IODOQUINOL
Drugs in Pregnancy and Lactation.
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Name: IODOQUINOL
Class: Amebicide
Risk Factor: C
Fetal Risk Summary
Iodoquinol (di-iodohydroxyquinoline; diiodohydroxyquin) is used in the treatment of intestinal amebiasis. It has been used in pregnancy apparently without causing fetal harm.
Two case reports described the use of iodoquinol in pregnancy for the treatment of a rare skin disease. The first case involved a woman with chronic acrodermatitis enteropathica who was treated with the amebicide in the 2nd and 3rd trimesters of her first pregnancy (1). She delivered a typical achondroplastic dwarf who died in 30 minutes. The second case also involved a woman with the same disorder who took iodoquinol throughout gestation (2). Dosage during the 1st trimester, 1.3 g/day, was systematically increased during pregnancy in an attempt to control the cutaneous lesions, eventually reaching 6.5 g/day during the last 4 weeks. A normal male infant was delivered at term. Physical examinations of the infant, including ophthalmic examinations, were normal at birth and at 6 weeks follow-up.
The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 169 of which had 1st trimester exposure to iodoquinol (3, pp. 299, 302). Ten of the infants were born with a congenital malformation, corresponding to a hospital standardized relative risk (SRR) of 0.88. Based on 3 infants, an SRR of 6.6 for congenital dislocation of the hip was calculated, but this association is uninterpretable without confirming evidence (3, pp. 467, 473). For use anytime during pregnancy, 172 exposures were recorded (3, pp. 434, 435). With the same caution as noted above, an SRR of 1.68 (95% confidence interval 0.62–3.58) was estimated based on malformations in 6 infants. The SRR for congenital dislocation of the hip after use anytime during pregnancy was 6.5 (3, p. 486).
Breast Feeding Summary
No reports describing the use of iodoquinol during lactation have been located. Although the oral bioavailability is low, the molecular weight (397) should allow transfer of some drug from the plasma into the milk. In addition, protein-bound serum iodine levels may be increased with the administration of iodoquinol and persist for as long as 6 months after discontinuation of therapy (4). The effects on a nursing infant from this exposure are unknown, but because iodide is concentrated in breast milk, serum and urinary iodide levels in the infant may be elevated (see Potassium Iodide).
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References
- Vedder JS, Griem S. Acrodermatitis enteropathica (Danbolt-Closs) in five siblings: efficacy of diodoquin in its management. J Pediatr 1956;48:212–9.
- Verburg DJ, Burd LI, Hoxtell EO, Merrill LK. Acrodermatitis enteropathica and pregnancy. Obstet Gynecol 1974;44:233–7.
- Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
- Product information. Yodoxin. Glenwood, 2000.
