Hi

Ive had my jpouch about 3 years now. Its been fine although i do have to take 3 types of medication every day to control the amount i go to the loo. Loperamide, codeine and mebeverine.

Ive just found out im 4-5 weeks pregnant and have had to come off my medication. My doctor didnt seem very sure of what i should be on so said to take mebeverine and codeine as before but stop the loperamide, then said the midwife would refer me to my surgeon but my appointment isnt until mid march with the midwife and stopping the loperamide has since left me constantly on the loo, unable to go to work and very tired. Ive rung my surgeon myself and am hopefully going to get a call from him tomorrow. Ive decided not to take any of the medication now as the codeine and mebeverine dont really help without the loperamide and i am already having to reduce anti-depressants to come off completely too which is also a worry. I just wish i could be medication free and still able to function. Im terrified being on tablets or not being on them and being ill throughout my entire pregnancy will affect my baby.

If anybody has experienced or is experiencing anything similar or have any advise it would be greatly appreciated.

Thanks Vicx

Hi Vicx,

I am a genetic counselor and one part of my job is to counsel woman regarding medications they can take during pregnancy. What anti-depressant are you on? There are many anti-depressants that are safe during pregnancy. And the others that have some risk have to be balanced with the risk of becoming depressed off of the medicine. Depression by itself can have ill effects on pregnancy. This goes for diarrhea too. Diarrhea equals decreased absorption of critical vitamins and minerals that are vital for the baby's development. Thus, it might be best to take the medications. Generally speaking, opium derivatives do not have teratogenic effects (cause birth defects) in pregnancy. They can cause withdrawl issues in the baby after he/she is born, but sometimes that is less of a risk that having severe diarrhea during the pregnancy.

I am at home right now and don't have access to my database of current research on each drug. But as soon as I get in to work, I will PM you with the research summaries for each drug and give you my thoughts.

Hope this helps. And CONGRATULATIONS!!!!!

I hope this helps.

I have attached the summaries from the official website I use to determine the risks of medications in pregnancy. I couldn't find mebeverine on the site, but did find an article about it on Pubmed that states that it causes uterine contractions. That would not be a good thing early in pregnancy.

As far as the loperamide and codiene go, they are relatively safe during pregnancy. There is limited human research on loperamide, but in animals it does not cause birth defects. And in the larger of two human studies, it was not associated with birth defects. You can also use this during breast feeding as it is only found if very low levels in breast milk.

Codiene also is not associated with birth defects, but it can cause withdrawl if used in the third trimester. This general can be managed easily as long as the doctors know what they are dealing with. I wouldn't recommend taking it while breast feeding though as it can be secreted in high levels in the breast milk.

Keep in mind that keeping you healthy and happy may outweigh the potential risks of any medications you need to help you. Particularly, diarrhea and depression are associated with miscarriage and adverse pregnancy outcomes, so the benefits of the medications you have listed seem to outweigh the risks.

Gook luck!! If you let me know what anti-depression medication you are on, I can find the summary for that too.

So it wouldn't let me attach the document so I have pasted the info below. . .sorry for the long post.



Agent Detail - LOPERAMIDE
Agent #: 1118 CAS #: 53179-11-6
Last Updated: 11/2008 Cross-references: IMODIUM (53179-11-6), LOPERAMIDE OXIDE (106900-12-3)

Agent Summary
Quick take: Based on experimental animal studies, loperamide exposure during pregnancy is not expected to increase the risk of congenital anomalies. One of two human reports showed a possible increase in congenital malformations associated with loperamide.

* * *

Loperamide (Imodium) is an antidiarrheal medication that shares some of the opioid binding properties of meperidine (#1390) in the intestine. Loperamide oxide is an inactive prodrug that can be metabolized into loperamide (1). Very little loperamide enters the central nervous system, so, unlike the morphine derivatives, it is unlikely this drug will be abused.

One study indicated that loperamide was not teratogenic when administered during gestation to rats and rabbits (2). A research group monitored the outcomes of pregnancies in 105 women who sought counseling through various teratogen information services because they had used loperamide during gestation (89 of the women had used the agent during the first trimester) and compared the incidence of birth defects in this population with a control population (3). No significant increase in congenital defects was found in this population of women who used loperamide during gestation. Another study identified an increased risk of congenital malformations among 683 pregnancies with exposure to loperamide. The adjusted odds ratio was 1.41 (95% confidence interval 1.03-1.93) based on 43 affected children (5). The risk estimate for hypospadias was 3.2 (95% CI 1.3-6.6) based on 7 cases. The authors pointed out that the findings could have arisen by chance given the large number of comparisons in the study and proposed that verification in a separate sample would be necessary for confirmation.

