Pregnant and Miserable - Back to Methadone??

RLS/WED occurs more frequently in certain populations, including people with end-stage renal disease, women during pregnancy, and people with iron deficiency. Also, RLS/WED in the elderly and children brings other challenges. Sharing your experiences may be extraordinarily helpful to others.
bekull
Posts: 32
Joined: Mon Jul 06, 2009 4:57 pm
Location: Pennsylvania

Postby bekull » Mon Nov 01, 2010 5:54 pm

I think you are very brave. You are doing what is best for you and your baby. There is no shame in taking care of yourself so your baby can be born healthy. Even if baby has to detox after birth, it is better than what could happen if you don't get your RLS under control. I hope you find peace in your decision.

User avatar
Neco
Posts: 2294
Joined: Tue Oct 04, 2005 10:18 am
Location: Somewhere in the midwest
Contact:

Postby Neco » Sat Nov 06, 2010 5:13 pm

I think you made the right decision to resume medication.

20 years from now you could tell your kid what you did, and they would shrug and say "you did what you had to do, and I love you and don't want you to suffer anyway".


Because that's the kind of bond a mother and her child will always have.

Andreadrea
Posts: 69
Joined: Sun Oct 03, 2010 4:30 am

Postby Andreadrea » Sat Nov 06, 2010 6:46 pm

Julie,

Please try not to feel ashamed about taking methadone. You're taking it for a medical condition, a serious one. Society freaks out about methadone because IV drug users take it, but it is used for so many other things. I think at least half the patients I see who are on methadone, aren't even on it for getting off drugs. But yet it is seen as a "druggie" thing.

It sounds like you've made an intelligent, informed decision based on the risks and benefits. From what I've read, a lot of babies don't even have withdrawal symptoms. Heck, if CPS shows up, have them speak to your physician. You aren't taking it for reasons that CPS should even be interested in. I really hope they don't get involved, but even if they do, you will get through it! Take care of yourself, and your baby will benefit :)

Andrea

User avatar
fraujoolie
Posts: 59
Joined: Fri Oct 22, 2010 8:54 pm
Location: Los Angeles
Contact:

Postby fraujoolie » Thu Nov 18, 2010 6:31 am

Hey - Just wanted to check in with an update. I'm currently 18wks and on 5mg Methadone.

I met with the Perinatologist again this week, and told him I needed to go back on the Methadone. He listened to my concerns, and was completely supportive. He's unalarmed at the medication, or the dosage. He told us he has a lot of experience with drug-addicted mothers, and "Five milligrams is nothing." He suggests I make an appointment for a consult with a pediatrician and NICU at the hospital where I will deliver, to go over what the protocol will be.

I will go back and see him in a month. I guess I have placenta previa, but it's still early enough, it might grow out of the way. Everything else looks great.

And... it's a boy!
:)
Julie

badnights
Moderator
Posts: 4569
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Postby badnights » Thu Nov 18, 2010 8:46 am

Well congratulations! A wee son!
It's fantastic when doctors are supportive, isn't it? They can make it a whole different world for you even tho all the same sh.t is happening.

Polar Bear
Moderator
Posts: 6888
Joined: Tue Dec 26, 2006 4:34 pm
Location: N. Ireland

Postby Polar Bear » Sat Nov 20, 2010 10:34 pm

Julie, you sound so much better. I am so pleased for you.

And congratulations on a second son.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

ViewsAskew
Moderator
Posts: 14894
Joined: Thu Oct 28, 2004 6:37 am
Location: Chicago

Postby ViewsAskew » Sun Nov 21, 2010 5:43 am

That is truly a wonderful outcome. Thankfully some smart, capable, and compassionate doctors exist.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

User avatar
Neco
Posts: 2294
Joined: Tue Oct 04, 2005 10:18 am
Location: Somewhere in the midwest
Contact:

Postby Neco » Sun Nov 21, 2010 5:13 pm

Glad to hear things are going well.

Are your symptoms under control? The doctor is right, 5mg while quite powerful, is really a drop in the bucket on the Methadone scale. Don't ever be afraid to discuss a small increase in your dose if you think its necessary. It sounds like they will listen and advice you appropriately without judging harshly.

