{"id":12407,"date":"2026-08-27T14:24:47","date_gmt":"2026-08-27T07:24:47","guid":{"rendered":"https:\/\/quoctesannhihaiphong.vn\/en\/medication-alert-bulletin-04-2024\/"},"modified":"2026-08-27T14:24:47","modified_gmt":"2026-08-27T07:24:47","slug":"medication-alert-bulletin-04-2024","status":"publish","type":"post","link":"https:\/\/quoctesannhihaiphong.vn\/en\/medication-alert-bulletin-04-2024\/","title":{"rendered":"MEDICATION ALERT BULLETIN 04\/2024"},"content":{"rendered":"<p><strong>I. Risk of Severe Allergic Reactions When Using Chlorhexidine: Information from the French National Agency for the Safety of Medicines and Health Products (ANSM)<\/strong><\/p>\n<p>Chlorhexidine is used in many topical formulations or mouthwashes, oral spray solutions, lozenges, eye drops, or urinary antiseptic gels, serving as a disinfectant. Additionally, chlorhexidine is present in other products such as toothpaste and in some cosmetics, acting as a preservative.<\/p>\n<p>Recently, ANSM has reported a steady increase in the number of reports of severe allergic reactions related to chlorhexidine. Allergic reactions after using chlorhexidine are rare and typically occur within one hour, with symptoms such as urticaria, facial swelling, difficulty breathing, or even anaphylaxis. ANSM has issued several preventive measures to minimize the risk of immediate, severe allergic reactions when using chlorhexidine.<\/p>\n<p>Recommendations for Healthcare Professionals:<\/p>\n<ul>\n<li>If a patient is suspected or confirmed to be allergic to chlorhexidine, it is recommended to use alternative formulations.<\/li>\n<li>Depending on the intended use, povidone-iodine, chlorine derivatives (sodium hypochlorite), and antiseptic alcohol can be chosen as substitutes for chlorhexidine. For example:<\/li>\n<\/ul>\n<p>+ In surgical interventions, povidone-iodine or sodium hypochlorite may be used;<\/p>\n<p>+ When performing injection or blood sampling techniques, use antiseptic alcohol;<\/p>\n<p>+ When cleaning external wounds, patients are advised to use soap and water.<\/p>\n<ul>\n<li>Note that the use of these antiseptics is also associated with the risk of allergies.<\/li>\n<li>In case of allergic reactions after surgical interventions, chlorhexidine may also be the cause and should be included in testing to identify the cause of the allergy.<\/li>\n<\/ul>\n<p><strong>II. Use of antiepileptic drugs during pregnancy and risks to the fetus: information from ANSM<\/strong><\/p>\n<p>Following the initial report published in 2019, ANSM has recently conducted a new assessment of the risks posed to the fetus by antiepileptic drugs used during pregnancy.<\/p>\n<p><strong>1. Valproate and its derivatives valpromide, divalproate<\/strong><strong>: the antiepileptic drug with the highest risk when used during pregnancy<\/strong><\/p>\n<ul>\n<li>When the mother uses the drug during pregnancy, valproate and its derivatives pose the highest risk of causing malformations in the child, with a risk increase of 4 &#8211; 5 times (11%) compared to when the drug is not used. The drug also poses a high risk of causing neurodevelopmental disorders, with an incidence of about 30 &#8211; 40% in children exposed to the drug in utero. According to ANSM recommendations, valproate and its derivatives are absolutely contraindicated in pregnant women for the treatment of bipolar disorder and should be avoided in pregnant women with epilepsy, unless there are no alternative treatment options.<\/li>\n<li>In addition, the potential risk of neurodevelopmental disorders is also related to the father using valproate in the three months prior to conception. This risk has recently been assessed and warned by the European Medicines Agency.<\/li>\n<\/ul>\n<p><strong>2. Topiramate<\/strong><strong>: confirmed risk of neurodevelopmental disorders<\/strong><\/p>\n<ul>\n<li>The risk of neurodevelopmental disorders in children exposed to topiramate during pregnancy is increased 2 &#8211; 3 times (the risk of autism spectrum disorders up to 6% and the risk of mental illness up to 8%) compared to children born to mothers with epilepsy who do not use antiepileptic drugs. Previously, the risk of serious birth defects when using topiramate was increased 3 times compared to when not using the medication, which has also been warned.<\/li>\n<li>ANSM has proposed that the European Medicines Agency (EMA) reassess new data on the risk of neurodevelopmental disorders after children are exposed to topiramate from the prenatal stage. Based on this, in October 2023, the EMA issued a recommendation against the use of topiramate during pregnancy for the treatment of epilepsy, except in cases where no alternative medications are available. Topiramate is also contraindicated for migraine prevention and weight control. Patients planning to become pregnant must discontinue the medication. Patients of childbearing age need to use highly effective contraception for at least 4 weeks before stopping topiramate.<\/li>\n<\/ul>\n<p><strong>3. Carbamazepine:<\/strong><strong> increased risk of neurodevelopmental disorders<\/strong><\/p>\n<ul>\n<li>According to new available data, the risk of neurodevelopmental disorders in children may increase when exposed to carbamazepine during pregnancy compared to children not previously exposed to this medication. The risk of serious congenital malformations associated with carbamazepine has now been identified as being 2 &#8211; 3 times higher than that of the general population.