Dr. Bob's Psychopharmacology Tips

Opiates during pregnancy

From: rherman729@juno.com (Robert A. Herman, M.D.)
Subject: Opiates during pregnancy
Date: Mon, 02 Jun 1997 23:18:46 EDT

I've been asked to consult on a woman who has been using hydrocodone about 14 mg per day in the form of cough medicine, "for the last 2 months or so." The patient is in her 8th month of pregnancy and also admits to propoxyphene 390 mg per day.

--Richard Rubin, MD

Methadone maintenance should be considered in such a case. Discuss the case with the medical director of a good methadone maintenance program; he or she should be able to help.

Date: 03 Jun 97 03:48:37 EDT
From: Leslie Gise <76106.413@compuserve.com>
Subject: Opiates during pregnancy

Traditionally narcotics are not withdrawn during pregnancy but maintained with methadone.

Date: Tue, 3 Jun 1997 16:29:07 -0400
From: gdavidson@sympatico.ca (George Davidson)
Subject: Opiates during pregnancy

Earlier in the pregnancy, methadone would be indicated. The risks of opiates during pregnancy are not the risks of the drugs but the risks of withdrawal and the effects of that on the fetus. You want to avoid withdrawal in this lady, and an easy way to do that is to maintain the hydrocodone. The baby can be detoxed at birth by standard procedures (no big deal, tincture of morphine in decreasing doses). Alternatively, as she is near term, you could simply taper the hydrocodone slowly to nil. Opiate blockers are contraindicated. Propoxyphene has metabolites which can make people feel pretty awful when it is used long term. I'd just stop it completely and treat any withdrawal (probably minimal) with an increase in hydrocodone.

Date: Fri, 6 Jun 1997 20:51:59 +0200
From: drandrea@bronner.vienna.at (Dr. Andrea Bronner)
Subject: Opiates during pregnancy

Based on my experience in about 80 pregnant opiate dependent addicts, I would consider a therapy with buprenorphine. Our so-far-mainatined 10 subjects on buprenorphine (mean daily dosage 8 mg sublingual) are stable without any problems for mother or unborn child, and there is no neonatal abstinence syndrome occuring. Prior to buprenorphine our subjects were on oral morphine (mean daily dosage around 300 mg). The adoption period from one substance to the other was two days.

--Gabriele Fischer

This topic is indexed under the following subjects:

URL: http://www.dr-bob.org/tips/split/Opiates-during-pregnancy.html
Original tips copyright 1994-97 original authors.
Web page copyright 1995-97 Robert Hsiung.