These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Codeine and pregnancy
Question: My wife is 19 weeks pregnant. She is very sick (throat and chest infection).
Her OB/Gynecologist put her on Amoxicillin for the infection, and on
Dicomal-DH Syrup. This product has codeine in it. Is this
safe for my wife and our baby?
Answer: Narcotics in small controlled doses are of no risk to the fetus until the last few days prior
to delivery. Then they can produce sedation which could impair early respirations. This
effect will be completely gone within 1-2 days after stopping and could be medically reversed
if necessary. Amoxicillin is of little or no risk during pregnancy and is one of the drugs of
choice in pregnant women.
Calcium Fluoride
Question: My wife is in her 5th month of pregnancy. Her dentist suggested her to take calcium-fluoride, but her gynecologist is against it. What is your opinion on the matter?
Answer: Many women develop dental problems with pregnancy. Most gynecologists recommend
a healthy calcium intake, so that’s unlikely to be the problem. Fluoride is an unknown in fetal
development and I suspect that is the issue. I’d prefer oral calcium with topical fluoride rather than
system fluoride.
Colorectal Cancer
Question: I was diagnosed with colorectal cancer in 1993 at the age of 29.
The doctor said the tumor had attached itself to the walls of the rectum and removing
it would mean that I would have to get a colostomy. I did have it removed and I am now
32 years old and living with a colostomy. In addition, I had to have radiation and
chemotherapy treatment. After the radiation, I have no longer had my period. The radiologists explained
that the radiation scarred the uterus, so it does not bleed. This was explained before
I attended the radiation treatment, however, my surgeon said she would tuck away my
ovaries so that if I wanted to have a child, my ovaries would be intact, but I would have
to use a surrogate to carry the child. I recently went to my gynecologist, who told me that my
estrogen levels are very low, and he does not think I am ovulating. Therefore, he
thinks my ovaries have been destroyed. I no longer have medical coverage, so I cannot
afford a specialist, or even get a second opinion. I desperately want to be able to have my own child. Is there any chance that my ovaries may still be intact even though I
showed a low level in my blood, (the gynecologist put me on Premarin)? Is there any
way to repair the walls of the uterus so I can carry a child?
Answer: I would like to able to say that you will be able to have children, but the likelihood is small. You may be occasionally ovulating, but it would require in vitro fertilization to achieve this. I suspect that proper hormonal manipulation might achieve fertilization, but this would take some time and effort starting now.
Pregnancy
Question: Could you please give me some in depth symptoms of pregnancy.
Also, do I have to wait for a missed menstrual period before
taking a home test?
Answer: Tender breasts, nausea, and occasionally flushing are symptoms of pregnancy. These are usually due to the production of hormones by the placenta. The home tests depend on this production, which rarely is detectable before 2 to 3 weeks. Serum blood tests can pick up pregnancy earlier before the loss of a period. Testing negative too early is of no help. If you desire earlier knowledge, you’ll need to get a blood test. This test can also have trouble early, but is better.
Birth control pill
Question: At the end of my last cycle, I stopped taking my birth control pill, Tri-Norinyl. I had my period soon after, but it has now been 33 days and I have not yet gotten my period for this cycle. I know that I am not pregnant. I do have some very light bleeding, but not what it should be. Is it common for this to happen after discontinuing use of birth control?
Answer: Were your periods regular before the pill? If not they will not be significantly different after the pill. Also, sometimes the lining of the uterus needs extra progesterone to completely slough. Low progesterone levels will give scanty or no period. This is not related to the pills except that large periods are uncommon on the pill.
Steroid use during pregnancy
Question: My doctor prescribed a steroid to alleviate my symptoms of poison ivy. I
am in the process of trying to get pregnant and I was wondering if this
would hurt a developing baby.
Answer: It should not have any effect.
Prenatal Multivitamins
Question: We have many manufacturers that offer prenatal multivitamins.
In order to choose the correct formula by specific case I wish to know if we can substitute brand names like stuart 1+1 for prenatal 1+1? Are the differences in the brand names based on the formulas for the specific stage of pregnancy?
Answer: The easiest way is to read the side label and see what the differences are. Usually prenatal vitamins will have much higher doses of folate, calcium and iron. Ask your pharmacist for the difference and merely add these on as extra generics. More pills but cheaper.
Pregnancy drugs
Question: If a person took amphetamines during pregnancy how would this affect the fetus and its quality of life after birth?
Answer: Amphetamines are stimulatory medications. However, they have many systemic effects in the
body, in addition to the sensation they provide. Among them, vessel spasms and as a result,
vessel narrowing is of particular importance in pregnant patients. In addition to increasing the
risk of damage to the placenta, these medications, when taken during a pregnancy, also increase
the risk of damage to the fetus, ranging from spontaneous abortion (loss of pregnancy), to
defects seen prior to, at the time of, or after, birth. The nature of these potential injuries is
variable, and if you are concerned about the possible effects of amphetamines on a pregnancy
or baby after it is born, consult your obstetrician and/or pediatrician. They can help you
determine whether there is a need for concern, and what interventions can be made.