Loperamide is secreted in human milk in small quantities. The milk of six mothers who ingested two 4 mg doses of loperamide oxide 12 h apart contained loperamide (1). The nonsteady state milklasma ratio measured in this study was about 0.3. A suckling infant would ingest less that 1/2000th of the recommended dose of loperamide (1). The American Academy of Pediatrics listed loperamide as compatible with breast feeding (4).

Selected References

1. Nikodem VC, Hofmeyr GJ: Secretion of the antidiarrhoeal agent loperamide oxide in breast milk [letter]. Eur J Clin Pharmacol 42: 695-6, 1992.

2. Marsboom R et al: Loperamide (R 18,553), a novel type of antidiarrheal agent. 4. Studies on sub-acute and chronic toxicity and the effect on reproductive processes in rats, dogs and rabbits. Arznein Forsch 24:1645-1649, 1974.

3. Einarson A, Mastroiacovo P, Arnon J et al: Prospective, controlled, multicentre study of loperamide in pregnancy. Can J Gastroenterol 2000;14:185-7.

4. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human breast milk. Pediatrics 108:776-89, 2001.

5. Kallen B, Nilsson E, Otterblad Olausson P. Maternal use of loperamide in early pregnancy and delivery outcome. Acta Pædiatrica 2008;97:541–545


Agent Detail - CODEINE
Agent #: 1061 CAS #: 76-57-3
Last Updated: 01/2010 Cross-references: METHYLMORPHINE (6059-47-8), CODEINE PHOSPHATE (41444-62-6)
Agent Summary Quick take: Based on experimental animal studies, codeine use during pregnancy is not expected to increase the risk of congenital anomalies. Reports of malformations in humans after pregnancy exposure to codeine have been inconsistent and are not believed to indicate an increase in risk. Neonatal withdrawal may occur after late pregnancy use of codeine. Rapid metabolism of codeine is a genetic characteristic that may lead to dangerous milk levels of morphine in a minority of women. Use of morphine as an analgesic may be preferred during lactation.

* * *

Codeine is a widely used narcotic analgesic and antitussive. Codeine is considered a prodrug, since it is largely metabolised to the principal active analgesic agent morphine (#1623). The conversion of codeine to morphine occurs in the liver and is catalysed by the cytochrome P450 enzyme CYP2D6. Approximately 6–10% of the Caucasian population have poorly functional CYP2D6 and codeine is virtually ineffective for analgesia in these patients (17). Many of the adverse effects, however, are still experienced. Some medications are CYP2D6 inhibitors and reduce or even completely eliminate the efficacy of codeine. The most notorious of these are some serotonin reuptake inhibitors, such as fluoxetine (#1898) and citalopram (#4062).

Teratogenicity studies in hamsters and mice have associated codeine administration with skeletal abnormalities (1,2). A more recent study did not find a significant increase in anomalies in the offspring of treated hamsters and mice; rather, developmental toxicity was manifest only in hamsters as a decrease in fetal body weight at a dose of 100 mg/kg/d (12). No increase in congenital anomalies was shown when codeine was administered to pregnant rats or rabbits (3). At the top dose in the rat study (120 mg/kg/d), maternal toxicity occurred and was associated with reduced fetal weight and increased resorptions. The top dose in the rabbit study (30 mg/kg/d) did not produce adverse effects on the pregnant animals or the offspring.

A case-control study of 141 infants with cardiac malformations did not find any association with first trimester use of codeine (14). No significant association with maternal use of codeine during the first trimester of pregnancy was seen in a case-control study of 538 fetuses and infants with neural tube defects (16). Retrospective studies of human pregnancies that involved the first trimester use of codeine have associated this compound with a variety of anomalies, including respiratory tract malformation, pyloric stenosis, inguinal hernia, cardiac and circulatory system defects, and cleft lip and palate (4-7). The absence of a consistent pattern in these retrospective associations, however, as well as criticisms of possible bias in the data collected for these observations, make it unjustified to consider codeine as causative of these malformations.