User avatar
SquirmingSusan
Posts: 2975
Joined: Sun Nov 12, 2006 4:08 am
Location: Minnesota
Contact:

Postby SquirmingSusan » Mon Nov 22, 2010 3:48 am

Hey Julie, it's good to hear that you're feeling better and are getting support for your RLS treatment from another doctor.

It was fun to meet you at the pier. As I sit here with snow on the ground and the temperature in the 20s, it's hard to believe that was just a couple weeks ago. Thanks again!
Susan

badnights
Moderator
Posts: 4569
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Postby badnights » Sat Dec 11, 2010 5:22 pm

another article on bupr. (I'm not recommending switching, julie, I just thought this was a good place to put the information)
http://www.nejm.org/doi/full/10.1056/NE ... ?query=TOC

Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure

Hendrée E. Jones, Ph.D., Karol Kaltenbach, Ph.D., Sarah H. Heil, Ph.D., Susan M. Stine, M.D., Ph.D., Mara G. Coyle, M.D., Amelia M. Arria, Ph.D., Kevin E. O'Grady, Ph.D., Peter Selby, M.B., B.S., Peter R. Martin, M.D., and Gabriele Fischer, M.D.

N Engl J Med 2010; 363:2320-2331December 9, 2010

Background

Methadone, a full mu-opioid agonist, is the recommended treatment for opioid dependence during pregnancy. However, prenatal exposure to methadone is associated with a neonatal abstinence syndrome (NAS) characterized by central nervous system hyperirritability and autonomic nervous system dysfunction, which often requires medication and extended hospitalization. Buprenorphine, a partial mu-opioid agonist, is an alternative treatment for opioid dependence but has not been extensively studied in pregnancy.

Methods

We conducted a double-blind, double-dummy, flexible-dosing, randomized, controlled study in which buprenorphine and methadone were compared for use in the comprehensive care of 175 pregnant women with opioid dependency at eight international sites. Primary outcomes were the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, the length of the hospital stay for neonates, and neonatal head circumference.

Results

Treatment was discontinued by 16 of the 89 women in the methadone group (18%) and 28 of the 86 women in the buprenorphine group (33%). A comparison of the 131 neonates whose mothers were followed to the end of pregnancy according to treatment group (with 58 exposed to buprenorphine and 73 exposed to methadone) showed that the former group required significantly less morphine (mean dose, 1.1 mg vs. 10.4 mg; P<0.0091), had a significantly shorter hospital stay (10.0 days vs. 17.5 days, P<0.0091), and had a significantly shorter duration of treatment for the neonatal abstinence syndrome (4.1 days vs. 9.9 days, P<0.003125) (P values calculated in accordance with prespecified thresholds for significance). There were no significant differences between groups in other primary or secondary outcomes or in the rates of maternal or neonatal adverse events.

Conclusions

These results are consistent with the use of buprenorphine as an acceptable treatment for opioid dependence in pregnant women. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00271219.)

User avatar
fraujoolie
Posts: 59
Joined: Fri Oct 22, 2010 8:54 pm
Location: Los Angeles
Contact:

Buprenorphine/Subutex

Postby fraujoolie » Thu Dec 30, 2010 6:21 am

I actually talked about this with the perinatologist last week. He says there's a new article that was just published in the New England Journal of Medicine, showing how Subutex (Buprenophine) babies have an easier withdrawl than Methadone babies. This doc suggested I switch.

I brought it up with Dr. Buchfuhrer. Dr. B says that there's not a lot of studies that show Buprenophine is effective with RLS, and he hasn't seen a lot of success with it. Furthermore, he won't prescribe it. Subutex is primarily classified as an addiction medicine, and doctors have to get some additional certification to prescribe it. He says that only addiction medicine specialists are allowed to prescribe this medicine (at least, in CA). And it's also a pregnancy Category C drug, which he also won't prescribe. He says that if I'm interested in Cat C drugs (such as Mirapex), that I would have to ask my OB to prescribe it. I am fairly certain she is not going to interfere with my RLS treatment. All of my docs seem so careful not to step on each other's toes with their suggestions. So, for those reasons, Dr. B suggests RLS mothers-to-be that need Methadone stay on Methadone.

