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Stimulant Medication to Treat ADHD While Pregnant

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  • Stimulant Medication to Treat ADHD While Pregnant

    Hello,

    I was diagnosed with ADHD in my late-20's and have recently switched medication from Adderall (45mg daily) to Vyvanse (70mg daily.) I spent most of last year pregnant with my first child and chose to stop taking the ADHD stimulant and anti-anxiety medications that I was prescribed at the time. I struggled to control my ADHD symptoms in the absence of medication. Functioning effectively in my job, in particular, was an issue. I came very close to being fired on two occasions during those nine months due to problems relating to my untreated ADHD. It has taken me months to make up the ground lost during that time.

    I recently discovered that I am pregnant with my 2nd child. I do not feel that I am in a position to discontinue medication entirely as I did with my first pregnancy. I have not been able to find much information regarding the use of Vyvanse during pregnancy and I would be open to switching to a different medication that might be safer.

    Based on the limited availability of studies on pregnancy and CNS stimulants, has one medication been shown to be safer than the others?

    Thank you in advance for your help!






  • #2
    cjayhawk,

    Here is the data we have on Adderall, Vyvanse, and Ritalin

    Adderall and Vyvanse:

    There are no adequate and well-controlled studies in pregnant women. Amphetamine, in the enantiomer ratio present in ADDERALL (d- to l- ratio of 3:1), had no apparent effects on embryofetal morphological development or survival when orally administered to pregnant rats and rabbits throughout the period of organogenesis at doses of up to 6 and 16 mg/kg/day, respectively. These doses are approximately 1.5 and 8 times, respectively, the maximum recommended human dose of 30 mg/day [child] on a mg/m2 body surface area basis. Fetal malformations and death have been reported in mice following parenteral administration of d-amphetamine doses of 50 mg/kg/day (approximately 6 times that of a human dose of 30 mg/day [child] on a mg/m2 basis) or greater to pregnant animals. Administration of these doses was also associated with severe maternal toxicity. A number of studies in rodents indicate that prenatal or early postnatal exposure to amphetamine (d- or d,l-), at doses similar to those used clinically, can result in long-term neurochemical and behavioral alterations. Reported behavioral effects include learning and memory deficits, altered locomotor activity, and changes in sexual function.

    There are no adequate and well-controlled studies in pregnant women. There has been one report of severe congenital bony deformity,tracheo-esophageal fistula, and anal atresia (vater association) in a baby born to a woman who took dextroamphetamine sulfate with lovastatin during the first trimester of pregnancy. Amphetamines should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. However, at this point, amphetamines do not apparently cause a major risk for congenital anomalies. Milk withdrawal symptoms have been reported, but wane quickly.

    Ritalin:

    In a collection of case reports for 48 women who used methylphenidate during pregnancy, no increase in congenital abnomalities were identified. However, the number of subjects may have been to small to make conclusions.

    In studies conducted in rats and rabbits, methylphenidate was administered orally at doses of up to 75 and 200 mg/kg/day, respectively, during the period of organogenesis. Teratogenic effects (increased incidence of fetal spina bifida) were observed in rabbits at the highest dose, which is approximately 40 times the maximum recommended human dose (MRHD) on a mg/m2 basis. The no effect level for embryo-fetal development in rabbits was 60 mg/kg/day (11 times the MRHD on a mg/m2 basis). There was no evidence of specific teratogenic activity in rats, although increased incidences of fetal skeletal variations were seen at the highest dose level (7 times the MRHD on a mg/m2 basis), which was also maternally toxic. The no effect level for embryo-fetal development in rats was 25 mg/kg/day (2 times the MRHD on a mg/m2 basis). When methylphenidate was administered to rats throughout pregnancy and lactation at doses of up to 45 mg/kg/day, offspring body weight gain was decreased at the highest dose (4 times the MRHD on amg/m2 basis), but no other effects on postnatal development were observed. The no effect level for pre- and postnatal development inrats was 15 mg/kg/day (equal to the MRHD on a mg/m2 basis). Adequate and well-controlled studies in pregnant women have not been conducted. Methylphenidate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

    Sandra Lovato R.N.
    InfantRisk Center
    806-352-2519

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