Tylenol with Codeine

Let me start out by saying that I trust my doctor...

I had a migraine yesterday. Oh, wow, did it suck. Because of my blood
pressure, the doctor said he wanted to know if I had a headache that
Tylenol didn't fix. So, being a good girl, I dutifully called his
office this morning, even though I knew that it was a migraine and not
preeclampsia (I didn't have any of the other preeclampsia symptoms, and
at 14 weeks, it's too early for that, anyway).

They called in a prescription for Tylenol with Codeine to my pharmacy,
and called me to let me know.

Codeine is a schedule C.

The nurse did say that I don't want to take it "all the time," but that
if I do have a migraine, it's better to get rid of it.

Like I've told you all before, I've had migraines since I was 5, and
have learned to cope with them pretty well... So, what do you think?
If I can "suck it up" and deal with it (usually by sleeping), am I and
my kid better off doing that than taking Tylenol with Codeine? Is
there a danger to letting a migraine run its natural, unmedicated
course that I'm not thinking about? Has anyone taken Codeine during
pregnancy and had adverse effects? Or not? Since we're past the point
of organ genesis, am I probably ok to take it?
http://www.rxlist.com/cgi/generic/acetcod_wcp.htm

I already took Tramadol (another schedule C) during the first
trimester, before I knew I was pregnant. I've been worried enough
about that... I can't imagine taking another one on purpose...

I've come to trust you folks, and while I also trust my doctor, I don't
get the opportunity to discuss the risks and benefits with him directly
until, oh, 3 weeks from now at my next appointment. What do you think?
Would you take codeine, or suck it up?

And do you think if I can survive 23 years of migraines, that labor
will probably be a piece of cake? That would be nice to hear...

Thanks,
Amy

wrote:

Like I've told you all before, I've had migraines since I was 5, and
have learned to cope with them pretty well... So, what do you think?
If I can "suck it up" and deal with it (usually by sleeping), am I and
my kid better off doing that than taking Tylenol with Codeine? Is
there a danger to letting a migraine run its natural, unmedicated
course that I'm not thinking about?

I've had migraines ever since childhood,
too, and my usual amount of med is 900
to 1200 mg of Ibuprofen. Thankfully, my
migraines have decreased in severity and
frequency in both pregnancies (maybe due
to pregnancy hormones..?), and when I do
get one, I hold out as long as I can until
I can't bear it, then I take ONE extra-
strength Tylenol.

I don't know the technical details of
taking codeine while pregnant, but I
would not if I could help it. I've always
wondered about letting a headache run its
course, especially during pregnancy, but
somehow that never works. It only gets
worse, never better, without medication.

-- Anita --

Hi Amy,

I can't speak with knowledge to the Codeine question,
but:

-- You don't *have* to wait 3 more weeks to speak
with your doctor. You can schedule an appointment
sooner, or call in a question.

-- I've never had a migraine, but my guess is that
if you can handle 23 years of migraines, labor will
be a piece of cake. I imagine you might need slightly
different coping strategies though -- I've never heard
of anyone dealing with labor by sleeping through it!
(Though that doesn't mean it hasn't happened...)

Emily

wrote:

I've come to trust you folks, and while I also trust my doctor, I don't
get the opportunity to discuss the risks and benefits with him directly
until, oh, 3 weeks from now at my next appointment. What do you think?
Would you take codeine, or suck it up?

Despite it being a schedule C, there's been quite a lot
of use of various narcotics during pregnancy. Heck, they'll give
you narcotics in labor if you ask ;-) Personally, if I were in
significant pain and lesser measure didn't work, I'd take it and
not worry much about it at all.

Best wishes,
Ericka

wrote:
Let me start out by saying that I trust my doctor...

I had a migraine yesterday. Oh, wow, did it suck. Because of my
blood
pressure, the doctor said he wanted to know if I had a headache that
Tylenol didn't fix. So, being a good girl, I dutifully called his
office this morning, even though I knew that it was a migraine and
not
preeclampsia (I didn't have any of the other preeclampsia symptoms,
and
at 14 weeks, it's too early for that, anyway).

They called in a prescription for Tylenol with Codeine to my
pharmacy,
and called me to let me know.

Codeine is a schedule C.