Pregnancy/Weightloss
Question: I have been trying to lose weight so that I am at my optimum
weight when my husband and I start trying to conceive.
I am 5’4” and 175 pounds. I have been exercising, eating well
(and in moderation), but I haven’t lost any weight in 3 months.
I went to see my doctor today, and he put me on a restricted
diet and also prescribed Pondimin and Ionamin for me to take.
I told him that my main objective is to lose weight so that
my pregnancy might be a healthier one for myself and the baby.
He told me that I need to make sure that I stop taking the
prescriptions before we try to conceive.
I am wondering if there should be a specific time period I
should wait before trying to get pregnant. Does the medicine
stay in your system after you stop taking it? My doctor didn’t
think this was a problem. I just wanted a second opinion.
Answer: Pondimin is the brand name of a medication known as fenfluramine hydrochloride. It is absorbed from the intestinal tract and usually its maximum anorectic effect (its effect on suppressing the appetite) is seen 2 to 4 hours after taking the medication. The reported “half-life” (or, the time it takes for half the medication to be cleared from the bloodstream) of fenfluramine is 20 hours, according to the Physician’s Drug Reference. Therefore, after 20 hours, 50% of the drug remains, and after 40 hours, 25% of the drug remains, and so on. After about one week, (168 hours), approximately 0.4% of the medication remains. To be assured that no significant medication remains in your bloodstream, give yourself 10-14 days time prior to trying to conceive.
Ionamin is a brand name of a medication known as phentermine, supplied in a resin form. The half-life of this medication is also approximately 20 hours, according to my hospital pharmacist. Thus, as for the Pondimin, give yourself 10-14 days prior to attempting to conceive.
Pregnancy & klonopin/prozac
Question: I would like some information on pregnancy and the use of
klonopin and prozac during pregnancy. Could you suggest the
best way to locate and talk to people who have experienced pregnancy
with these drugs? I am especially concerned with the use of klonopin
during pregnancy.
Answer: Klonopin is technically a drug which is only approved for treatment of seizures. In fact, it is used for treatment of many disorders which require a benzodiazepine. There have been insufficient data to really give you information. The PDR states that there are potential risks of birth defects in women taking the drug for seizure prevention. Data in rats show several non-dose related birth defects including cleft palate, eye fold abnormalities and limb defects. There has not been shown to be a major problem with other benzodiazepines and pregnancy. You can obtain more up to the date information from the company Roche 800-526-6367.
Inducing Labor
Question: My wife is overdue and the doctor is considering giving her
pitocin, which is a labor inducing drug. What is it? Who makes it?
How does it work? Are there natural alternatives?
Answer: Pitocin is naturally produced by the
hypothalamus – close to the neurons that produce ADH(antidiuretic hormone). Oxytoxins’
purpose is to contract the muscle of the uterus and normal labor is stimulated by a sharp rise
in this hormone. Consequently, external administration will usually produce labor. It also
has an effect on the mammary gland to release milk and has been used in helping milk
production post delivery. It is usually given intravenously, but can be administered with nasal
spray. The dose is critical and close monitoring is necessary to prevent excessive
contractions.
Amoxicillin and Augmentin
Question: My wife was prescribed Amoxicillin and Augmentin for an infected insect
bite, and she is 10 weeks pregnant. Could this have any effects on the
pregnancy?
Answer: Use of any medicine during pregnancy always presents some risk to the fetus. However,
there are some drugs which are high risk and some which appear to be low risk. Penicillin
and the penicillin like drugs(like Amoxicillin) is one of the preferred antibiotics to use during
pregnancy. Clavulanic acid which is the other ingredient in Augmentin(amoxicillin and
clavulanic acid) is added to block some of the penicillin resistance of some bacteria, making
amoxicillin much more powerful. Studies performed in pregnant mice and rats have
demonstrated no apparent problems. However, studies in women have not been performed.
Consequently this drug, like most, is only used if truly necessary.
Fibroids in the Uterus
Question:If you are pregnant and have fibroids in the uterus, how
dangerous is it. What complications can you expect throughout the pregnancy? Can you take anything for the pain?
Answer: Fibroids of the uterus are medically called leiomyomas. Many women have one or more of these benign muscle growths in their uterus. They are responsible for a host of problems including painful periods, heavy bleeding, and difficulty in becoming pregnant. The number and size of these muscle growths is important since small ones generally don’t cause major problems. Once pregnancy is established, they rarely cause major problems with the pregnancy. Again it is very dependent on the size and position of these tumors. Taking any drugs during pregnancy is to be avoided;but, acetaminophen is generally safe in controlled amounts.
