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A patient of mine has arthropathy, +ANA, with diagnostic work-up underway. Her pain was well controlled on buprenorphine patch (10 mcg) and tramadol 50 mg as needed. She stopped them when she learned she was pregnant 3 weeks ago. Her pain is now poorly controlled. I prescribed some hydrocodone/apap 5/500 mg to tide her over until I did more research. She's only planning to take 1 at night before bed. Is a buprenorphine patch a better and/or safer option for chronic pain during pregnancy? Any known risks, other than possible neonatal withdrawl symptoms?
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Knoyes:
The two best choices for treatment of chronic pain in pregnancy are probably buprenorphine and fentanyl. Both are available in patch form for continuous therapy. Below is some data on buprenorphine use during pregnancy.
Tom Hale Ph.D.
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Buprenorphine is a narcotic agonist-antagonist analgesic that is used to treat addiction to opioids. Abrupt discontinuation of opioids leads to symptoms of withdrawal, but in adults, even with abrupt discontinuation of buprenorphine, there are little or no symptoms of withdrawal.[1] Maternal treatment of opioid addicted mothers with buprenorphine appears to be well tolerated.[2] Buprenorphine also does not appear to cause fetal malformations.[3] The use of buprenorphine in pregnancy reduces the incidence and severity of NAS (neonatal abstinence syndrome) as compared to methadone.[1, 4, 5] In a study by Kahila et al, no structural brain abnormalities were noted in neonates exposed to burprenorphine during gestation and actually the drug may prevent the brain changes of HIE (hypoxic ischemic encephalopathy) seen in neonates exposed to uncontrolled drug abuse.[6] In summary, methadone has been the drug of choice for opioid dependent women during pregnancy, but buprenorphine may be better tolerated. Further studies are needed to recommend buprenorphine over methadone. There are no long term studies on the effects of buprenorphine on children exposed during gestation, therefore, this drug should only be used in pregnancy when the benefit to the mother outweighs the risk to the infant.
1.Johnson RE, Jones HE, Fischer G. Use of buprenorphine in pregnancy: patient management and effects on the neonate. Drug Alcohol Depend. May 21 2003;70(2 Suppl):S87-101.
2.Fischer G, Johnson, RE., and Eder, H. Treatment of opioid-dependent pregnant women with buprenorphine. Addiction. 2000;95:239-244.
3.Kastrup Eea. Drug Facts and Comparisons 2010: Wolters Kluwer Health; 2010.
4.Farid WO, Dunlop SA, Tait RJ, Hulse GK. The effects of maternally administered methadone, buprenorphine and naltrexone on offspring: review of human and animal data. Curr Neuropharmacol. Jun 2008;6(2):125-150.
5.Hytinantti T, Kahila H, Renlund M, Jarvenpaa AL, Halmesmaki E, Kivitie-Kallio S. Neonatal outcome of 58 infants exposed to maternal buprenorphine in utero. Acta Paediatr. Aug 2008;97(8):1040-1044.
6.Kahila H, Saisto T, Kivitie-Kallio S, Haukkamaa M, Halmesmaki E. A prospective study on buprenorphine use during pregnancy: effects on maternal and neonatal outcome. Acta Obstet Gynecol Scand. 2007;86(2):185-190.
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