Clinical trials

The British Medical Journal recently released several papers looking into the problem of unpublished data, including one study from Yale University, which found that fewer than half of the 635 the clinical trials funded by the National Institutes of Health were actually published in medical journals within 30 months of trial completion.

Drug companies that delay publishing these findings or even deliberately hide trial data are breaching their ethical duty, says lead researcher Joseph Ross. “The evidence we publish shows that the current situation is a disservice to research participants, patients, health systems, and the whole endeavor of clinical medicine,” he said.

Drug companies have often been caught withholding data, especially with drugs that are widely prescribed and bring in billions in profits. Drugmaker Grunenthal, now part of GlaxoSmithKline (GSK) and Sanofi, is currently being sued by 13 Americans who were born with birth defects after their mothers took the drug Thalidomide to treat morning sickness. The lawsuit claims that the drug company hid results of studies that would have revealed the drug caused birth defects.

Now, makers of the most commonly prescribed antidepressants are feeling some of the same wrath. New studies have linked selective serotonin reuptake inhibitors (SSRIs) to birth defects, particularly of the heart and lungs. Women who took the drug during pregnancy and gave birth to babies with these serious birth defects allege the drug companies did not reveal just how dangerous the drugs were to developing fetuses.

It wouldn’t be the first time these SSRI drug companies reportedly tried to cover up data that could hurt sales. In 2006, a U.S. court found drug maker GSK guilty of promoting Paxil or Paxil CR for children and adolescents while withholding and concealing information about the medication’s safety and effectiveness for minors. The lawsuit stemmed from a consumer advocate protest against GSK, which alleged that consumers were not sufficiently warned in advance of the drug’s side effects and addictive properties.

“Most clinicians assume that the complex regulatory systems that govern human research ensure that (clinical data) is relevant, reliable and properly disseminated,” Dr. Richard Lehman from Oxford University and the British Medical Journal’s Dr. Elizabeth Loder told the Daily Mail. “It generally comes as a shock to clinicians, and certainly to the public, to learn that this is far from the case.”

Sources:
Daily Mail
Wikipedia
The Dr. Rath Health Foundation

SOURCE: Paxil and Pregnancy › Do drug companies cover up data about drugs’ safety, efficacy?

Paxil is in a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs. Other drugs in this class include Zoloft, Celexa, Lexapro and Prozac. When Paxil was approved by the Food and Drug Administration (FDA) in 1992 for the treatment of depression and anxiety disorders, it was listed as a Category C pregnancy drug, meaning that there have been no studies to show whether the drug could harm fetuses. However, reports of birth defects including those affecting the heart, lungs and other organs, from women who took the drug while pregnant were enough for the FDA to require the drug be reclassified as a Category D drug, meaning studies have proven that use during pregnancy can cause birth defects.

Since the drug was approved, more than 600 cases alleging birth defects linked to Paxil have been filed. The first trial resulted in a verdict for the plaintiffs and an award of $2.5 million in compensatory damages for the family of Lyam Kilker, who was born with three cardiac birth defects after his mother took Paxil while pregnant.

While Paxil is the only SSRI classified as a Category D drug, newer studies are beginning to question the safety of other SSRIs on fetuses, particularly Zoloft. Two studies published in the New England Journal of Medicine found a statistically significant increased risk of various birth defects possibly linked to Zoloft. Canadian and Swedish studies backed up that claim, singling out persistent pulmonary hypertension as a potentially fatal condition from SSRI exposure.

Animal experiments have also shown that not only do SSRIs pass through the placental barrier, they have direct effects on the developing neural crest and brachial arch cells that migrate in a very early developing embryo to form all of the major organ systems in babies. When neural crest cells don’t migrate properly or they’re interfered with by an agent such as Paxil or Zoloft, many problems can arise.

More and more lawsuits filed against makers of SSRIs are holding these drug companies accountable for their actions in response to these studies, and their responsibility to adequately warn users of the potential dangers of their drugs.

Source:
Dissident Voice/Bloomberg

SOURCE: Paxil and Pregnancy › Paxil lawsuits have cost drug maker $1 billion

GlaxoSmithKline

Paxil is a type of medication known as selective serotonin reuptake inhibitors (SSRIs), and is prescribed for the treatment of depression and anxiety disorder. Other brands of SSRIs include Zoloft, Lexapro, Prosac and Celexa. Paxil is considered more toxic to unborn babies than any other SSRI, and is listed as a Category D drug. All other SSRI drugs are Category C drugs, meaning they are safer for use during pregnancy.

