Preg. woman

Buprenorphine Post
mbutka
Posts: 6

Postby mbutka » Thu Oct 02, 2003 1:00 pm

I've had a similar experience. She became pregnant while on Suboxone, switched to Subutex, and reduced her dose mostly to 2mg qd. She was unable to come off, and did have one minor relapse with Percocet, but 2 weeks ago delivered a healthy average size infant at 40 1/2 weeks with no signs of withdrawal. This is also only one case, but at least with low dosing I feel fears about effects on the neonate are unfounded.

If it were my wife or sister I'd feel safer recommending buprenorphine over withdrawal or methadone during pregnancy and labor.

judymartin
Posts: 22

Postby judymartin » Thu Oct 02, 2003 1:00 pm

Hi, Terry,
"wanting to stay away from methadone" in pregnant opioid abusing women is a date resistant, evidence-proof behavior that is very common, even among physicians...I'm glad you had a good outcome, and I hope the family does well in future.

trustin
Posts: 83

Postby trustin » Thu Oct 02, 2003 1:00 pm

A pregnant 24 year old woman, mother of 2, on Vicodin 30-40 tabs a day, sought my help in March 04. Heavy smoker, also using mj, Xanax, some Ecstasy; previous babies quite small but not malformed. I discussed the options with her, and we both wanted to stay away from methadone. I put her on buprenorphine and stabilized her at 6 mg a day. She saw me every 1-2 weeks, and her OB-Gyn on a frequent schedule, too. She had one major relapse on Vicodin and Xanax lasting a week or so, then stayed on buprenorphine under supervision. Last week, she delivered 3 weeks early, a 4 pound baby, no malformations (other than small for dates) yet apparent. The baby is still in the hospital, but has had no opioid withdrawal symptoms, and is doing well. She is ready to detox now, and we dropped her dose to 4 mg daily. She's very happy with buprenorphine and is willing to keep working on sobriety.

One case isn't a series, but thus far I prefer buprenorphine to methadone in this situation.

Terry Rustin


steve
Posts: 2

Postby steve » Thu Oct 02, 2003 1:00 pm

quote:
Originally posted by brautigan

The international literature on buprenorphine in pregnancy is very supportive of its safety. However, it has yet to have a formal acceptance of its use by ACOG and I think it would be wise to be cautious especially if methadone maintenance is available in your community.

Obstetrics and Gynecology Clinics
Volume 30 Number 3 September 2003
Copyright 2003 W. B. Saunders Company
Pharmacologic treatments for women with addictions
Michael P. Bogenschutz, MD *
Cynthia M.A. Geppert, PhD, MD

"Early trials indicate effective in women and may be safe in pregnancy. Currently not recommended as pregnancy-risk class C."



Thank you for this info. My first OBOT pregnancy presented itself today.

brautigan
Posts: 8

Postby brautigan » Thu Oct 02, 2003 1:00 pm

The international literature on buprenorphine in pregnancy is very supportive of its safety. However, it has yet to have a formal acceptance of its use by ACOG and I think it would be wise to be cautious especially if methadone maintenance is available in your community.

Obstetrics and Gynecology Clinics
Volume 30 Number 3 September 2003
Copyright 2003 W. B. Saunders Company
Pharmacologic treatments for women with addictions
Michael P. Bogenschutz, MD *
Cynthia M.A. Geppert, PhD, MD

"Early trials indicate effective in women and may be safe in pregnancy. Currently not recommended as pregnancy-risk class C."

livornese
Posts: 1

Postby livornese » Thu Oct 02, 2003 1:00 pm

I have been treating pregnant women with methadone since 1970. No bad babies!!! So why use something that is not proven and the studies with pregnant patient are very thin with bup.


MSN [Bot]

Postby MSN [Bot] » Thu Oct 02, 2003 1:00 pm

Hi, the frustrating part about reading the literature about pregnancy and buprenorphine, or methadone for that matter, is that it is all done in hospitals, with patients hooked up to stress test machines and fetal monitors. In actual daily life in my community it is very unlikely that the obstetrician will admit for induction.
Most of the things I've read support trying to prevent fetal withdrawal as a key clinical goal , in fact that is why methadone maintenance is the current treatment of choice, and detox relatively contraindicated. So I could see keeping a woman on buprenorphine who becomes pregnant during treatment if she wants to stay on it, and doesn't want methadone. But I am more hesitant about induction with buprenorphine during pregnancy, since we either have to wait for withdrawal, or risk precipitating withdrawal during induction, ie precisely what we are trying to avoid. It seems methadone would be safer in that situation.

FAST WebCrawler [Crawler]

Postby FAST WebCrawler [Crawler] » Thu Oct 02, 2003 1:00 pm

bup may be prescribed for pregant women, but keep in mind that currently methadone is the treatment of choice for pregnat women. there is limited clinical expereincei with bup in pregnant women, but the research that is avialable does not show any adverse effects on pregancy with bup. if treating iwth bup, use subutex, the bup only forulation, since naloxone could precipiatet withdrawal in mother and fetus. on the other hand, if taken sublinguially, the naloxone should have no effect.


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