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Naproxen - folic acid inhibitor!

(5 Posts)
FayeWP Thu 15-Sep-11 10:47:51

hi all

I just wanted to share this info with you all. I suffer from rheumatoid arthritis and take naproxen for the pain. DH and I have been ttc our 2nd for about 3 months and I've just found out I'm 6wks pregnant.

I've just had my doctor's appointment where she asked me if I'd been taking 5mg of folic acid a day - much more than in pregnancy supplements - because of the naproxen! This is because Naproxen is a folic acid inhibitor.

I'm really angry about this - I've not been on naproxen for very long and when I switched I specifically said to the doctor that we were ttc but they didn't mention that I should be on extra folic acid. I've been taking pregnancy supplements the whole time we've been ttc and now I find out it's not enough. I'm scared and angry - I really don't need the extra worry.

Anyway, sorry for the long story but the point is this:

if you're on naproxen when ttc, don't just take pregnancy supplements - take a specific folic acid supplement that contains 5mg of folic acid

gasman Thu 15-Sep-11 11:13:14

This is from the UK Teratology Information Service (ie a reputable source).

^Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation in various disease states. Currently available NSAIDs in the UK (including both COX2 selective and non-selective agents) are aceclofenac, acemetacin, azapropazone, celecoxib, dexibuprofen, dexketoprofen, diclofenac, etodolac, etoricoxib, fenbufen, fenoprofen, flurbiprofen, ibuprofen, indometacin, ketoprofen, ketorolac, trometamol, mefenamic acid, meloxicam, nabumetone, naproxen, parecoxib, piroxicam, sulindac, tenoxicam and tiaprofenic acid.

The available data on NSAIDs generally do not indicate that exposure before 30 weeks of pregnancy is associated with an increased risk of malformations. While recent data have suggested that there may be an increased risk of cardiac malformations associated with NSAID use in early pregnancy, this finding has not been confirmed. An increased risk of spontaneous abortion following maternal exposure to NSAIDs during pregnancy has been suggested, but has not been conclusively proven.

Exposure to NSAIDs after 30 weeks of pregnancy is associated with an increased risk of premature closure of the ductus arteriosus and oligohydramnios. These effects are related to the inhibitory effect of NSAIDs on prostaglandin activity. The incidence and severity of premature closure of the ductus arteriosus appears to be dose related and increases with advancing gestational age beyond 30 weeks.

If an NSAID is clinically indicated in the first or second trimester, ibuprofen would be the preferred agent. NSAIDs should, where possible, be avoided during the third trimester. In circumstances where the clinical condition requires treatment with NSAIDs during the third trimester, the fetus should be monitored regularly for oligohydramnios and to ensure normal circulation. Fetal circulation should be monitored via fetal echocardiogram following any NSAID exposure in late pregnancy. Oligohydramnios may be detected through serial scans measuring amniotic fluid volume and growth. Detection of an abnormality following third trimester exposure to an NSAID warrants referral to a fetal medicine unit for further investigation. Provided that there are no other risk factors involved, inadvertent exposure to NSAIDs at any stage of pregnancy does not constitute medical grounds for termination of pregnancy^

There is no mention of increasing folic acid supplementation either here or in the BNF.

I have just checked as I wondered if you had highlighted a deficient area in my own practice.

If you are really worried then I suggest that you make an appointment to discuss this with either your own GP or the rheumatologist (whoever initiated Naproxen). It might be worth dropping them a note in advance so they have a chance to look up the data/ discuss it with a pharmacist.

gasman Thu 15-Sep-11 11:13:31

Sorry the italics haven't worked.

RunnerHasbeen Thu 15-Sep-11 11:26:26

Have you taken methotrexate in the past, which would be associated with taking more folic acid? Is it possible she just said the wrong drug name by accident as NSAIDs are not really folic acid inhibitors? I would read through the patient information leaflet that comes with your medication and if there is cause for concern talk to a pharmacist and your rheumatologist.

They can also do a blood test to check your folate levels, I had this done pre being given green light to TTC (after weaning off methotrexate), it might help to put your mind at rest.

FayeWP Thu 15-Sep-11 11:40:57

Gasman - thank you for that, it has put my mind at rest somewhat. I think I may still take the increased folic acid for the first 3 months any way - can't do any harm.

Runner - I was on methotrexate but that was about 4 years ago (I stopped taking it 6 months before ttc with my first child) so it wouldn't be that. Thank you for the advice about the blood test. I am scheduled for one soon so will speak to my dr and make sure they are doing that too.

Thank you both

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