Since 2005, studies have linked Paxil to birth defects including cardiac (heart) defects, pulmonary (lung) defects, neural tube defects (brain and spinal cord), craniosynostosis (abnormally shaped skull), infant omphalocele (abdominal wall defects), club foot (one or both feet turn downward and inward), and anal atresia (complete or partial closure of the anus).

Newer studies also have linked the antidepressant to an increased risk of Neonatal Persistent Pulmonary Hypertension (PPHN).

More recent studies have also linked serious birth defects with other types of SSRIs, which has led some people to question whether all SSRIs should be labeled as Category D drugs and avoided during pregnancy.

Anyone who has taken an SSRI during pregnancy and delivered a child with a birth defect may have a case against the drug’s maker.

SOURCE: Paxil and Pregnancy › Millions awarded to women in Paxil, birth defects lawsuits

Lyam’s parents filed suit against GlaxoSmithKline (GSK) claiming the drug company failed to adequately warn users of the risks associated with using Paxil while pregnant. The trial resulted in a landmark $2.5 million verdict against the pharmaceutical company.

Hundreds of more lawsuits were filed against GSK, and for the second quarter of 2010, GSK announced legal charges of about $2.4 billion. Soon, lawsuits against other antidepressants began to surface suggesting other antidepressants in the class were just as likely to cause birth defects.

Paxil has since been downgraded from a Category C drug to a Category D. Category D means that studies in pregnant women have demonstrated risk to the fetus. Paxil is in a class of antidepressants known as SSRIs, or selective serotonin reuptake inhibitors.

All other SSRIs are currently listed as Category C drugs, meaning the drugs have been shown to harm fetuses in animal studies but have not been adequately studied in humans. With Category C medications, doctors and patients must decide if the benefits are greater than the risks. However, new studies suggest that other types of SSRIs may be more dangerous to developing fetuses than previously thought.

Pregnant women or women considering pregnancy should discuss with their doctors any concerns they have about SSRIs and birth defects, and whether the benefits of taking the drug outweigh the possible risks to the fetus.

Source: Unite for Life

SOURCE: Paxil and Pregnancy › Other SSRIs may be just as dangerous as Paxil to fetuses

Paxil, manufactured by GlaxoSmithKline (GSK), is an antidepressant in a class of medications called selective serotonin reuptake inhibitors (SSRIs), which work by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. It is used to treat depression, panic disorder, and social anxiety disorder. The medication is also used to treat chronic headaches, tingling in the hands and feet caused by diabetes, and certain male sexual problems. It is also used in combination with other medications to treat bipolar disorder. It may also be prescribed for other uses.

The drug’s safety label now warns patients that, “epidemiological studies have shown that infants born to women who had first trimester paroxetine exposure had an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects (VSDs and ASDs). In general, septal defects range from those that are symptomatic and may require surgery to those that are asymptomatic and may resolve spontaneously. If a patient becomes pregnant while taking paroxetine, she should be advised of the potential harm to the fetus. … For women who intend to become pregnant or are in their first trimester of pregnancy, paroxetine should only be initiated after consideration of the other available treatment options.”

In 2005, when the FDA first warned of the dangers with Paxil in women of childbearing age, GSK was ordered to change the pregnancy category of the drug from C to the stronger warning of D. Category D means that studies in pregnant women (controlled or observed) have demonstrated a risk to the fetus.

In 2010, a new study using the Swedish Medical Birth Register from July 1, 1995 to 2007 identified women who reported the use of antidepressants in early pregnancy or were prescribed antidepressants during pregnancy by antenatal care. Data showed a specific association between Paxil use and infant cardiovascular defects. There was also a strong association between Paxil and hypospadias, a birth defect of the urethra in male infants. The drug has also been associated with an increased risk for spontaneous miscarriage.

Beasley Allen Law Firm is currently investigating cases of birth defects caused by Paxil, or generic versions of the drug, known as paroxetine.

Source: FDA

SOURCE: Paxil and Pregnancy › New study shows Paxil during pregnancy causes heart defects

“GSK knew it was not safe to take Paxil (during pregnancy) but said nothing,” his parents say in a video on YouTube. Now Manie has a broken heart, and a scar that runs down the center of his chest. He holds a sign against his scarred chest. It reads, “Why?”

