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Thread: Neurontin & Pregnancy

  1. #1

    Neurontin & Pregnancy

    Does anyone have any experience in using Neurontin while pregnant? Is it safe? I am not pregnant yet but hope to be within a year or so. I currently take 900 mg 3 times a day and am wondering if I should try to cut back my dosage. I have tried to decrease my dosage before but haven't been able to stand the increase in pain. Any real life advice would be appreciated as I seem to get conflicting opinions from my doctors on this subject. Thanks!

  2. #2

    while on the subject

    what about valium and ditropan?

  3. #3
    Senior Member julran's Avatar
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    i have no helpful information but, good luck on starting your family...

  4. #4

    Not real life data

    I can't give you real life data on the questions about these drugs, only the official position:

    Neurontin is classified as C for pregnancy risk
    Animal studies show adverse fetal effect(s) but no controlled human studies. Weigh possible fetal risks versus maternal benefits.

    Diazepam is classified as D for pregnancy risk
    This means positive evidence of human fetal risk; maternal benefit may outweigh fetal risk in serious or life threatening situations.

    Ditropan is classified as B for pregnancy risk
    This means Anniman studies show no risk or adverse fetal effects but controlled human studies in the first trimester are not available or do not confirm; no evidence of second or third trimester risk.; fetal harm possible but unlikely.

    You would do well to discuss these questions with a good doctor or nurse practitioner in advance of becoming pregnant.

    RAB

  5. #5
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    drugs and pregnancy -- no easy answers

    I am not a doctor, so I can't give you any medical advice -- I can only pass on the information that I was given.

    First of all, congratulations on starting a family! What an exciting time for you! I am currently about 9 weeks pregnant with twins (I am a T11 para), so I am followed by a number of specialists in high risk pregnancy, urology, orthopedics, and anesthesiology.

    I am currently taking ditropan (oxybutynin), macrobid (nitrofurantin), and a few other drugs. I was advised to stop taking doxepin at least during the first trimester, and I have taken that advice. I was taking neurontin at one time but stopped before attempting to get pregnant, again on the advice of my anesthesiologist. The macrobid is considered controversial, because some studies have shown liver dysfunction in a special group of fetuses, but my urologist and I made the decision to stay on the drug for the first 2 trimesters, when it is considered non-harmful to the fetuses.

    One thing you will learn about drugs and pregnancy is that there is a lack of information out there for you. It's very discouraging to read "No information" again and again from book/web search/doctor's visit, and it's hard to get really good information on how to make a decision about a drug. Keep asking questions, and see if you can make an appointment for a consult with a high risk o.b. specialist. I did, and mine turned out to be a fetalpharmacologist as well, which means he is an expert in this very subject. He's been a wealth of information and comfort to me, because now I feel like I am not the only one faced with these difficult decisions. Also, he is now my o.b., so I have continuity of care.

    Whatever you decide, make the decision and don't look back. You'll make the best decisions you can with the information that exists, so don't ever feel like you've made a mistake.

    Good luck, and let me know how it turns out for you.

  6. #6

    Thanks Chipper

    Thanks for your help and advice. Can you tell me why your anesthesiologist told you to stop the Neurontin? My gynecologist told me it is safe to use during pregnancy while my neurologist said he was unsure. As you said, all of this conflicting information drives me crazy! You're the first person I've talked to who seems to have any real experience with this subject. Congratulations on your pregnancy!! Twins run in my family so maybe I'll need even more advice from you later on!

  7. #7
    Phillis, I just wanted to add one comment... Drug effects on fetal development are dose-dependent. Therefore, regardless of classification and particularly for drugs that have been shown to have an effect on fetal development, it is probably a good idea to evaluate the doses that you need and work with your doctor to titrate all the doses to the minimal level possible, particularly during the early trimesters.

    Neurontin or gabapentin inhibits neuropathic pain in a number of ways but much of the data now is pointing towards a single mechanism: inhibition of phosphokinase C (PKC). This enzyme influences receptor sensitivity and calcium channels. Your body gets use to the drug and probably increases expression of PKC to compensate for the drug. That is probably the main reason why the drug effects decline and the dose must be increased over time to treat neuropathic pain. However, beyond a certain level, the cells can no longer accomodate to the drug and the pain benefits stabilize. I don't know what neurontin would do to human fetus and the data suggest that very high doses (300 mg/kg or greater) do not have apparent effects on rodent or rabbit fetal development. Nevertheless, you should minimize the amount of exposure that your baby has to the neurontin.

    There are now attempts in various countries to establish registries of people with who take anti-epileptic drugs (neuronton is an anti-epileptic drug) and who are pregnant, to collect data on the subject of drug effects on pregnancy. As you can see from the following abstract, this effort is just beginning.

