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Pregnant on meds

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  • #1

    Pregnant on meds

    I'm 10 weeks pregnant with my first baby and have suffered from panic attacks and depression since I was a small child. I started meds at the age of 16 and have been on some kind of cocktail since. I am currently on 30mg Cymbalta, 12.5mg of Lamictal and 50mg of 5-HTP, all once a day. Two years ago my Dr. started to ween me off of my meds and replaced part of the dosage with 5-HTP....it has been working for over a year now. I plan to take my meds through pregnancy because I've already tried to get off and the benefits outweigh the risk. I've read from a bunch of women that they stayed on cymbalta/lamictal and their babies were ok, my question is about 5-HTP.....my Dr. thought once I was pregnant it would be safe to stay on since its natural, however I've been reading online that you should'nt take it for longer than 12 weeks (i've been on it for a year) and you should not take it while pregnant. My concern is if I stop I will have to up my dose of Cymbalta and Lamictal again..I'm just not sure. Thanks for reading this.
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  • #2
    Dear ebcinlbc,

    Lamotrigine (Lamictal) does not appear to increase the risk of birth defects. Plasma levels should be monitored as pregnancy alters how the drug is metabolized within the body, and drug levels may decrease resulting in break through symptoms.
    Duloxetine (Cymbalta) has limited study during pregnancy. One case report has been published of a woman who delivered a term, healthy infant. The cord blood/maternal blood level ratio was small suggesting
    limited transfer of the drug across the placenta.
    There were no human studies of 5-HTP located. There have been contaminants found in some formulations of the drug. In animals, growth retardation and eosinophilia (high number of white blood cells) have been seen with 5-HTP. Due to the untoward effects of 5-HTP seen in animal studies and the lack of human study, 5 HTP is not recommended for use during pregnancy. Thus said, we also know that depression itself may have an adverse effect on pregnancy so talk with your physician and determine a risk/benefit for each of your medications during pregnancy in your specific case.

    Sincerely,
    Cindy Pride, MSN, CPNP
    TTUHSC InfantRisk Center

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    • #3
      I have given birth and my baby is 7 weeks premature. the NICU is not letting me breast feed, nor are they letting me use my breast milk, saying that it is on the high risk drug list. Please advise, as i really would like to nurse my baby, as i am against formula.

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      • #4
        Dear Ebcinlbc

        In order to answer your question accurately, i would need to know what medications you are currently on, and the doses if possible.


        Tassneem Abdel Karim, MD
        InfantRisk Center

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        • #5
          Hi,

          Sorry, I didn't know this went through I was trying to post and thought I couldn't :/ Glad I checked!! OK
          I'm on 30 mg Cymbalta once a day for depression and 25 mg of Lamictal once a day for anxiety.
          I have been stable on these two drugs for 5 + years and even was able to decrease my original dosage of both before I got pregnant.
          Thank you for your valuable time!!!
          Ellen

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          • #6
            NOTE: beginning of pregnancy I was on 12.5 mg of Lamictal and 50 mg of 5-HTP. I stopped taking 5-HTP per your recommendation (see above) and felt depressed and low so upped the Lamictal back to 25 mg, which is what I was on before starting the 5-HTP.

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            • #7
              Dear Ebcinlbc

              It is probably okay to breastfeed while you are on Cymbalta, new data suggest that the milk/plasma ratio is low, and the RID (Relative Infant Dose) is low as well (0.1%-1.1%). This RID probably too low to have clinical effects on the baby.

              On the other hand, Lamictal has a high relative infant dose and significantly high infant plasma levels (<=45% of maternal levels). This suggests significant transfer to the infant. If you decide to breastfeed while on this medication, baby should be closely monitored for apnea and sedation with occasional plasma levels. Exposure in utero is considerably higher, and levels will probably drop in newborn breastfed infants who are breastfed. Nevertheless, it is advisable to monitor the infant's plasma levels closely to ensure safety.

              However, please be advised that the baby will probably go through withdrawal.

              Tassneem Abdel Karim MD
              InfantRisk Center

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