Pregnant and taking Orap / Piimozida. Now What?

[Angus]

Hello

New here, and have yet to introduce myself, but will get around to that. I don?t have TS, but my wife does. Since about 4 years she has been taking 4mg Orap to help control her Tics. in December became pregnant by surprise and attempted to take herself off Orap, in one go, to not very positive results.

Our Psy. has suggested that she continue (we are now at month 6) with 6mg of Orap. In the first three months of the pregnancy, she was taking up to 2mg of Clonazepam at night. I am a little concerned because Cl. is contra-indicated and the research concerning Orap and pregnancy is, at best, sketchy. Even the helpdesk of the manufacturers here in Brasil siad taht they didn?t know. The good news is that, so far, every Ultrasound has come back absolutely perfect.

Is there a doctor in the forum who would be able to tell me if 6mg of Orap is "a lot"? Are there any mums with TS who took Orap during the pregnancy?

All responses gratefully received.

 

[Retired]

Welcome to Psychlinks and thank you for posting your question with regard to your wife's medication.

At this moment, I don't have any insights to offer because I do not have experience with Orap and what information is available in pregnancy. I will try to find out from one of my resources, however.

Your wife's psychiatrist who prescribed the Orap should be your best resource, because a psychiatrist specializes in these medications and should have the clinical background to evaluate the benefits versus the risks.

Perhaps Dr. Baxter may have further information, so we'll wait for him to read your question.

she was taking up to 2mg of Clonazepam at night. I am a little concerned because Cl. is contra-indicated

What specific contraindication are you referring to?

If your wife does not take her medications, to what extent do her tics disrupt her quality of life? For what diagnosis was the clonazepam prescribed?

 

[David Baxter PhD]

I was also going to ask about your source for the statement about clonazepam.

The reality is that most doctors would prefer that pregnant women take NO medications, zero. But that's not because we have evidence to indicate that all of the possible medications a woman could take or might need are hazardous to the foetus. Rather, it's because we are lacking any good evidence as to the long-term effects of many/most medications on the developing foetus and subsequently on the child as it matures into adulthood. Part of the caution is the indications that some medications used in the past appeared to have delayed adverse effects, e.g., increased risk of certain medical mproblems in the "child" many years later in the 30s or 40s, or in one case suggestions that the "child" appeared normal but the offspring of that "child" years later had some problems (second generational).

But all that has to be balanced against the potential risks for both mother and foetus of NOT taking medication. For example, the effects of hiogh levels of anxciety or szevere depression in the mother on the developing foetus are not well known but can be presumed to be negative. Which is worse: high levels of maternal stres and anxiety impacting the developing foetal brain, or 1 mg. of lorazepam?

At this point, your best source for advice is your physician, who best knows the medical and family history of the mother.

 

[Angus]

David and Steve

Thank you very much to both of you for your quick responses, and I remain hopeful that others will respond with their insights.

To respond to Steve, in reference to Clonazepam. If one reads the patient information insert, and also if one trawls the internet, it is much written that Cl. is indicated to cause greater chance of an unborn developing Cleft Lip / Cleft Pallet and leg contortion than in mothers who do not take it. That having been said, all the Ultrasounds come back as suggesting that the development is completely normal. So far so good

Clonazepam was prescribed because of very high anxiety. It was prescribed for a relatively short time at a relatively low dose - but, just at *exactly the time when one shouldn't take it (within the first trimestre).

When I first came to Brasil my wife was not taking any medication at all, having run out of Orap, and her tics were very strong. Gradually she went back on to it, and continued to take 4mg until the day that she decided to stop taking it (4 years later) having found out that she was pregnant, and spent two nights without sleeping, with Tics coming one after the other the whole night. In this case, I believe that continuing to take Orap is the better option, and so did our medics.

Kindest regards

 

[Retired]

Angus,

Thank you for the clarification on what was meant by your concern with clonazepam in pregnancy. You are correct in that there are warnings about the use of clonazepam and perhaps other benzodiazepines in pregnanacy, especially during the first trimester. For further clarification, this would not be considered a contraindication, but rather a warning. A contraindication is an absolute condition that precludes the use of a medication. A warning describes an elevated risk in a certain situation, where the physician and patient must weight the benefits of the medication against the risks in that situation.