The nurse did say that I don't want to take it "all the time," but
that
if I do have a migraine, it's better to get rid of it.

Like I've told you all before, I've had migraines since I was 5, and
have learned to cope with them pretty well... So, what do you think?
If I can "suck it up" and deal with it (usually by sleeping), am I
and
my kid better off doing that than taking Tylenol with Codeine? Is
there a danger to letting a migraine run its natural, unmedicated
course that I'm not thinking about? Has anyone taken Codeine during
pregnancy and had adverse effects? Or not? Since we're past the
point
of organ genesis, am I probably ok to take it?
http://www.rxlist.com/cgi/generic/acetcod_wcp.htm

I already took Tramadol (another schedule C) during the first
trimester, before I knew I was pregnant. I've been worried enough
about that... I can't imagine taking another one on purpose...

I've come to trust you folks, and while I also trust my doctor, I
don't
get the opportunity to discuss the risks and benefits with him
directly
until, oh, 3 weeks from now at my next appointment. What do you
think?
Would you take codeine, or suck it up?

And do you think if I can survive 23 years of migraines, that labor
will probably be a piece of cake? That would be nice to hear...

I suffered from migraines during both my pregnancies, and took both
Vicodin and Percocet. I was told from numerous doctors (both OBs and
neurologists) that it has been studied extensively during pregnancy and
is not harmful for the baby. I feel quite comfortable using it during
pregnancy at this point.

As a side note -- while labor isn't a walk in the park, I found it to
be easier than a really bad migraine, even when I was at transition
unmedicated.

Bryna

On 17 Feb 2005 08:46:33 -0800, "
wrote:

Let me start out by saying that I trust my doctor...

I had a migraine yesterday. Oh, wow, did it suck. Because of my blood
pressure, the doctor said he wanted to know if I had a headache that
Tylenol didn't fix. So, being a good girl, I dutifully called his
office this morning, even though I knew that it was a migraine and not
preeclampsia (I didn't have any of the other preeclampsia symptoms, and
at 14 weeks, it's too early for that, anyway).

They called in a prescription for Tylenol with Codeine to my pharmacy,
and called me to let me know.

Codeine is a schedule C.

here are some abstracts from studies about migraine and pregnancy,
just for info

Neurology. 1999;53(4 Suppl 1):S26-8.
Migraine in pregnancy.
Aube M.
McGill University and the Montreal Neurological Institute,
Quebec, Canada.

Migraine does not increase the risk for complications of pregnancy for
the mother or for the fetus: the incidences of toxemia, miscarriages,
abnormal labour, congenital anomalies, and stillbirths are comparable to
those of the general population. Several retrospective studies have
shown a tendency for migraine to improve with pregnancy. Between 60 and
70% of women either go into remission or improve significantly, mainly
during the second and third trimesters. Women with migraine onset at
menarche and those with perimenstrual migraine are more likely to go
into remission during pregnancy. The migraine type does not seem to be a
significant prognostic factor for improvement. However, in the small
number of women (4-8%) whose migraines worsen with pregnancy, migraine
with aura appears to be overrepresented. In a small number of cases
(1.3-16.5%), migraine appears to start with pregnancy, often in the
first trimester; these headaches involve a higher proportion of migraine
with aura. Management of migraine during pregnancy should first focus on
avoiding potential triggers. Consideration should also be given to
nonpharmacologic therapies. If pharmacologic treatment becomes
necessary, acetaminophen and codeine can be used safely as abortive
agents; ASA and NSAIDs (ibuprofen, naproxen) can be used as a second
choice, but not for long periods of time, and they should be avoided
during the last trimester. For treatment of severe attacks of migraine,
chlorpromazine, dimenhydrinate, and diphenhydramine can be used;
metoclopramide should be restricted to the third trimester. According to
the United States FDA risk categories, meperidine and morphine show no
evidence of risk in humans but should not be used at the end of the
third trimester. In some refractory cases, dexamethasone or prednisone
can be considered. Should prophylactic treatment become indicated, the
beta-adrenergic receptor antagonists (e.g., propranolol) can be used.


Expert Opin Pharmacother. 2002 Apr;3(4):389-93.
Pregnancy and chronic headache.
Marcus DA.
Pain Evaluation & Treatment Institute, 4601 Baum Boulevard,
Pittsburgh, PA 15213, USA.

Headache patterns in women change in relation to fluctuations in
oestrogen levels. Increasing oestrogen levels in early pregnancy offer a
protective effect against headache, particularly for women with
migraine. However, some women continue to experience troublesome
headache throughout pregnancy. Headache persisting at the end of the
first trimester will usually continue without improvement for the
remainder of pregnancy and should be treated. Safe and effective acute
care treatment options include paracetamol, opioids and anti-emetics.
The use of triptans during pregnancy is controversial and not broadly
recommended. Safe and effective preventive treatments include
relaxation, biofeedback, beta-blockers, some antidepressants and
gabapentin in early pregnancy.

Neurol Clin. 1997 Feb;15(1):209-31.
Migraine and pregnancy.
Silberstein SD.
Comprehensive Headache Center, Germantown Hospital and Medical
Center, Pennyslvania, USA.

Migraine and tension-type headache are primary headache disorders that
occur during pregnancy. Migraine sometimes occurs for the first time
with pregnancy. Most migraineurs improve while pregnant; however,
migraine often recurs postpartum. Some disorders that produce headache,
such as stroke, cerebral venous thrombosis, eclampsia, and SAH, occur
more frequently during pregnancy. Diagnostic testing serves to exclude
organic causes of headache, to confirm the diagnosis, and to establish a
baseline before treatment. If neurodiagnostic testing is indicated, the
study that provides the most information with the least fetal risk is
the study of choice. Although drugs are used commonly during pregnancy,
there is insufficient knowledge about their effects on the growing
fetus. Most drugs are not teratogenic. Adverse effects, such as
spontaneous abortion, development defects, and various postnatal
effects, depend on the dose and route of administration and the timing
of the exposure relative to the period of fetal development. Although
medication use should be limited, it is not absolutely contraindicated
in pregnancy. In migraine, the risk of status migrainosus may be greater
than the potential risk of the medication use to treat the pregnant
patient. Nonpharmacologic treatment is the ideal solution; however,
analgesics, such as acetaminophen and narcotics, can be used on a
limited basis. Preventive therapy is a last resort.

here is a periodic posting to alt.support.headaches.migraine
by an Australian doctor. I recommend a.s.h.m as a place where many
well informed migraineurs hang out.


-----begin pasted article-----



I'm glad your doctor has allowed you some relief!
Here is a brief summary of drugs in pregnancy (wrt
migraine) -- mostly from "Drugs in Pregnancy" 3rd
ed. Australian Drug Classification Committee.
(It closely parallels your FDA classification)
The classifications refer to drugs when taken in
the recommended or prescibed manner only.
================================================== =
The following drugs are safe in pregnancy, and have a
Category A pregnancy rating in Australia:

--codeine phosphate; dihydrocodeine.
--paracetamol (acetaminophen)
--metoclopramide (Reglan, Maxolon)
--diphenhydramine (Benadryl); dimenhydrinate
(Dramamine); doxylamine (and most other sedative
antihistamines --but check)

My favourite safe treatment for migraine attacks in
pregnancy is intramuscular Maxolon and oral
Panadeine Forte (codeine 30 + paracetamol 500 ie.
Tylenol with codeine No.3)
or Mersyndol Forte (above + doxylamine)
or IM Pethidine (Demerol) if necessary.

(Cat A is the safest possible rating: Officially:
"Drugs which have been taken by a large number of pregnant
women without any proven increase in the frequency of
malformations or other direct or indirect harmful effects
on the foetus having been observed".
======
Drugs to be avoided in pregnancy if possible
(Cat C = drugs which have caused harmful, but often
reversible effects of the fetus, but not malformations) are :
All NSAIDs (naproxen, ibuprofen, diclofenac -- Aleve,
Motrin, Voltarol, Toradol etc.); aspirin (avoid in last
trimester; prochlorperazine (Compazine); promethazine
(Phenergan); tricyclic antidepressants (Elavil etc),
benzodiazepines (Valium etc); ergotamine; DHE;
methysergide (Sansert, Deseril); barbiturates.