<\/li>\n<li>To ensure the provision of complete information to patients and reduce the number of pregnant women using carbamazepine, which remains too high in France, starting in 2024, patients and prescribing doctors will be required to sign an information acknowledgment form and submit it to the pharmacist before a decision is made to dispense the medication.<\/li>\n<\/ul>\n<p><strong>4. Pregabalin<\/strong><strong>: risk of malformations has been identified<\/strong><\/p>\n<ul>\n<li>New data now confirms the risk of serious malformations in children related to exposure to pregabalin during pregnancy. This risk is nearly 1.5 times higher compared to children who have never been exposed to this medication. This risk was only mentioned in the 2019 report by ANSM.<\/li>\n<\/ul>\n<p><strong>5. Oxcarbazepine:<\/strong><strong> under evaluation for potential increased risk of malformations<\/strong><\/p>\n<ul>\n<li>The risk of effects on the fetus from oxcarbazepine is still under evaluation and further studies are needed before conclusions can be drawn regarding the drug&#8217;s risk of causing malformations.<\/li>\n<\/ul>\n<p><strong>6. Other antiepileptic drugs:<\/strong><strong> does not change the conclusion from 2019<\/strong><\/p>\n<ul>\n<li>For lamotrigine and levetiracetam, the available data do not provide evidence of an increased risk of serious congenital malformations or neurodevelopmental disorders associated with these two drugs.<\/li>\n<li>Regarding vigabatrin, felbamate, zonisamide, and gabapentin, the current information is insufficient to conclude about the increased risk of serious congenital malformations or neurodevelopmental disorders.<\/li>\n<li>Concerning (fos)phenytoin, phenobarbital, and primidone, exposure to these drugs during pregnancy carries a risk of serious congenital malformations. Regarding the risk of neurodevelopmental disorders, the available information is not sufficient to draw a conclusion.<\/li>\n<\/ul>\n<p><strong>7. Some other drugs<\/strong><\/p>\n<ul>\n<li>Finally, for some other drugs including: brivaracetam, cannabidiol, cenobamate, eslicarbazepin, ethosuximide, fenfluramine, lacosamide, perampanel, rufinamide, and tiagabine, there is currently no information to conclude about the risk of congenital malformations and neurodevelopmental disorders of these drugs.<\/li>\n<li>It should be noted that the lack of data does not mean there is no risk. The information is currently unclear at this time.<\/li>\n<\/ul>\n<p><strong>References: <\/strong>Electronic portal of the National Center for Drug Information and Adverse Drug Reaction Monitoring, accessed on 12\/04\/2024, link:<\/p>\n<p>http:\/\/magazine.canhgiacduoc.org.vn\/Magazine\/Details\/293.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I. Risk of Severe Allergic Reactions When Using Chlorhexidine: Information from the French National Agency for the Safety of Medicines and Health Products (ANSM) Chlorhexidine is used in many topical formulations or mouthwashes, oral spray solutions, lozenges, eye drops, or urinary antiseptic gels, serving as a disinfectant. Additionally, chlorhexidine is present in other products such<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1161],"tags":[1210,1211,1238,1169,1239,1226,1240,1201,1218,1221,1249,1203,1224,1200,1251,1241,1242,1232,1243,1234,1244,1229,1230,1220,1214,1228,1245,1236,1235,1219,1227,1237,1250,1246,1213,1253,1248,1254,1212,1252,1247,1225,1222,1223,1231,1233],"class_list":["post-12407","post","type-post","status-publish","format-standard","hentry","category-ban-tin-duoc","tag-ansm","tag-antoansudungthuoc","tag-brivaracetam","tag-canhgiacduoc","tag-cannabidiol","tag-carbamazepin","tag-cenobamat","tag-chongchidinhthaiky","tag-clorhexidin","tag-consatkhuan","tag-ditatbamsinh","tag-diungthuoc","tag-divalproat","tag-doctinhthainhi","tag-ema","tag-eslicarbazepin","tag-ethosuximid","tag-felbamat","tag-fenfluramin","tag-gabapentin","tag-lacosamid","tag-lamotrigin","tag-levetiracetam","tag-natrihypoclorid","tag-nhikhoa","tag-oxcarbazepin","tag-perampanel","tag-phenobarbital","tag-phenytoin","tag-povidoniod","tag-pregabalin","tag-primidon","tag-roiluanphattrienthankinh","tag-rufinamid","tag-sankhoa","tag-satkhuan","tag-socphanve","tag-thienkinh","tag-thongtinthuoc","tag-thuocchongdongkinh","tag-tiagabin","tag-topiramat","tag-valproat","tag-valpromid","tag-vigabatrin","tag-zonisamid"],"_links":{"self":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts\/12407","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/comments?post=12407"}],"version-history":[{"count":0,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/posts\/12407\/revisions"}],"wp:attachment":[{"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/media?parent=12407"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/categories?post=12407"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/quoctesannhihaiphong.vn\/en\/wp-json\/wp\/v2\/tags?post=12407"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}