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FARMACI DEL SISTEMA NERVOSO CENTRALE
Tranquillanti
- benzodiazepine. Le benzodiazepine erano da tempo considerate non affidabili in gravidanza, essendo stati segnalati già negli anni ’70 danni fetali costituiti da labiopalatoschisi. Il farmaco più indiziato era il diazepam. Altre benzodiazepine di più recente introduzione (flurazepam, lorazepam) sono ritenute più affidabili. Rimane comunque buona regola sconsigliare l’uso di questi farmaci in gravidanza: se vi è una chiara indicazione al loro impiego occorre prescriverne basse dosi da assumere non in modo continuativo. Il loro uso prolungato nell’ultimo trimestre può determinare una sindrome da astinenza nel neonato (“Floppy Infant Syndrome”) caratterizzata da bradicardia, ipertermia, iperiflessia, diarrea, vomito, tachipnea, cianosi, pianto irrefrenabile. Stessa sinrome si può osservare nei lattanti lacui madre sospenda improvvisamente la terapia. Invece la somministrazione di benzodiazepina in prossimità del parto può provocare ipotonia e sonnolenza neonatale.
- Zolpidem (Stilnox, Niotal): è una imidazopiridina che si lega preferenzialmente al sottotipo recettoriale omega-1 (anche conosciuto come sottotipo BZ1) che è la sottounità alfa-1 del complesso recettoriale GABA-A, mentre le benzodiazepine si legano in modo non selettivo ai sottotipi recettoriali omega-1 e omega-2. La modulazione del canale dell’anione cloro a seguito dell’interazione con questo sottotipo recettoriale porta agli specifici effetti sedativi dimostrati con zolpidem. Questi effetti sono neutralizzati dagli antagonisti benzodiazepinici quali il flumazenil.
- Meprobramato. Il meprobramato è teratogeno; tutti gli esperti lo considerano controindicato in gravidanza.
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Antidepressivi, antipsicotici: Agiscono aumentando l’onset dei neurotrasmettitori carenti (noradrenalina, dopamina e serotonina) ottenendo un effetto ansiolitico e/o disinibente. La clorpromazina, neurolettico fenotiazinico agisce principalmente a livello dei gangli della base, del sistema limbico e dell’ipotalamo; a livello del SNC l’effetto più importante è quello del blocco dei recettori dopaminergici D2. Impiegata nei casi più gravi di disturbi psicotici come la schizophrenia e la psicosi senile. Tutti gli antidepressivi, triciclici, antiMAO, SSRI e Sali di litio sono gravati dal rischio di danni fetali. Il rischio è minore per i triciclici, maggiore per gli antiMAO e il litio (malformazioni cardiache) ma nessuno di essi è utilizzabile con sicurezza almeno nel I° trimestre. Le fenotiazine sono state impiegate in gravidanza come antiemetici (antiscialorrea) di emergenza sfruttando l’effetto antimuscarinico.
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Tab. 28 – Psicolettici |
management |
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sonniferi |
Melatonina |
(melasin-up, |
Ctg A; Nessuna controindicazione in gravidanza |
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(passiflora + camomilla + piscidia + |
Sedatol |
Ctg A; Nessuna controindicazione in gravidanza |
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Infuso di camomilla |
Ctg A; Nessuna controindicazione in gravidanza |
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Tranquillanti ctg C |
benzodiazepine |
Valium, Ansiolin, Noan, Tavor, Lorans, Control, Diazepam, flurazepam, lorazepam, Xanax, Valeans, Frontal, Lexotan, Lexil, Librium, Frisum, Rivotril, Transene, Dalmadorm, Felison, Flunox, Mogadon, serpax, Normison, Euipnos, Halcion, Songar, Ipnovel |
Labiopalatoschisi fino a 14 w. Nel 3° trimestre: sindrome da astinenza nel neonato: “Floppy Infant Syndrome” depressione, |
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Zolpidem |
Stilnox, Niotal |
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Zopiclone |
Imovane |
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meprobamato |
Quanil |
teratogeno se |
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Antidepressivi |
Mg + triptofano + valeriana + passiflora |
Xerenal cpr |
Farmaco di prima |
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Ctg C SSRI (inibitori selettivi del |
Escitalopram (Citalopran, Entact), Paroxetina (Sereupin, Seroxat ) |
teratogeni se somministrati <14 settimane malformazioni cardiache se somministrato nel 3° trimestre: per lunghi periodi: nel neonato: sindrome da astinenza ipo/ipertonia muscolare, agitazione/torpore, pianto continuo, ipoglicemia, vomito, instabilità della temperatura corporea |
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Fluoxetina (Prozac, Fluoxeren) |
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Duloxetina (Cymbacta, Xeristar, Ariclaim) |
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Mirtazapina (Remeron) |
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Venlafaxine (Effexor) |
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Escitalopram (Entact) |
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Antidepressivi Triciclici Struttura triciclica, derivati dalle fenotiazine, inibiscono il re-uptake della nor-adrenalina, della serotonina e dopamina a livello delle sinapsi Possiedono anche capacità antistaminiche e antiadrenergiche con rischio ipotensivante |
Amitriptilina (Laroxyl, Triptizol, Elavil, Endep) |
Ctg C tachicardia, irritabilità, tremore, ritenzione urinaria |
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Clomipramina (Anafranil) |
Ctg C |
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Doxepina (Adapin, Sinequan) |
Ctg C |
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Imipramina (Tofranil, Pertrofan) |
Ctg D focomelia |
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Desipramina (Nortimil) |
Ctg C |
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Nortriptilina (Pamelor, Aventyl, Noritren) |
Ctg C |
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Protriptilina (Vivactil) |
Ctg C |
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Dotiepina (Protiaden) |
Ctg C |
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Maprotilina (Ludiomil) |
Ctg C |
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Trimipramina (Surmontil) |
Ctg C |
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Mianserina (differisce dai triciclici perché manca la catena laterale di base cui è legata l’attività anticolinergica dei composti triciclici) |
Lantanon |
Ctg D |
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antiMAO (inibitori delle monoaminossidasi) |
Fenelzina (Nardil, venduta nella farmacia del Vaticano) |
Ctg C |
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Sali di litio (Carbolithium) |
Carbonato di litio cpr 150 mg, 300 mg |
anomalie cardiache fetali (anomalia di Ebstein) ipotonia, cianosi nella gestante: gozzo e ipotiroidismo, blocco di conduzione, aritmie cardiache, sincopi, diabete insipido nefrogeno |
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Ansiolitici |
Alprazolam (benzodiazepina) |
Xanax cpr 0.25, 0.50 e 1 mg |
Ctg C della FDA Ipotensione, depressione respiratoria e ipotermia nel neonato |
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Idrossizina cloridrato |
Atarax cpr 25 mg | ||||
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Meprobamato |
Quanil | ||||
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Buspirone |
Zyban | ||||
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Antipsicotici, Neurolettici Ctg C Se somministrati nel pre-parto provocano prolungati disturbi neurologici nel neonate di tipo extrapiramidali |
Fenotiazine |
Clorpromazina (Largactil) |
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Flufenazina (Moditen) |
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Tioridazina (Melleril, Mellerette) |
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Prometazina (Fargan) |
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Anatensol, Trilafon, Mutabon, Talofen, Neuleptil, Modalina, Orap, Zyprexa, Belivon, Risperdal |
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Clozapina |
Leponex |
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Zuclopenthixol |
Clopixol |
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Aloperidolo (deriv. butirrofenolo) |
Serenase, Haldol cpr, fl, gocce |
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