    • Beghi E and Annegers JF (2001). Pregnancy registries in epilepsy. Epilepsia. 42 (11): 1422-5. Summary: The risk of major malformations in the offspring of mothers with epilepsy receiving antiepileptic drugs is 4--8% compared to 2--4% in the general population. Risk factors include daily dose and polytherapy. Selected drugs have been found to be associated with a higher risk of specific malformations (congenital heart defects and cleft palate with phenytoin and barbiturates; neural tube defects with valproate and carbamazepine). Although some of these findings are unquestionable, several questions are still unsolved, depending the characteristics of the target populations, the small samples of patients, and the design and limiting factors of the published reports. In the last decade, pregnancy registries have been activated by collaborative groups of physicians in Europe (EURAP), North America (NAREP), Australia and India (the latter two recently merged into EURAP), to enroll a large number of exposed women to be monitored prospectively with standardized methods, and by three pharmaceutical companies marketing lamotrigine, gabapentin and vigabatrin, as part of their post-marketing surveillance. Even though the structure of these registries and the target populations should theoretically result in the identification of a sufficient number of women exposed to different drugs and examined for the occurrence of malformations of any type and severity, the implementation of a common database with information from the existing registries may provide valuable information in a shorter time period. Although differences between some of the registries limit the possibility to pool data, a gradual development of a collaboration is highly desirable to discuss a list of design issues and assess to what extent and how data could be compared and organized. Centro per l'Epilessia, Ospedale "San Gerardo," Monza, and Istituto "Mario Negri," Milano, Italy. beghi@marionegri.it.

    • Petrere JA and Anderson JA (1994). Developmental toxicity studies in mice, rats, and rabbits with the anticonvulsant gabapentin. Fundam Appl Toxicol. 23 (4): 585-9. Summary: The developmental toxicity of the anticonvulsant agent gabapentin was evaluated in mice, rats, and rabbits treated by gavage throughout organogenesis. Mice received 500, 1000, or 3000 mg/kg on gestation days (GD) 6-15 and rats and rabbits received 60, 300, or 1500 mg/kg on GD 6-15 (rats) or 6-18 (rabbits). Additional groups received an equivalent volume of the vehicle, 0.8% methylcellulose, or remained untreated. All dams were observed daily for clinical signs of toxicity. In mice, body weights and food consumption were recorded on GD 0, 6, 12, 15, and 18 while in rats and rabbits these parameters were evaluated daily. Near term (mouse, GD 18; rat, GD 20; and rabbit, GD 29) each female was euthanatized, necropsies were performed, and litter and fetal data were collected. Live fetuses were examined for external, visceral, and skeletal variations and malformations. No adverse maternal or fetal effects were observed in mice or rats given doses up to 1500 or 3000 mg/kg, respectively. No treatment-related maternal or fetal effects were apparent in rabbits given 60 or 300 mg/kg. At 1500 mg/kg, one rabbit died, four others aborted, and reduced food consumption and body weight gain were observed. No other reproductive, litter, or fetal parameters were affected, except that the incidence of visceral variations in rat fetuses was slightly but statistically significantly increased at 1500 mg/kg due to a slight increase in the incidence of dilated renal pelvis. This finding was not considered biologically significant because this degree of variability has been seen in this strain of rats.(ABSTRACT TRUNCATED AT 250 WORDS). Parke-Davis Pharmaceutical Research, Division of Warner-Lambert Co., Ann Arbor, Michigan 48105.

    [This message was edited by Wise Young on Jun 01, 2002 at 06:14 PM.]

  8. #8
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    drugs and pregancy, SPASMS

    Hi Chipper,
    I'm TTC (trying to conceive) and have been working at cutting back on meds, especially for first trimester. I'd be really happy to share info back and forth, especially if my blood test next Tuesday shows a + pg test.
    Anyone know of ways to reduce spasms without using baclofen or other drugs? That's my main problem at the moment. I NEED my anti-spasm drug since my smasms have been inducing Autonomic Dyserflexia (which can kill fetuses) but the meds that I'm using have caused fetal deformities in animal studies. Yikes!
    ~Dr2Be

  9. #9
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    Phillis, since the neurontin wasn't helping me significantly, my doctor advised stopping the dosage gradually before trying to get pregnant. I believe I was told conflicting information on this drug as well -- but since 2 of the 3 experts told me to stop the drug if possible, I did so before I got pregnant. I am sorry, but I honestly don't remember what the risk factors were for the drug. I had so many questions about so many drugs that I am afraid I can't remember the risks potentially associated with neurontin.

    I was told the risks of taking opiates during pregnancy include failure to thrive and low birth rate babies, and that doxepin had some fetal development issues associated with it (but my ob advised I remain on the doxepin, even though my anesthesiologist recommended I stop the drug). Some doctors advise their patients to stay on opiates, others request the drugs be stopped during the entire 9 months of pregnancy. Oxybutynin had no risk factors, from what I was told, but I don't know about baclofen.

    Good luck Phillis and Dr2be! Please let me know when you get pregnant! I am looking forward to swapping ideas and advice. You can email me directly if you'd like. I know these issues will come up again when we start to worry about breastfeeding.

  10. #10

    Dr2Be

    Hi, I had 2 successful although preterm births post SCI. I also have a seizure disorder so I needed some med changes. Neurontin, Depokote, and Tegretol were 3 that the geneticist recommended I not take. They were in the HIGH risk area.

    I have spasticity but stopped meds during my last pregnancy. I had pre-term labor and they gave me meds to control the labor. Funny thing was it also controlled the spasticity. It was over the counter. I will look in my medicine cabinet and see what it is. Four years later and the memory fades. I took it as an alternative to terbualine. Look for me to post later.

    Mass General is completing a long term study of antiepileptic drugs on pregnancy outcome. I participated. You might want to contact them and/or Brigham and Womens. I participated in their study also.

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