How do you make decisions about medicines you can and can't take?

[Eskoala]

(first post, pregnancy frustration)

Some drugs are definitely contraindicated, ok.

The vast majority of medicines, though, there is simply no evidence either way that it makes a difference to anything. The advice is vague and generally "try not to take anything but if you do it's probably ok". Everything says "check with your GP" - surely they don't intend me to be on the phone to my GP this often? Can I have a cough sweet? Nobody knows. My husband thinks I'm being silly to check everything but there have been some surprising substances that are definitely bad, so I can't just be laissez-faire about it.

I read Expecting Better and it helped put a lot of it into perspective, but it's still difficult to feel ok taking anything at all, which I don't think should be the case.

It's infuriating that there's just no answer. The bumps website only has a small number of drugs listed, phenylephrine found in lemsip is an example of something not represented there. (yes I have a cold and I'm grumpy...)

For food, we take the approach of having a blacklist of things you can't have and everything else is in moderation. Why is it not the same with medicine? Why am I made to feel guilty about a couple of paracetamol that as far as anyone can tell is perfectly OK but still "take the minimum dose for as short a time as possible"?

I have a science background and I'm beginning to wonder if medicine is actually a science at all...

Looking for resources and/or reassurance

It all comes down to litigation. Theoretically a lot of drugs would cause no harm to a foetus and work perfectly well in a pregnant lady. However drug companies cannot/will not test their drugs in pregnant ladies and therefore cannot classify the drug as 'safe' in pregnancy. If they did classify it as safe and something happened to your unborn child (see thalidomide tragedy of the 60s/70s) then they'd be paying millions in lawsuits.

A good example is Clotrimazole cream/Canesten for thrush. No theoretical reason why a pregnant woman couldn't use it, but no practical testing to back up the theory. It's up to the individual and their health professionals to decide what's best for them.

Paracetamol is fine to take in pregnancy. Other than that, most medicines manufacturers won't test their drugs in pregnant women for ethical reasons and therefore can't claim that they're safe to take in pregnancy. Your GP or pharmacist will have access to resources that gives anecdotal evidence of people who have intentionally or accidentally taken certain medicines when they were pregnant, and can use that to help advise but then again if the medicine isn't licensed for use in pregnancy, it's the GP or pharmacist who would then be at fault for giving you that advice if anything did ever happen to the baby.

Best thing is to stick to paracetamol and non medicine treatments where possible e.g. Steam inhalations, throat lozenges containing honey and lemon only etc. Your GP will be able to advise on any long term medicines you might be taking. And if you really have to take something else then ask your GP or pharmacist.

The summary of product characteristics pages on the electronic medicines compendium will give you some information about specific drugs in pregnancy, and anyone can access that online, but I would advise that that information is best to be interpreted by someone with experience in the field.

Yes, it's a tough one and I sympathise. I find the American drugs.com website quite helpful for looking at the FDA categorisations of different drugs re. risk in pregnancy: Categories A (no risk), B, C, D etc. It also briefly describes research findings. I made the decision this pregnancy and last to take some antihistamines. There has been some research on these, although more needs to be done. I chose the lowest risk. In the U.S.A. pregnant women are told these particular antihistamines are fine to take throughout pregnancy, so there are different approaches.

Would that be loratadine? I recall from the book it's cat B like paracetamol (acetaminophen) is. Few things are cat A apart from folic acid! Even the rest of the pregnancy vitamins... But we don't apply the same level of caution to all untested chemicals. Only the ones we call "medicine"... Thanks.

Yes, loratadine. I've also occasionally taken 25mg (lower dose) of Diphenhydramine at night to help me sleep (drowsy making) in second trimester, as I've suffered some really shocking insomnia - 3 hours a night sleep etc. (Also cat. B. Some studies showed risks of premature labour if high doses of it are taken towards the end of pregnancy , but there was also a very large study that showed that it decreased risk of antenatal & postnatal depression if taken by women suffering insomnia. No reported birth defects). I look into it on a case by case basis. My DH disapproves and feels it should be no meds in pregnancy - people have different approaches, I think.

If it's non prescribed drugs, do you not just ask the pharmacist rather than phoning doctor?

My pharmacist has been excellent and has a list of medications that they class as "safe" in pregnancy which he has referred to for me. Things like sore throats medication etc.

I found pharmacy staff / pharmacists were very cautious regarding any medication. Understandable from their perspective, intensely frustrating from mine. Particularly when at 40+10 they refused to sell me Clarityn which my Midwife had told me to take to alleviate PUPPS.

OP I was going to suggest the BUMPS website but can see you've already tried that. Can second the PP's suggestion of looking at the FDA website though.

Thanks, I will try the pharmacy next time and see how cautious they are - I was feeling too ill to leave the house at the time but I guess I could have phoned or sent the DH, wasn't thinking straight. I did phone 111 but they didn't seem to think this was what their service was for.

It is frustrating. I've been having to make the slightly risky choice to take my sleeping medicine because lack of sleep was making me so ill but my OB was happy to tell me that although they don't officially say its OK during pregnancy the current knowledge is that it isn't known to cause issues so his recommendation was that I take it if I really need it.

I look up all the info I can find on every medicine I consider taking, there's a lot of info out there but if you're really stuck it is worth asking your doctor as they can look up what's currently considered safe by medical professionals.

It depends really, I went into my work (pharmacy) and because we didn't have our regular pharmacist, he wouldn't sell me anything for my allergies. (currently making my asthma worse so I can't breathe or sleep!) whereas I know our regular one would give me something as many medicines can still be prescribed by the gp so therefore must be safe! It's a pain getting a gp appointment for things but may be worth it, saves faffing around with all of the debating in each pharmacy whether they should or not! After all, as long as there is no known damage, surely its up to you to decide as you obviously have to put up with pregnancy symptoms too! (sorry this turned into a rant regarding similar issues I've had from a member of pharmacy myself) (:

*(I'm a member of pharmacy myself)

Yes, it should be about making an informed decision yourself after the professionals give you all the info you need, like any medical problem. Instead it's more like nobody wants to tell you anything so that you have to say no to everything!

Clearly the tiniest possible risk, or even no risk as far as anyone knows, to the foetus means that you should put up with all possible ailments no matter the discomfort without help.

OK, this time it's a cold and I can deal, but as you say you do need to be able to breathe and sleep! Mother's health and stress levels also matter and can affect things anyhow. More generally, this is part of feeling pressure already to do everything "right" as others see it, I'm surprised at how early this has started (I'm 11 weeks), was hoping to be practical and relaxed about everything... Seems impossible. Hormones not helping, naturally!

Mother's health is very important (for instance fevers present a risk to the baby in the first trimester - used to be thought that the risk was from sauna but it was from fever yet they still warn against sauna in most countries but not against fevers)

I went to my local pharmacy a few weeks weeks ago needing something for my allergies and they were thankfully happy to check which were considered safest. With my last pregnancy I was always just told I can't take anything and really suffered.