# A bit worried about my pain control whilst doing IVF



## PinkPeacock (Nov 9, 2006)

Hi,

I saw my GP last week and we talked about my last cycle which ended with an early miscarriage. She said, very blase, that some of the drugs I am on may have contributed to the mc. Perhaps it wouyld have been helpful of her to say something _before_ the cycle.

Anyway, I'd really appreciate some advice on my drug regime. I kind of don't trust what the GP says now as she'd previously been fine with what I was on.

OK, drugs I'm on are:
Amytriptelene - 75mg daily
Citalopram - 40mg daily
Tramadol - 100mg 4xdaily
Codeine phosphate - 50mg 3xdaily
Paracetamol - sorry, never looked at the dose but two normal tablets 4xdaily

I have endo, fibromyalgia and have been diagnosed as depressed so don't want to stop any of the above unless necessary as I need the pain to be under control in order to function. But, if any of the drugs would jeopordise our next IVF round I will stop them in a heartbeat.

If I do need to stop any, I'm quite worried that I'll get withdrawal symptoms. I've tried to come off tramadol many times and have cut down slowly but whenever I get to alow dose my pain intensifies and I have to up the dose. If ever I forget to take the anti-Ds I notice I get twitchy and restless and can't sleep so I imagine I would have simalar problems with those. I'd really appreciate your advice if I need to reduce or quit taking any of these.

Thanks for teh help,
Carys
xxx


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## mazv (Jul 31, 2006)

Hi Carys,

Sorry to hear of your early miscarriage   Bit surprised to hear that GP has said that   It would be very hard, given the regime that you are on to state for definite that one or more of these drugs could have been a contributing factor. As you will know early miscarriage is a risk in all pregnancies and these things do happen to many women whether they are taking anything else or not. 

All of these drugs have been used in women during pregnancy when required for various medical conditions and as far as the evidence goes there doesn't appear to be an increased risk of miscarriage, over and above the natural risk, with any these. As with all prescribing in pregnancy then any risk to baby has to be weighed up against the risk to mother. You should be aware that untreated depression and chronic pain during pregnancy are both associated with an increased risk to the baby so it is important to treat medical conditions when necessary.

You definitely shouldn't stop or reduce any of your drugs without discussing it with the prescriber first. Might be worth asking to speak to your clinic consultant about the risks to see if they can help or ask GP if they can get a second/specialist opinion from a local Obs & Gynae Consultant.

Hope this helps. Wishing you all the best for your next cycle  
Maz x


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## PinkPeacock (Nov 9, 2006)

Thanks so much for your reply. Its been worrying me for two weeks and I haven't even told my husband what the GP said in case he thought it was my fault the last round failed. Not that he would hve but my miond was blaming myself. She said that the citaloplan can cause birth defects such as cleft palate and hare lip. Not a disaster but I don't want to do anything that would cause my future baby pain or distress. Have you heard that citalopram can cause that sort of problem?

Just for peace of mind I shall ask the clinic when I book in but thank you for reassuring me. I was going to try to start cutting down but will definately not do this.

Thank you!
Carys
xxxx


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## mazv (Jul 31, 2006)

Carys,

As far as I know there is no increased risk of malformations after exposure to citalopram. The limited data that is available suggests that there is no increased risk over the normal background rate of 2-3% Usually citalopram wouldn't be first choice for depression in pregnancy but this is mainly because we have more data on using older drugs such as amitriptyline or fluoxetine. However if a patient was well controlled on citalopram it is unlikely that their treatment would change because they became pregnant. With all prescribing in pregnancy though the risks v benefits need to be weighed up taking into account all the factors specific to the individual patient.

Would be interested to know what data GP is basing this on as I'm not aware of any new data to suggest an increased risk with citalopram   (I'm a mental health specialist so like to think that I'm pretty up to date on all things to do with mental health drugs  )

Do speak to clinic about your meds and any concerns about any affect they may have on IVF cycle. They should at least be advising on what to do when you do become pregnant   as someone needs to be monitoring your physical and mental health. Sorry you've been worrying these past few weeks   it might help to share your feelings with DH  

All the best for next cycle  
Maz x


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## PinkPeacock (Nov 9, 2006)

Maz, thank you so much. I told OH last night that I'd been worrying about it. I wish these GPs wouldn't just spout off what they think is right without thinking of the impact that it would have on the patient. You have really helped me be less stressed over it as I wasworrying that I'd caused it to fail and I would have to stop all my meds.

Thanks,
Carys
xxx


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