Neonatal withdrawal, characterized by tremor, jitteriness, diarrhea, and poor feeding, has been seen in babies born both to addicted and nonaddicted women when the women had been taking codeine-containing medications in the days prior to delivery (8,9,15). If present during labor, codeine can produce respiratory depression in the newborn, which can be alleviated by naloxone (#1571) administration.

Codeine and its active metabolite, morphine (#1623), are transferred to human milk (10,13,18). The rate of morphine formation may be very rapid in some individuals because of their genetic makeup (19). A 2006 case report described a fatal opioid intoxication in a suckling neonate whose mother was found to be an ultrafast metabolizer of codeine. The milk in this case had a morphine content that proved lethal to the nursing infant on postnatal day 11 (18, 21), although commentators did not find the pharmacokinetic estimates to provide convincing cause-and-effect evidence (20). The incidence of ultrafast metabolism as a genetic trait varies widely in various populations, ranging from 1% in some Scandanavian countries to as high as 29% among Ethiopians (19). In mothers who do not metabolize codeine rapidly, if the dose is <240 mg/d, the quantity of codeine and morphine ingested by a suckling infant is not sufficient to contraindicate breastfeeding (11,13). Use of morphine as an analgesic may be preferable to the use of codeine because of the lack of influence of this genetic variation in metabolism.

Selected References

1. Geber WF and Schramm LC: Comparative teratogenicity of morphine, heroin, and methadone in the hamster. Pharmacologist 11:248, 1975.

2. Zellers JE and Gautieri RF: Evaluation of teratogenic potential of codeine sulfate in CF-1 mice. J Pharm Sci 66:1727-1731, 1977.

3. Lehmann VH: (Teratologic studies in rabbits and rats with the morphine derivative codeine.) Arznein Forsch 26:551-554, 1976.

4. Heinonen OP et al: Birth Defects and Drugs in Pregnancy, Littleton, Publishing Sciences Group, pp 287-95, 1977.

5. Bracken MB, Holford TR: Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 58:336-44, 1981.

6. Saxen I: Associations between oral clefts and drugs taken during pregnancy. Int J Epidemiol 4:37-44, 1975.

7. Rothman KJ et al: Exogenous hormones and other drug exposures of children with congenital heart disease. Am J Epidemiol 109:433-9, 1979.

8. Van Leeuwen G et al: Narcotic withdrawal reaction in a newborn infant due to codeine. Pediatrics 36:635-6, 1965.

9. Mangurten HH, Benawra R: Neonatal codeine withdrawal in infants of nonaddicted mothers. Pediatrics 65:159-60, 1980.

10. Horning MG et al: Identification and quantification of drugs and drug metabolites in human breast milk using GC-MS-COM methods. Mod Probl Paediatr 15:73-9, 1975.

11. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human breast milk. Pediatrics 108:776-89,2001.

12. Williams J, Price CJ, Sleet RB, George JD, Marr MC, Kimmel CA, Morrissey RE. Codeine: developmental toxicity in hamsters and mice. Fundam Appl Toxicol 1991;16:401-413.

13. Meny RG, Naumburg EG, Alger LS, Brill-Miller JL, Brown S: Codeine and the breastfed neonate. J Hum Lact 9: 237-40, 1993.

14. Shaw GM, Malcoe LH, Swan SH, et al.: Congenital cardiac anomalies relative to selected maternal exposures and conditions during early pregnancy. Eur J Epidemiol 1992;8:757-760.

15. Khan K, Chang J: Neonatal abstinence syndrome due to codeine. Arch Dis Child Fetal Neonatal Ed 1997; 76: 59-60.

16. Shaw GM, Todoroff K, Velie EM, Lammer EJ: Maternal illness, including fever, and medication use as risk factors for neural tube defects. Teratology 57:1-7, 1998.

17. Fagerlund TH, Braaten O: No pain relief from codeine...? An introduction to pharmacogenomics. Acta Anaesthesiol Scand 2001;45:140-9.

18. Koren G, Cairns J, Chitayat D, Gaedigk A, Leeder SJ: Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother. Lancet 2006; 368:704.

19. Cascarbi I. Pharmacogenetics of cytochrome P4502D6: genetic background and clinical implication . Eur J Clin Invest 2003; 33 (suppl 2): 17-22.

20. Bateman DN, Eddleston M, