Effect of pregnancy on topiramate pharmacokinetics in rabbits.

Pregnancy is associated with various physiological changes that may lead to significant alterations in the pharmacokinetic profiles of many drugs. The present study was designed to investigate the potential effects of pregnancy on the pharmacokinetics of topiramate (TPM) in the rabbit model. Nineteen female New Zealand white rabbits (nine pregnant and 10 non-pregnant) were used in this study. Blood samples were collected from the animals just before receiving TPM orally at a dose of 20 mg/kg and then serially for up to 24 h. TPM plasma samples were analysed using a validated tandem mass spectrometric (LC-MS/MS) method. The mean values of TPM pharmacokinetic parameters (t(1/2), T(max), AUC(0-∞), and CL/F) were significantly modified in pregnant rabbits as compared with non-pregnant group. Pregnancy significantly (P < 0.05) increased TPM half-life (t(1/2)), time to attain the maximum plasma concentration (T(max)), and the area under TPM plasma concentration-time curve (AUC(0-∞)) and decreased the drug's oral clearance (CL/F) compared with non-pregnancy state in rabbits. The present study demonstrates that pregnancy alters the pharmacokinetics of TPM in rabbits in late gestational period and considerable inter-animal variability was observed. The findings of the present study indicate that TPM CL/F is decreased during late pregnancy in the rabbit model.

Awareness of hormonal emergency contraception among married women in a Kuwaiti family social network.

OBJECTIVE: Awareness and use of hormonal emergency contraception are not known in the Arab world. This study investigated awareness and perceptions of hormonal emergency contraception among women within a Kuwaiti extended family and their social contacts. STUDY DESIGN: A cross-sectional survey was conducted using a self-administered questionnaire which was distributed to 66 married women within a Kuwaiti family's social network. The questionnaire provided a short explanation of hormonal emergency contraception and then elicited the respondent's prior awareness, concerns and perception on future availability. RESULTS: The mean (S.D.) age of the respondents was 35.1 (6.3) years. Over 30% were currently using oral contraceptives; 28% were using no contraceptive method. Four women (6.1%) had heard of hormonal emergency contraception before, one had used it. Most respondents (65.2%) would not use or inform a friend about hormonal emergency contraception. Main concerns were risks to the health of the woman (83.3%) or the baby (54.5%) or that it was abortifacient (21.2%). However, 90.9% of respondents wanted hormonal emergency contraception to be available. CONCLUSIONS: Awareness of hormonal emergency contraception is low among Kuwaiti women. Despite some concerns, they feel it should be made available. Health care providers and policymakers should address this situation.

Awareness and perceptions of emergency contraception among retail pharmacists in Kuwait.

OBJECTIVE: To describe the awareness and perceptions of hormonal emergency contraception (EC) among retail pharmacists. SETTING: Private retail pharmacies in Kuwait City. METHOD: A self-administered questionnaire was developed to elicit pertinent demographic information as well as awareness of and concerns about EC and administered to the senior pharmacist in 51 randomly selected private retail pharmacies. MAIN OUTCOME MEASURE: Proportion of pharmacists aware of EC and who had recommended EC. RESULTS: The respondents had a mean (SD) age of 34.2 (7.7) years; 58.8% were male, and all but one were non-Kuwaiti. The median practice experience of the pharmacists was 6 years. Oral contraceptives and male condoms were universally available in the pharmacies, but none stocked emergency contraceptives, female condoms, or diaphragms. Twenty respondents (39.2%; 95% confidence intervals 25.5-53.9%) said they were aware of EC, and 4 (7.8%) that they had ever offered EC. Nine (17.6%) respondents saw EC as offering no advantages over other contraceptive measures and effectiveness was perceived to be low. Most cited concerns were of encouraging irresponsible behaviour and women relying on EC in place of regular contraceptive measures. Religious opposition (41.2%), lack of awareness by clients (51.0%) and lack of awareness by health providers (35.3%) were seen as the most significant obstacles to provision of EC. CONCLUSION: Knowledge of EC is poor among community pharmacists in Kuwait. Action is needed to address this deficit and to make EC more accessible to women who wish to use it.

Awareness of and attitude toward hormonal emergency contraception among married women in Kuwait.

OBJECTIVE: To describe the awareness of and attitudes toward hormonal emergency contraception among women in Kuwait. METHODS: A cross-sectional survey was conducted among married women at obstetrics/gynecology outpatient clinics at the government Maternity Hospital in Kuwait. A pretested Arabic self-administered questionnaire was distributed to the women in March 2005. The questionnaire provided a short explanation as to what was meant by hormonal emergency contraception and then elicited whether the respondent was aware of it, what concerns she had, and whether she thought it should be made available in Kuwait. RESULTS: One hundred three questionnaires were completed. Respondents were mostly Kuwaiti (78%) and non-Bedouin (78%) with postsecondary school education (74%) and a mean (SD) age of 33.1 (7.8) years and a mean (SD) number of children of 2.8 (1.9) About half of the women were not currently using contraceptive methods; 40% of contraceptive users were taking oral contraceptive pills. Bedouin women were more likely than non-Bedouins to use breastfeeding as a contraceptive measure (p = 0.012). Ten women (9.7%, 95% CI 4.8-17.1) reported having heard of hormonal emergency contraception, mostly from informal sources, 1 had used it, and 7 knew of other women who had used it. Only 8 (7.8%) respondents were willing to use or inform a friend about hormonal emergency contraception, but 89.3% thought it should be available in the health system. CONCLUSIONS: Awareness of hormonal emergency contraception is low among women in Kuwait. Despite concerns and apparent negative attitudes, women believe it should be made available in the health system.