The product monograph states:

In general, the use of Klonopin (clonazepam) in women of childbearing potential, and more specifically during known pregnancy, should be considered only when the clinical situation warrants the risk to the fetus

Orap should not be discontinued abruptly, especially if it has been taken over a prolonged period of time. Also, if your wife is considering breast feeding, discuss this with your doctor.

The product monograph states:

It is not known whether pimozide is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for tumorigenicity and unknown cardiovascular effects in the infant, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

I believe that continuing to take Orap is the better option, and so did our medics.

As has been said, your doctor(s) are your best resource in evaluating the benefits and risks given your wife's medical history. Is your wife comfortable with this decision and is the medication providing her the relief she wants aat the comfort level she is happy with?

Because of my personal interest in Tourette, may I ask you these questions:

What is the nature of your wife's repertoire of tics?
Does she experience vocal as well as motor tics?
How does her tic activity affect her quality of life?
Is there local Tourette support in your community?

Have you ever had contact with:

Euripedes C. Miguel, MD, Ph.D.
Rua Jose Pereira de Queiros, 67
Sao Paolo
Brazil 01241-040
Phone/Fax: 55-11-853-3531
E-mail: ecmiguel@terra.com.br

who is indicated (by the Tourette Syndrome Association) as being a resource person for Tourette in your Country.

 

[Angus]

Steve

Excuse the long delay - I just dipped off the radar a little bit there.. You asked me the following:


What is the nature of your wife's repertoire of tics? Primary tics revolve around neck movements and sniffing / barking. The neck movements can be set off by her seeing someone touch their neck on the television. Aditionaly she has a tic which requires her to scream at the top of her voice.

Does she experience vocal as well as motor tics? I would say yes, although motor tics are stronger.

How does her tic activity affect her quality of life? she is nearly in her thirties, and from the age of about six she has been very shy and at times almost hates herself. In the evening she gets very troubled by her tics, and they affect her ability to sleep. She refuses to drive because she is afraid to be driving and get a tic happen.

Is there local Tourette support in your community? Brazil appears to be very poorly supported, and I am in the process of considering setting up an information website.

---------------

Dr. Baxter, I would be grateful if you could have a look to see if 6 or 8mg of Orap would be considered a strong dose.

Thank you again for all responses.

 

[David Baxter PhD]

Orap (Pimozide) Drug Information: Uses, Side Effects, Drug Interactions and Warnings at RxList

Adults
In general, treatment with ORAP should be initiated with a dose of 1 to 2 mg a day in divided doses. The dose may be increased thereafter every other day. Most patients are maintained at less than 0.2 mg/kg per day, or 10 mg/day, whichever is less. Doses greater than 0.2 mg/kg/day or 10 mg/day are not recommended.

 

[Angus]

Steve and Dr. Baxter

a long while back I posted here, and I would like to thank you again for your various responses. On September 6, 2010, Yasmin was born by Ceserian Section in one of the best Maternity hospitals, in S?o Paulo. I am attempting to upload a photo of her (now 11 months), but don?t know if I will succeed..

Right throught the pregnancy, all of the Ultrasounds came back fine, according to our ultrasonographist even though I was watching it and seeing Cleft Lip with every scan. I guess it goes to show that parents worry without due cause, even if the medical practicioners say that there is nothing to worry about.

So then, here we are 11 months up the road and apart from the normal ups and downs, "Yas" is doing very nicely thank you - all except for the fact that we both (N?dia and I) are seeing, or appearing to see what might look like Tourette Syndrome tic-like activity, and would like to know if it is possible that tics would present at such a young age. Would it be possible for me to upload a (very short) video?

I suppose that with N?dia taking Orap at a dose of 6mg right through her pregnancy, Yasmin will have gotten a dose, right from the word go?

All responses very warmly welcome..

 

[Retired]

Angus,

Congratulations on the arrival of Yasmin! At the present time the Forum software does not provide for videos to be uploaded, so you may want to upload to You Tube.

Tourette Syndrome does not typically appear in children younger than four or five to my knowlege and there are may other possible explanations that could explain Yasmin's activity. The pediatrician and perhaps a pediatric neurologist would be your best resource to consult.

Have you discussed what seems to be "tics" to the pediatrician?