“How many more babies will suffer,” they ask. “Answer this, GSK, please.”

In September 2005, a study on infants born to women taking antidepressants, including Paxil, during the first trimester of pregnancy, revealed a greater risk for overall birth defects and an increased risks for heart defects specifically. Following the study, GSK updated the PRECAUTIONS subsection of its label for Paxil to include the risk of birth defects, including heart defects.

“Do the benefits outweigh the risks?” Manie’s parents ask.  “No. Never.”

What’s to become of Manie’s broken heart?

Read more of Manie’s story at bigpharmavictim.blogspot.com

Source: YouTube, jiedgi

SOURCE: Paxil and Pregnancy › Parents ask GSK: ‘How many more babies will suffer?’

Sometimes drugs are essential for the health of the pregnant mother. In those cases, it is imperative for women to discuss their condition with their doctor and weigh the benefits and risks of medication. Drugs taken by a woman who is pregnant most often reach the fetus by crossing the placenta, just as nutrients and oxygen do. When a pregnant woman takes medication, it can cause premature birth by forcefully contracting muscles in the uterus, starve the fetus of nutrients and oxygen thus resulting in an underweight or underdeveloped baby, or cause abnormal development (or birth defects) and even death.

The Food and Drug Administration (FDA) classifies drugs according to the degree of risk they may cause the fetus during pregnancy, as it did with Paxil in 2005 after reports that women taking Paxil during the first trimester of pregnancy had a greater risk of delivery a baby with a birth defect, especially a heart defect. Some drugs are highly toxic and should be avoided during pregnancy. In some cases, doctors may prescribe an alternative medicine that is safer for the unborn baby.

Source: Merck

SOURCE: Paxil and Pregnancy › Pregnant women beware: Some medications can be lethal to fetus

Researchers looked at data collected between 1990 and 1996 from a larger study investigating heart disease risk, and pulled data from 555 women who were 24 years old on average when they gave birth. Researchers studied that data for links between race, preterm birth and pre-pregnancy depressive mood. The data showed that 18.1 percent of the 249 black women gave birth prematurely – at less than 37 weeks gestation – compared to 8.5 percent among the 306 white participants.

The prevalence of pre-pregnancy depression was also higher among black women compared with white women – 9.4 percent compared to 7.2 percent, respectively. Researchers say the findings suggest that a woman’s overall health must be viewed when considering reproductive outcomes.

But it also points to a need for health care professionals to address a woman’s emotional presence especially if she is pregnant or considering pregnancy. Depression during pregnancy can be dangerous for both the mother and her unborn child, leading to poor nutrition; dependence on alcohol, drugs or cigarettes; and suicidal behavior, all of which can contribute to premature birth. Psychotherapy and antidepressants are a viable option but doctors and patients must both be advised of the potential risks that antidepressants carry. Some SSRIs commonly used to treat depression, such as Paxil, can increase the risk of birth defects, especially heart defects, which have led manufacturers like GlaxoSmithKline to include warnings of potential birth defects on the medication’s label.

Source: Reuters

SOURCE: Paxil and Pregnancy › Depressed, black women at higher risk of delivering prematurely

The study, published earlier this year in the Journal of the American Medical Association, examined more than 11,000 low-income mothers in New Jersey. The data indicated that 9.6 percent of women with diabetes who had no indication of depression during pregnancy, developed depression during the year following delivery.

Researchers say that the findings do not establish that diabetes causes postpartum depression, only that the two are related and that health care professionals should consider the mental health of patients when dealing with low-income individuals with diabetes both during pregnancy and the postpartum period.

About 10-20 percent of women will struggle with some symptoms of depression during pregnancy, and a quarter to half of those will suffer major depression, according to the American Pregnancy Association. Untreated depression can have potential dangerous risks to both the mother and baby, leading to poor nutrition; dependence on alcohol, drugs or cigarettes, and suicidal behavior that can cause premature birth, low birth weight and developmental problems. Add maternal diabetes to the mix, and mothers can feel even more consumed by emotions.

While antidepressants can serve as a viable treatment for depression, women should discuss their options with their healthcare provider. Some SSRI medications, such as Paxil, have been shown to increase the risk of overall birth defects and in particular heart defects, when taken during pregnancy. As of September 2005, Paxil manufacturer GlaxoSmithKline has updated its precautions section on the Paxil labels to warn of the potential risk to babies when taken by mothers during the first trimester.

SOURCE: Paxil and Pregnancy › Women with diabetes more likely to suffer postpartum depression

Dr. Zachary Stowe, director of the Women’s Mental Health Program at Emory, is listed as the primary investigator on at least three National Institutes of Health grants that involve antidepressant use in pregnant women and the effects on children delivered by those women.

According to records, Dr. Stowe received payments totaling more than $250,000 between 2007 and 2008 from drugmaker GlaxoSmithKline PLC, during which time Dr. Stowe delivered at least 95 promotional talks on behalf of the drug company. Dr. Stowe contends his work with GlaxoSmithKline was not a conflict of interest and that such relationships are not uncommon in research.

Dr. Stowe is the second Emory researcher who has been reprimanded for not properly disclosing his financial arrangements with drug companies. Last fall, Dr. Charles Nemeroff resigned as chairman of Emory’s Department of Psychiatry for similar conflict of issues concerns.

Of heightened concern is GlaxoSmithKline’s antidepressant Paxil, which recent studies have shown have a greater risk of causing serious birth defects in the children of women who took the antidepressant during the first three months of pregnancy. As a result, GlaxoSmithKline updated the cautions section of Paxil to indicate the risk of overall birth defects, in particular heart defects.

Sources:
Atlanta Journal Constitution
Wall Street Journal

SOURCE: Paxil and Pregnancy › Psychiatrist reprimanded for taking money from drug maker

For the study, researchers observed a group of 300 pregnant women, most of whom did not suffer from depression but some either had a history of depression or reported becoming depressed during pregnancy. Of those observed, some took medication to treat their depression either for part of their pregnancy or for the entire pregnancy; some did not take medication and remained depressed; and some did not take medication and reported being depressed for only part of their pregnancy.

The research found that the women who took medication for the duration of their pregnancy and the women who did not take medication but still suffered with depression had a much higher rate of premature birth (20 percent) than the women who took no medication and recovered from their depression during their pregnancy (4 to 9 percent).

Antidepressants can also carry others risks to unborn babies. A 2005 scientific study showed a link between birth defects in babies born to women who took antidepressants during pregnancy. The recurrence was rare enough that some antidepressants are still considered viable options for pregnant women.

However, one antidepressant showed a greater risk to unborn children in the first trimester over other antidepressants, Paxil. As a result of the study, drug manufacturer GlaxoSmithKline updated the PRECAUTIONS subsection on the labeling for its popular antidepressant Paxil, citing a greater risk for overall birth defects, in particular heart defects.

Women who are pregnant or are considering becoming pregnant should consult with their doctors to determine what depression treatment is best for them.

SOURCE: Paxil and Pregnancy › Study: antidepressants, depression linked to preterm birth

Seeking help from a health care provider is vital not only to the mother, but to her unborn child. Depressed mothers-to-be may not have the energy to take care of themselves or seek optimal prenatal care. She may even rely on smoking cigarettes or drinking alcohol to cope, which can have detrimental effects on an unborn child. Health care providers can discuss healthier options, such as group or one-on-one therapy. In some cases, antidepressants may be recommended.

According to the Mayo Clinic, few medications have been proven safe beyond a doubt for use during pregnancy, which is why many doctors advise their patients who are pregnant or are considering pregnancy to wean off most drugs. However, some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), should only be taken during pregnancy after a woman weighs the risks with her doctor because of the possibility of serious birth defects.

Common SSRIs that have previously been prescribed for depression during pregnancy include Celexa, Prozac, Zoloft and Paxil. However, with all those medications there is a possible risk of persistent pulmonary hypertension, or PPHN, in the newborn. The risk is so rare that Celexa, Prozac and Zoloft are still considered options for use during pregnancy.

However, in 2005, a scientific study indicated that women who took Paxil during the first three months of pregnancy had a greater risk of their unborn child developing birth defects – in particular heart defects – than any other antidepressant. As a result of that study, GlaxoSmithKline, makers of Paxil, updated the PRECAUTIONS section of its medication label discouraging use of Paxil during pregnancy.

The Mayo Clinic urges women to consult with their doctors and learn the risks and benefits of antidepressants during pregnancy before making a decision.

