Better to have more of one med, or less of 2?

[Arianwen1174]

I could be pregnant so I've been trying to be careful with meds. I have fibromyalgia and am in a flare so some type of pain relief is necessary these days. I try to keep it as little as possible but sometimes (like tonight) my pain level pushes me to take more. My question, if anyone knows, is would it be better to take a larger dose of just one medication or smaller doses of a combo of 2 (sometimes 3) meds? Especially if both meds are in the same risk category? The meds in question are ibuprofen (C), acetaminophen (B), cyclobenzaprine (B), and Vicodin (C). Vicodin is already a combo med because it contains acetaminophen and hydrocodone but it helps the most when I do take it.

[katelove]

Wow, tricky one!

I would not take the ibuprofen at all. There are many risks during pregnancy including miscarriage in early pregnancy and premature closure of ductus arteriousus in late pregnancy.

Acetominphen is still the pain relief of choice for pregnant women however it is associated with an increased risk of asthma in the child. It is unknown what doses and at what stage of pregnancy the risk is greatest.

We do not have cyclobenzaprine in Australia so I have no personal experience however I found this...

"PREGNANCY: There are no adequate studies of cyclobenzaprine in pregnant women. However, studies in animals suggest no important effects on the fetus. Cyclobenzaprine therefore can be used in pregnancy if the physician feels that it is necessary." http://www.medicinenet.com/cyclobenzaprine/article.htm

Vicodin has the acetominphen risks as I mentioned above. As it also contains a narcotic you would need to consider the possibility of a baby born with a narcotic addiction if you took it throughout the pregnancy. Other than the addiction risk, narcotics aren't known to cause problems when taken during pregnancy.

I think you are in a really difficult position. I guess I, personally, would use the acetominphen on it's own whenever possible. If I needed more than that my next choice might be the cyclobenzaprine but, as I said, we don't use it here so I am only basing that on the above quote. I would save the vicodin as last resort due to the potential for narcotic addiction in the baby.

Do you have a specialist you can talk to about other options? Is there a chronic pain clinic/specialist you could see?

ETA - I know you only might be pregnant at this stage but I assume that you will have ongoing pain medication needs so I've written this on the assumption that you will need pain relief for the next 40 weeks.

[rparker]

I agree with the pp to stop ibuprofen immediately if there is any chance that you might be pregnant because some research has suggested that there is an increased link between NSAIDs and miscarriage. http://www.bmj.com/cgi/content/abstract/327/7411/368

Like the pp I know nothing about cyclobenzaprine... sorry.

The main caution I'd have with both acetaminophen and Vicodin is the possible effect on both your liver and the baby's of accidentally getting a toxic dose of acetaminophen if you're taking more of one or both to compensate for not taking the other medications.

www.safefetus.com doesn't have the most encouraging information on Vicodin in the first trimester but it's still probably better than ibuprofen if acetaminophen alone doesn't manage your pain (and it seems unlikely that it would). There may be another narcotic that your doctor could prescribe, however, that is safer for 1st trimester use.

If I were in your position I would call my primary care doctor (or OBGYN if I were planning to use one for prenatal care) and explain my concerns as soon as I had a positive pregnancy test. It's unlikely that the medications you're on (with the exception of ibuprofen) can do very much harm (if any) before you're "pregnant enough" to get a positive HPT.

[mediumcrunch]

I came off everything for my fibro except the cyclobenzaprine and tylenol. I almost never bother with the tylenol since it does pretty much nothing and take the cyclo nightly. The ibuprofen is contraindicated except in the 2nd trimester. Vicodin occasionally wouldn't bother me (except it gives me a hangover) but not chronically. You risk withdrawal in the neonate as it is an opiate.

[Arianwen1174]

Now I feel bad for not doing legwork myself. Thanks for your help! It'll be hard to stop the ibuprofen but that's clearly a given, especially when the link suggests an 80% increase in miscarriage. I'm definitely calling my doctor right away if I get a BFP.

[bambolina]

I have a chronic pain condition, and had to take Vicodin through the last trimester of my pregnancy, everyday. My daughter had NO problems after birth. I'd say stick to the Tylenol or Vic's when you really need it. If you're only taking it sparingly then everything should be fine Best wishes

[MaerynPearl]

I agree to stick to tylenol or vicodin

of course, its best to talk with your doctor about it, they may be able to fix you up with something else to suit your particular case (dont know IF there is anything else, but I was in pain and given Flexeril, because my pain was in my muscles and thats a muscle relaxant which is generally considered safe in pregnancy)

[MyFillingQuiver]

I want to say first, that I am sorry you are in this predicament! I know how hard it is to deal with needing a medication vs wanting the best for our babies!

My 3rd pregnancy was plagued by 3rd trimester headaches. I was taking vicodin when needed..but it rarely helped all the way. I felt like I was suffering still from headaches, AND the meds!

My 4th pregnancy I got a break in that I didn't have to take a thing. My 5th and this pregnancy, I've had headaches, but had much better success with them using Fioricet when needed. It's the tylenol/caffeine/butalbital combo.

I feel HORRIBLE about it. Even though I know it's best to keep bad headaches away, due to vasoconstriction, and I've been given the OK by both OB's and my MW, it still hurts. I drink a gallon of water a day, eat healthfully, take supplements and probiotics, and I'm putting THAT into my body and my baby?

However, I know in my heart that letting the headache get to the place of vomiting, and CNS side effects is NOT a better option.

So, I understand. I pray you find a good balance for you that is the least toxic and keeps your pain under control!