I do wish I could just get them all on the phone for a conference call. If they'd only just talk to each other, I think it would be less work on me. I'm also seeing a cardiologist right now. Trying to juggle four different opinions, waiting for the next appointment, etc, creates a lot of extra stress. They all seem willing to talk to each other, but none of them will pick up the phone and dial out.

As a side note, I'm now 24 weeks, and the 5mg is barely holding me. I'm afraid I might have to go up on my dose. This happens, I guess, because blood volume increases with pregnancy. I was also on 10-12mg pre-pregnancy, so it's not a huge surprise to me...but still disappointing.
Julie

badnights
Moderator
Posts: 4569
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Postby badnights » Thu Dec 30, 2010 8:06 am

well, Dr. B certainly has a point - have ANY studies been done with buprenophine and RLS? Not sure if you want to experiment with RLS effectiveness while there's a baby inside you.

At least you can be fairly confident the baby will be long-term OK with the methadone. On the other hand, knowing your baby will have an easier time is a powerful motivator. The only other question is how it will affect the baby to swtich and then switch back if the buprenophine doesn't work on the RLS.

User avatar
Helen518
Posts: 179
Joined: Wed Sep 17, 2008 5:02 pm
Location: Delaware

In nearly same boat as you . . .

Postby Helen518 » Mon Jan 03, 2011 2:55 pm

I am taking methadone 15 mg a day (5 mg 3 times a day) and am pregnant with twins. It is early days - I am only 5 weeks (I had IVF and that is why I know it is twins already - I had an ultrasound on 12/31.)

I did not know that all parents who deliver babies with opiods in their system are investigated Is this a state thing? My docs did not tell me this and I consulted them all before beginning the IVF process!

Also, I thought that it was not advisable to taper methadone in pregnancy - that it causes miscarriage - can you tell me where you found out the info that you coudl taper? I don't think I could survive without meds. In my last pregnancy I took 1-2 mg of ativan daily from 20 weeks and I also took an antidepressant from 28 weeks (mirtazapine) because I became suicidal due to the RLS controlling my life - can't sit, can't watch TV, can't enjoy anything etc . . .

Mirtazapine (remeron) is supposedly awful for RLS but it saved my life and has a powerful sedative effect that allowed me to sleep at night. I stopped the mirtazapine after delivery as it has no withdrawal period.

Would love to hear from you.

Helen

User avatar
Neco
Posts: 2294
Joined: Tue Oct 04, 2005 10:18 am
Location: Somewhere in the midwest
Contact:

Postby Neco » Mon Jan 03, 2011 2:57 pm

Dr. B has a habbit of not doing anything unless it is extensively backed up with Studies. Sometimes this has negative affects.

There was one person here who posted on the forum, probably a year or more ago, who was successfully using 1mg/day of Suboxone to treat her RLS.

That's the only person I personally know of who has tried it. I know it's painful to think about what the baby might go through, but at this point if the Methadone is working and you have a willing prescriber - it may be best not to rock the boat.

User avatar
Helen518
Posts: 179
Joined: Wed Sep 17, 2008 5:02 pm
Location: Delaware

Postby Helen518 » Mon Jan 03, 2011 3:37 pm

Thanks. I definitely am not going to taper any time soon if at all . . . I put a call in to my neuro to find out if he knows anything. I called the perinatologists office and they had not heard of the parents being investigated when babies are born to methadone patients. She thought it would be a situational thing, e.g. if they suspect abuse or problems at home they would investigate. I'm sure it must be state-specific as methadone laws/regs vary from state to state.
I guess I could also call the hospital to find out what they can tell me. I just want to prepare my husband - this would really send him around the bend. He is already not happy about the fact that we got twins insted of one . ..


Return to “Special Populations: Pediatric, Pregnancy, Secondary, etc.”

Who is online

Users browsing this forum: No registered users and 1 guest