SOURCE: Paxil and Pregnancy › Mothers-to-be should weigh risks of antidepressants during pregnancy

Christine K had been prescribed a combination of Paxil, Risperdal and Depakote five years prior to becoming pregnant. While pregnant she read that Paxil could be harmful to her unborn baby. She asked her doctor take her off the meds, but he insisted she stay on them.

Christine K did more research on the medications and learned that a scientific study on infants born to women taking antidepressants during the first trimester of pregnancy showed that women who took Paxil had a greater risk of birth defects compared to other antidepressants.

As a result of the study, in 2005, GlaxoSmithKline informed health care professionals that it was updating the precautions section of the label for its antidepressant Paxil to include the risk of birth defects and, in particular, heart defects.

In 2006, the Food and Drug Administration (FDA) released another Public Health Advisory based on another study that indicated additional risks associated with taking antidepressants during pregnancy including persistent pulmonary hypertention (PPHN), a serious and life-threatening lung condition that occurs soon after birth, omphalocele and craniosynostosis.

Six months into her pregnancy, against her doctor’s orders, Christine K heeded the warning signs she had read about online and weaned herself off Paxil and the other antidepressants. But the damage had already been done. While her son doesn’t have any of the above mentioned severe birth defects, he does experience sleep problems, aversions to eating, and overall poor health.

“In the first three years of his life, this child has needed more medical care and doctor’s appointments than my other three children combined,” she told the Dissident Voice. “All I can do is watch and wait and hope (his medical problems) resolve on their own.”

SOURCE: Paxil and Pregnancy › Child is helpless victim of mother’s use of Paxil during pregnancy

What Gibson soon realized was that a warning about heart defects in infants born to women who took Paxil during pregnancy was issued the very month her daughter was born.

“I never would have taken the (Paxil) had I been told,” Gibson told a reporter for The Province.

The long, red scar down the middle of her daughter’s chest is a painful reminder of the condition she was unnecessarily born with. She says her daughter’s heart defect has made the little girl prone to infections and stunted her growth.

In 2005, the FDA issued a warning to pregnant women and their doctors to stay away from Paxil because of the increased risk of heart defects in newborns. The agency fell short of banning the medication for pregnant women but stated that it “is advising patients that this drug should usually not be taken during pregnancy.”

The risk of heart defects among newborns is about 1 percent overall. For infants born to women taking Paxil, that number jumps to 1.5 to 2 percent, according to studies cited by the FDA.

SOURCE: Paxil and Pregnancy › Babies born to women taking Paxil at higher risk for heart defects

The families contend that the mothers’ use of Paxil during pregnancy resulted in severe heart defects in their infants and have sued GlaxoSmithKline for failure to warn the public about the dangers of the drug for pregnant women.

The American College of Obstetricians and Gynecologists recently recommended that pregnant women not use Paxil, according to the plaintiffs’ lawyer, Karen Barth Menzies of Los Angeles.

Two of the plaintiffs are from West Virginia, two from Ohio and one from Nebraska.

Source: Lawyers USA

SOURCE: Paxil and Pregnancy › Parents sue Paxil maker for heart defects

ACOG’s Committee on Obstetric Practice “recommends that treatment with all SSRIs [selective serotonin reuptake inhibitors] or selective norepinephrine reuptake inhibitors or both during pregnancy be individualized and paroxetine [Paxil] use among pregnant women or women planning to become pregnant be avoided, if possible,” read the statement, which is in the December issue of Obstetrics & Gynecology.

The guidelines come a full year after the U.S. Food and Drug Administration(FDA) issued a warning about possible birth defects associated with Paxil when the drug is taken during the first trimester of pregnancy.

This warning was based on two studies. The first found about a 2 percent risk of heart defects in babies born to mothers who took Paxil early in their pregnancy, compared with a 1 percent risk in the general population.

The second study found that the risk of heart defects was 1.5 percent in babies whose mothers took Paxil in the first three months of pregnancy, compared with 1 percent in babies whose mothers took other antidepressants in the first trimester. The most common defects were cardiovascular.

“Since the FDA warnings a year ago, most ob/gyns have been trying to avoid Paxil during pregnancy,” noted Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. “This is just a formal statement by ACOG.”