Sometimes these effects are dependent on the stage of
pregnancy and other factors. The butalbital is safe in
intermittent doses after the first 3 months. The advice
for barbiturates is "continuous use during pregnancy
should be avoided".
As far as narcotics go, they are safe. Morphine, pethidine
(demerol) etc are given a Cat C, but the proviso is:
"The only concern with these drugs in pregnancy is
with their use during labour when narcotic analgesics
may cause respiratory distress in the newborn infant"
So the comparative safety of narcotics is vindicated
yet again.
===========
Drugs known or suspected to increase the incidence of
fetal malformations (Cat D) a
carbemazepine (Tegretol), valproic acid/divalproex
(Depakote, Epilim, Depakene etc.).
Don't take them even if you think you're pregnant!
============
Cat X = drugs which have a high incidence of causing
fetal malformations:
Eg; isotretinoin (Accutance, for acne);
misoprostol (Cytotec -- for stomach ulcers -- beware
NSAIDS with added misoprostol eg. Arthrotec, Napratec);
Thalidomide.
Little needs to be added here.
============
There are a wide range of drugs in Categories B1-3
B1 = no evidence of harm in animal studies, no evidence
but limited experience in use in pregnant humans:
Examples a pizotifen (Sandomigran); gabapentin
(Neurontin)

B2 = no evidence of harm, but inadequate animal studies and
limited human experience;
Eg. hyoscine; mebeverine (anti-cholic drugs)

B3 = limited experience in humans, but no evidence of harm.
Animal studies show increase in fetal damage, significance of
which is not known in humans.
Eg; sumatriptan (Imitrex); clonidine (Catapres, Dixarit))

Obviously, it's the Cat B and C drugs which give most
decision problems, and a risk/benefit analysis has to be
made. Often the stage of pregancy and general health
issues are factors.
All these categories are only a guide, and the rules
are a bit laxer during the second trimester. In general
acetaminophen is safer than aspirin, ergo Fioricet is
better then Fiorinal etc.
But every pregnancy is different, so check with your GP,
obstetrician or pharmacist.

Raymot (GP)
==========
Brisbane, Australia
==============
International CNS and Psychotropic Drug Dictionary:
http://www.powerup.com.au/~rmottare/drugs.htm
[It just keeps getting better! -- suggestions still welcome]
[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[

Emily wrote:

I can't speak with knowledge to the Codeine question,
but:

-- You don't *have* to wait 3 more weeks to speak
with your doctor. You can schedule an appointment
sooner, or call in a question.

I talked to a friend IRL and she said the same thing... I have an
appointment to discuss my concerns on Monday. Hopefully I won't have
another headache between now and then!

-- I've never had a migraine, but my guess is that
if you can handle 23 years of migraines, labor will
be a piece of cake. I imagine you might need slightly
different coping strategies though -- I've never heard
of anyone dealing with labor by sleeping through it!
(Though that doesn't mean it hasn't happened...)

HAHAHA! When I start getting really worried that I'll "do it wrong"
(I'm a control freak, and a perfectionist - horrible combo for
situations where I have no hope of being in control, like labor -
nature takes over) I remember that women in a coma can give birth.
That's a creepy thought, but really comforting for me!

Amy (I know, I'm a sicko)

Bryna wrote:

I suffered from migraines during both my pregnancies, and took both
Vicodin and Percocet. I was told from numerous doctors (both OBs and
neurologists) that it has been studied extensively during pregnancy
and
is not harmful for the baby. I feel quite comfortable using it
during
pregnancy at this point.

No kidding? Well, that's interesting... I wonder if one of those
would be safer, as the article I found on codeine said it hadn't really
been sufficiently studied in humans at all...

As a side note -- while labor isn't a walk in the park, I found it to
be easier than a really bad migraine, even when I was at transition
unmedicated.

That's the best news I've heard all day! YAY!!!

Amy

Wow, that's a lot of information in one post. I may have to check out
that newsgroup!!

I wonder why codeine is a category A in Australia, but it's a schedule
C here. That doesn't make a whole lot of sense...

Maybe Australian mice, rats, and rabbits are tougher than their
American cousins?

Thanks everyone for the very helpful info... I'm going to go bug my
doctor Monday (it's his job), and I'll let you know what I decide.

Thanks again,
Amy