continuo controllo medico.
- INIBITORI DELLA DNA-POLIMERASI: Aciclovir: tra gli antivirali è quello più utilizzato. I dati in campo umano sull’impiego di questa sostanza in gravidanza non sono numerosi. Dal 1984 al 1998 la ditta produttrice ha istituito un Registro Internazionale “Aciclovir in gravidanza” dove sono state registrate poco più di 600 gravidanze esposte al farmaco, nel primo o secondo trimestre. La frequenza di anomalie congenite nei neonati non è stata più elevata dell’atteso. Inoltre non si è osservato uno spettro ricorrente di anomalie alla nascita.
- Imiquimod: Aldara™ 5% crema in bustine: utilizzata nella terapia dei condilomi acuminati (papilloma virus) in associazione a rimozione chirurgica con lasera, diatermocoagulazione, causticazione con ac. tricloroacetico. Appartiene alla classe degli «Immune Response Modifier», modulatori della risposta immunitaria cioè stimolano la risposta immunitaria locale. Non vi sono dati disponibilisull`uso di imiquimod crema derivante la gravidanza o sui suoi effetti durante l`allattamento. Si raccomanda quindi l`uso esclusivamente nei casi in cui i benefici sono decisamente superiori al rischio potenziale per il feto o il lattante.
- INIBITORI della TRANSCRPTASI INVERSA: inibiscono la replicazione dell’HIV inibendo la DNA-polimerasi RNA-dipendente (transcriptasi inversa). Possono solo rallentare la malattia ma non sono in grado di eliminare l’infezione né di modificare l’evoluzione della malattia. Utilizzati nelle donne sieropositive in gravidanza e puerperio per ridurre il rischio di trasmissione materno-fetale dell’infezione. L’AZT non va mai associata allo Zerit, in quanto è stato dimostrato un effetto di antagonismo tra questi due farmaci.
- INIBITORI della PROTEASI: (enzima necessario per la segmentazione proteolitica dei precursori poliproteici virali); mancano studi adeguati per la somministrazione in gravidanza e allattamento.
- ANTIRETROVIRALI: Non vi sono dati adeguati provenienti dall’uso Degki antiretrovirali in gravidanza e non è noto se possono causare danni al feto. L’acidosi lattica, talvolta fatale, è stato riportata nelle donne in gravidanza che hanno ricevuto la combinazione di antiretrovirali e inibitori della transcriptasi inversa. Pertanto, l’uso degli antiretrovirali durante la gravidanza deve essere considerata solo quando il potenziale beneficio superi il possibile rischio. Allattamento: Non è noto se gli antiretrovirali vengano escreti nel latte umano.
- LISOZIMA: uno dei fattori naturali dell’iimunità aspecifica cellulare ed umorale. Il lisozima, legandosi alla superficie batterica, ne riduce la carica elettrica negativa negativa superficiale, rendendo più facile la fagocitosi da parte dei macrofagi,
- TIMOSINA: la timosina α-1 è utilizzata come coadiuvante nella vaccinazione antinfluenzale nei soggetti immunocompromessi: Zadaxin® fl 1.6 mg: una fiala im/sc due volte a settimana per 4 settimane dal giorno 0 dalla vaccinazione antinfluenzale. Assolutamente controindicato in gravidanza e allattamento.
|
Tab. 10 – antivirali |
Management |
||
|
Inibitori della DNA |
Acyclovir (HSV 1-2, VZV, EBV, CMV) |
Zovirax, Aciclovir cpr, Talavir 500 cpr |
Ctg C della FDA; IUGR, morte fetale, anomalie |
|
Valaciclovir |
Talavir, Zelitrex |
||
|
Famciclovir |
|||
|
Cidofovir (Cytomegalovirus) |
Vistide |
Ctg D |
|
|
Ganciclovir |
Cymevene, Citovirax |
D Teratogeno ed embriotossico |
|
|
Ribavirina |
Rebetol |
Ctg X Aborto, morte fetale improvvisa, |
|
|
Inibitori della proteasi |
Indinavir |
Crixivan |
Ctg C; mancano studi adeguati |
|
Ritonavir |
Norvir |
||
|
Nelfinavir |
Viracept |
||
|
Inibitori nucleosidici della transcriptasi |
Zidovudina (AZT) terapia HIV |
Retrovir cpr, |
Ctg B3 |
|
Zalcitabina |
Hivid |
Ctg D; teratogeno |
|
|
Nevirapina |
Viramune |
B3 |
|
|
Delavirdina |
Rescriptor (HIV 1) |
B3 |
|
|
Saquinavir |
Invirase |
Ctg B2; |
|
|
Stavudina |
Zerit |
B3 |
|
|
Lamivudina |
Epivir, Zeffix |
B3 |
|
|
Antiretrovirali |
Didanosina |
Videx EC |
B2 Pancretite, acidosi lattica ed epatomegalia |
|
Inibitori della neuramidasi |
Zanamivir |
Ctg C |
|
|
Derivati dall’ac. fosfonico |
Foscarnet |
Foscavir, Virudin |
B3 |
|
Altri antivirali |
Lisozima |
||
|
Metisoprinolo Affezioni erpetiche |
Viruxan (incrementa formazione ed efficienza dei linfociti B e T; limita la replicazione virale interferendo a livello poliribosomale). |
ctg C | |
|
Neuramide |
Inibisce la replicazione virale Terapia herpes zoster-varicella, herpes genitalis |
ctg A2 | |
|
Papilloma virus (condilomi |
Imiquimod: Aldara™ 5% crema in bustine |
Ctg B3 |
|
|
SIERI IMMUNI, IMMUNOGLOBULINE e VACCINI |
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