The initial FDA warning came in September of 2005. In December of the same year, the FDA instructed Paxil’s maker, GlaxoSmithKline, to reclassify the drug from a Category C to D (a stronger warning) for pregnant women. Category D means studies in pregnant women have demonstrated a risk to the fetus.

Other reports had indicated that SSRIs, the category of antidepressants which includes Paxil as well as Celexa, Prozac and Zoloft, may cause newborns to have withdrawal symptoms.

ACOG acknowledged that these potential problems must be weighed against yet another study which found that pregnant women who discontinue their antidepressant medication are five times more likely to relapse into depression than women who continue with the medication.

“Untreated depression has its own risks, including low weight gain, alcohol and substance abuse, and sexually transmitted diseases, all of which have negative maternal and fetal health implications,” the statement said.

Women of reproductive age have the highest prevalence of major depressive disorders, with ACOG experts estimating that about 1 in 10 will experience a bout of major or minor depression sometime during pregnancy or the postpartum period.

Ideally, these issues should be considered before a woman becomes pregnant, the ACOG panel said. But, given that about half of all pregnancies are not planned, many decisions regarding treatment will inevitably happen after the woman has conceived. Fetal echocardiography, which looks for heart trouble, should be considered for women who were exposed to Paxil in early pregnancy, the statement recommended.

“Women who have certain health problem such as depression really should try to plan their pregnancies with their ob/gyn and psychiatrist,” Wu confirmed. “The major danger will be to women who have an unplanned pregnancy and don’t realize it until they’re two months along. There’s a lot of organ development during that time, and exposure to certain SSRIs may pose some dangers.”

SOURCE: Health Day News

SOURCE: Paxil and Pregnancy › Ob/Gyn Group Urges Pregnant Women to Shun Paxil

The family sued the company in state court in Philadelphia for failing to warn consumers of the possible risks of taking the medication during pregnancy, according to the family’s attorney Karen Barth Menzies.

The family is seeking unspecified damages.

Source: Laywers USA

SOURCE: Paxil and Pregnancy › First Paxil birth defect lawsuit filed

The extent of the heart defects ranged from mild to those that were severe enough to require surgery.

The FDA said that based on the data, it is asking that Paxil’s drug classification be changed from “C” to “D”. Doctors use the classification system to decide whether or not to prescribe a specific drug to a woman who is pregnant.

Despite the warning, the FDA said that Paxil’s benefits may outweigh its risks for certain patients. Paxil is also known by the generic name paroxetine.

The FDA noted that Glaxo (GSK ) had changed its label in September to reflect results from one of the clinical studies. The agency said it now asked the company to update Paxil’s label to now include results from the second study.

In September, Glaxo also sent out letters to health professionals advising of the labeling changes for pregnant women, according to the FDA’s website.

Like many other popular antidepressants, Paxil also carries a warning advising that it can trigger suicidal thoughts in some children and adolescents. The drug is not approved for pediatric use.

Paxil was first approved by the FDA in December 1992.

Source: MarketWatch

SOURCE: Paxil and Pregnancy › FDA strengthens pregnancy warning on Glaxo’s Paxil

The company cited newly analyzed data from a retrospective epidemiologic study of major congenital malformations in infants, saying that “preliminary results suggest an increase in the risk of congenital malformations associated with the use of paroxetine as compared to other antidepressants.”

Changes in the drug’s labeling are being made after consultation with the U.S. Food and Drug Administration (FDA).

Current FDA-approved labeling lists paroxetine as a pregnancy Category C drug. Category C is defined as drugs with “no adequate and well-controlled studies in humans to determine the effect on the fetus.” Current labeling reminds prescribers that paroxetine during pregnancy should be used only if the potential benefit justifies the potential risk.

Information will be added to the product label indicating that of 3,581 pregnant women exposed to paroxetine or other antidepressants during the first trimester, use of paroxetine, compared with other antidepressants, was associated with an “increased risk of overall major congenital malformations.”

Specifically, women who took paroxetine were 2.2 times more likely to give birth to an infant with a major congenital malformation and 2.08 times more likely to give birth to an infant with a cardiovascular malformation than women on other antidepressants. Of 14 infants with a major congenital malformation born to women taking paroxetine, 10 of those with cardiovascular malformations had ventricular septal defects.

The new labeling goes on to note that a separate study based on the Swedish Medical Birth Registry “evaluated 4,291 infants exposed to SSRIs in early pregnancy. This study reported no increased risk for overall major malformations in 708 infants born to women with paroxetine exposure early in pregnancy.”

