{"id":24471,"date":"2021-04-08T09:30:16","date_gmt":"2021-04-08T13:30:16","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=24471"},"modified":"2021-03-31T12:53:42","modified_gmt":"2021-03-31T16:53:42","slug":"amitriptyline-and-pregnancy","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/amitriptyline-and-pregnancy\/","title":{"rendered":"Is amitriptyline safe in pregnancy?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">When you find out you are pregnant, it can be confusing (and even scary) to figure out exactly <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/safe-medication-during-pregnancy\/\"><span style=\"font-weight: 400;\">what medications you should and shouldn\u2019t take<\/span><\/a><span style=\"font-weight: 400;\">. To complicate matters, many drugs don\u2019t have conclusive results as to whether they are safe or not. It raises the question: Do you prioritize your own health, even if there\u2019s a potential risk to your baby?<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This dilemma may be of special concern to women who are taking antidepressants, before or during pregnancy. Luckily, physicians are well-versed in explaining the potential benefits and dangers of any prescription. Here\u2019s what you should discuss with your healthcare provider if you are taking, or considering taking, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/amitriptyline-hcl\"><span style=\"font-weight: 400;\">amitriptyline<\/span><\/a><span style=\"font-weight: 400;\"> during pregnancy or while breastfeeding.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is amitriptyline used for?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">This <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/tricyclic-antidepressants\/\"><span style=\"font-weight: 400;\">tricyclic antidepressant<\/span><\/a><span style=\"font-weight: 400;\"> has a variety of uses from migraine to pain control, but it is primarily for patients with unipolar major depressive disorder. <\/span><span style=\"font-weight: 400;\">Valeria Contreras-Crowley, MD, a board-certified OB-GYN at <\/span><a href=\"https:\/\/wsnm.org\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Women\u2019s Specialists of New Mexico<\/span><\/a><span style=\"font-weight: 400;\"> says it has other <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/off-label-prescription-drugs\/\"><span style=\"font-weight: 400;\">off-label<\/span><\/a><span style=\"font-weight: 400;\"> uses as well. It is sometimes prescribed to treat:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chronic fatigue syndrome-related sleep disturbances and pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fibromyalgia<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recurring indigestion<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headache and migraine prevention<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Interstitial cystitis (bladder pain syndrome)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Irritable bowel syndrome<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Neuropathic pain, chronic (including diabetic neuropathy)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Postherpetic neuralgia (a shingles complication)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Sialorrhea (excessive salivation)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Dr. Contreras-Crowley says this medicine isn\u2019t the most commonly prescribed antidepressant, by her or other doctors, and she doesn\u2019t see patients commonly listing this as something they take at their first prenatal appointment.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201c<\/span><span style=\"font-weight: 400;\">I personally do not prescribe amitriptyline as a first-line agent for women with depressive disorder during pregnancy primarily because I have more experience with SSRIs [<\/span><span style=\"font-weight: 400;\">Selective Serotonin Reuptake Inhibitors]<\/span><span style=\"font-weight: 400;\">,\u201d she says. \u201cMore studies are available for SSRIs than other antidepressant drugs.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If a patient visits her and is already on the medicine for another off-label use, she refers them back to their primary care doctor to determine if they should discontinue that medicine or find an alternative.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Is amitriptyline safe to take during pregnancy?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Like many medicines, there\u2019s not a clear-cut answer on the safety of taking amitriptyline while pregnant.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Amitriptyline pregnancy category<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">It\u2019s considered a Category C drug by the <\/span><a href=\"https:\/\/chemm.nlm.nih.gov\/pregnancycategories.htm\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">U.S. Food and Drug Administration<\/span><\/a><span style=\"font-weight: 400;\"> (FDA). Meaning, animal reproduction studies have shown possible adverse effects on the fetus, and there are no adequate or well-controlled studies in humans. Potential benefits may warrant use of the drug in pregnant women despite risks.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Potential risks of amitriptyline and pregnancy<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">\u201cThere are few studies that have reported safety of this medication in pregnancy,\u201d says <\/span><a href=\"https:\/\/med.uc.edu\/depart\/ob\/directory\/faculty-profile\/Index\/Pubs\/defranee\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Emily DeFranco<\/span><\/a><span style=\"font-weight: 400;\">, DO, director of maternal-fetal medicine at the University of Cincinnati College of Medicine. \u201cOf the limited data available from humans, it does not appear that use in the first trimester is associated with a higher than average risk of birth defects. However, there are some reports that similar medications in its class may interfere with embryo development in experimental animal studies.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In addition, some small studies have reported slightly higher rates of high blood pressure complications of pregnancy in the pregnant person, and withdrawal symptoms of the newborn when amitriptyline was taken throughout the gestational period. <\/span><a href=\"https:\/\/www.sciencedaily.com\/releases\/2019\/10\/191001184927.htm\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">A 2019 study<\/span><\/a><span style=\"font-weight: 400;\"> published in <\/span><i><span style=\"font-weight: 400;\">BMJ<\/span><\/i><span style=\"font-weight: 400;\"> also found a connection between antidepressants and gestational diabetes. The risk was the most heightened with amitriptyline of the antidepressants they studied, showing a 52% increased risk compared to those not on antidepressants.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Amitriptyline and miscarriage\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Pregnant women often worry that their medicines may increase their risk of miscarriage. There are no studies specifically on amitriptyline and miscarriage. \u201cWe do know that women with depression have slightly higher miscarriage rates,\u201d says Dr. DeFranco. \u201cWe don&#8217;t know if this risk is primarily attributable to the medications used for depression treatment, or the depression itself even without medication use.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dr. Contreras-Crowley adds that a <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3756033\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Danish National registry study<\/span><\/a><span style=\"font-weight: 400;\"> examining cases of women who were diagnosed with depression concluded there was not a difference in risk of miscarriage in women who were treated with antidepressants and those who were not treated with antidepressants. The study concludes that <\/span><span style=\"font-weight: 400;\">antidepressants were not associated with miscarriage among women with a diagnosis of depression.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Should I stop taking amitriptyline if I find out I\u2019m pregnant?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Both experts caution against abruptly stopping use of an antidepressant. Weaning off of the medication should only happen under the direction of your healthcare provider, so alert your OB-GYN when you find out you are pregnant if you are on an antidepressant, including amitriptyline. The best course of action is to determine the risk of discontinuing versus continuing with your healthcare team.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cDepression in pregnancy can be serious so the patient&#8217;s history is important,\u201d Dr. Contreras-Crowley says. The questions she will ask are: \u201cHas she ever tried to commit suicide? Has she ever been hospitalized? What other medications has she been on before?\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIf she has been stable on this medication, then the benefit to her baby and the pregnancy may be worth continuing,\u201d she explains. Some of the risks of leaving depression untreated during pregnancy can include fetal growth restriction, poor fetal growth, preterm delivery, poor language development, and decreased IQ.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">What happens if a pregnant person quits amitriptyline abruptly?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Abruptly stopping this medication can lead to intense symptoms including: <\/span><span style=\"font-weight: 400;\">agitation, anxiety, chills, diaphoresis (sweating), headache, insomnia, irritability, malaise, myalgia (muscle pain) and nausea and may rarely cause cardiac arrhythmia, and parkinsonism. Slowly tapering off of the medication is recommended by decreasing the dose weekly. It may take two to four weeks or more to fully wean off the medication without experiencing withdrawal symptoms.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Is amitriptyline and breastfeeding safe?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Amitriptyline might be safe to use while breastfeeding. While it does cross through into the breast milk, Dr. DeFranco says the amount the baby is exposed to through breastfeeding is reported to be a fraction of the maternal levels. The <\/span><a href=\"https:\/\/www.aap.org\/en-us\/advocacy-and-policy\/aap-health-initiatives\/Breastfeeding\/Pages\/Resources.aspx\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">American Academy of Pediatrics<\/span><\/a><span style=\"font-weight: 400;\"> classified the lactation effects of this medication &#8220;unknown but may be of concern,\u201d she explains, stating that there have been some reports of sedation in the baby. Dr. Contreras-Crowley says that it is safe, but the baby should be monitored for signs of sedation. She typically recommends nortriptyline or amitriptyline for breastfeeding mothers.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For any stage of trying to conceive, pregnancy, or breastfeeding, it\u2019s best to consult with your provider about your medication choices.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>When you find out you are pregnant, it can be confusing (and even scary) to figure out exactly what medications you should and shouldn\u2019t take. To complicate matters, many drugs don\u2019t have conclusive results as to whether they are safe or not. It raises the question: Do you prioritize your own health, even if there\u2019s [&hellip;]<\/p>\n","protected":false},"author":94,"featured_media":24805,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[8970,788,8615],"coauthors":[20478],"class_list":["post-24471","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-breastfeeding","tag-drug-safety","tag-pregnancy","franchise-maternal-matters","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Is it safe to take amitriptyline during pregnancy?<\/title>\n<meta name=\"description\" content=\"Here\u2019s what you should discuss with your healthcare provider if you\u2019re considering taking amitriptyline during pregnancy.\" 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