Are Triptans Safe During Pregnancy?
Are Triptans Safe During Pregnancy?
I am Christoph Diener, a neurologist from the University of Essen in Germany. Today's topic is migraine and the use of triptans in pregnancy.
When the triptans were introduced in 1990 (sumatriptan was the first one), the label stated that these drugs are contraindicated during pregnancy. This labeling occurred despite the fact that triptans were not teratogenic in any of the experiments. GlaxoSmithKline started a prospective pregnancy registry in 1992 to find out whether taking sumatriptan or naratriptan during pregnancy was associated with a higher risk for major birth defects.
This registry covered a period of 16 years and included 680 pregnant women. These women had 689 children; 626 of the women used sumatriptan, 57 used naratriptan, 7 used both sumatriptan and naratriptan, and 6 used the combination of sumatriptan and naproxen. Most of the pregnant women in the registry lived in the United States, United Kingdom, Germany, and Sweden.
The rate of major birth defects in women who took triptans during pregnancy was 4.2%, and this is exactly the same number that would be expected in women who do not take any drugs. There are also registry data looking at whether there is an increased risk in women with migraine for a higher rate of birth defects. On average, the rate of birth defects in women without and with migraine is 4%-4.5%.
It seems that at least sumatriptan and naratriptan are safe to use during pregnancy. Most women, by the way, had taken sumatriptan in the first trimester.
I am aware that triptans are still contraindicated, but I am very comfortable prescribing a triptan to a pregnant woman if she has very severe migraine attacks that are long-lasting and with vomiting and fluid loss, because I am convinced that a severe migraine attack is probably more dangerous than taking a triptan.
These are very reassuring data, with no signs that taking triptans increases the risk for birth defects if taken during pregnancy. I am Christoph Diener.
I am Christoph Diener, a neurologist from the University of Essen in Germany. Today's topic is migraine and the use of triptans in pregnancy.
When the triptans were introduced in 1990 (sumatriptan was the first one), the label stated that these drugs are contraindicated during pregnancy. This labeling occurred despite the fact that triptans were not teratogenic in any of the experiments. GlaxoSmithKline started a prospective pregnancy registry in 1992 to find out whether taking sumatriptan or naratriptan during pregnancy was associated with a higher risk for major birth defects.
This registry covered a period of 16 years and included 680 pregnant women. These women had 689 children; 626 of the women used sumatriptan, 57 used naratriptan, 7 used both sumatriptan and naratriptan, and 6 used the combination of sumatriptan and naproxen. Most of the pregnant women in the registry lived in the United States, United Kingdom, Germany, and Sweden.
The rate of major birth defects in women who took triptans during pregnancy was 4.2%, and this is exactly the same number that would be expected in women who do not take any drugs. There are also registry data looking at whether there is an increased risk in women with migraine for a higher rate of birth defects. On average, the rate of birth defects in women without and with migraine is 4%-4.5%.
It seems that at least sumatriptan and naratriptan are safe to use during pregnancy. Most women, by the way, had taken sumatriptan in the first trimester.
I am aware that triptans are still contraindicated, but I am very comfortable prescribing a triptan to a pregnant woman if she has very severe migraine attacks that are long-lasting and with vomiting and fluid loss, because I am convinced that a severe migraine attack is probably more dangerous than taking a triptan.
These are very reassuring data, with no signs that taking triptans increases the risk for birth defects if taken during pregnancy. I am Christoph Diener.
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