In the company’s “Dear Healthcare Provider” letter regarding the new labeling, GSK said that “it is important to note that because the GSK study was designed to evaluate the relative risk of congenital malformations in infants born to women exposed to antidepressants, the study did not include a comparison to infants who were not exposed to any antidepressant. Therefore, these data should be viewed within the context of the overall prevalence of congenital malformations in the general population, which is estimated in the U.S. to be approximately 3 percent for any malformation, and approximately 1 percent for cardiovascular malformations alone.”

GSK reviewed other epidemiological studies of SSRI exposure during pregnancy in its “Dear Healthcare Provider” letter, as well as several case-control studies. In addition, it cited the National Birth Defects Prevention Study of infants delivered from 1997 through 2001.

In that study, women who took any SSRI were more likely than those who were not exposed to have an infant with omphalocele.

The strongest effect was reported in that study to be with paroxetine, which accounted for 36 percent of all exposures to an SSRI. Infants born to mothers taking paroxetine during the first trimester were found to be 6.3 times more likely to have an omphalocele compared with infants born to mothers who took no SSRIs. An association was also found between SSRI exposure and infants being born with craniosynostosis.

GSK concluded, “The differences in the results from the available studies and the diversity in type of abnormalities recently reported makes it difficult to definitively conclude a causal relationship for any particular congenital abnormality with paroxetine.”

The company, in cooperation with FDA requests, is conducting additional epidemiologic studies “to more fully understand these preliminary findings.”

SOURCE: Paxil and Pregnancy › New Paxil Labeling Warns Of Birth-Defect Risk

Paxil Linked to Twice as Many Birth Defects

GlaxoSmithKline recently conducted a study of major birth defects in infants born to women who took antidepressants (including Paxil) during the first trimester of pregnancy.

In a study of more than 3,500 pregnant women, Paxil was linked to twice as many major birth defects as other antidepressants, according to the FDA.

Birth defects are very rare in the U.S., and it’s not certain what role, if any, Paxil played in the birth defects seen in the study, notes GlaxoSmithKline.

Changes have been made to the labeling information on pregnancy precautions that accompanies Paxil, says the FDA.

GlaxoSmithKline is a WebMD sponsor.

Most of the birth defects seen in the study were heart related; the most common heart malformations were ventricular septal defects, which are holes between the heart’s two main pumping chambers. These are common birth defects overall as well.

The study was a retrospective epidemiological study. That means it looked at large groups of people in hindsight. There was no data on birth defects in babies born to women who didn’t take antidepressants during early pregnancy.

From the Company to Doctors

It is “difficult” to determine whether Paxil caused those birth defects, says GlaxoSmithKline in a letter sent to doctors.

In the letter, the company notes that these findings differ from previous studies looking at birth defects and antidepressants.

Data from the large Swedish Medical Birth Registry hasn’t shown evidence of increased risk of major birth defects with antidepressants, including Paxil, notes GlaxoSmithKline.

GlaxoSmithKline spokespeople were not immediately available for comment.

Paxil’s Warning

Paxil’s official web site puts it this way:

“Tell your doctor if you are pregnant or plan to become pregnant as there is a potential risk to the fetus with [Paxil]. Some studies of [Paxil] in pregnant women have suggested a possible increased risk of malformations, while others have not shown such a risk.”

Antidepressants, including Paxil and others, such as Prozac and Zoloft, have been linked to withdrawal symptoms in babies born to mothers taking these medications. These antidepressants are known as selective serotonin reuptake inhibitors (SSRIs).

The Paxil web site also says: “Babies born to mothers who have taken antidepressants, including SSRIs such as Paxil, in the third trimester of pregnancy have reported complications, including difficulties with breathing, turning blue, seizures, changing body temperature, feeding problems, vomiting, low blood sugar, floppiness, stiffness, tremor, shakiness, irritability or constant crying. Tube feeding, help with breathing and longer hospitalization may be needed. There have also been reports of premature births in pregnant women exposed to SSRIs, including Paxil.

“Like many antidepressants, Paxil can be present in breast milk so tell your doctor if you are nursing.”

Source: WebMD Health News

SOURCE: Paxil and Pregnancy › New Study Links Paxil to Twice as Many Birth Defects as Other Antidepressants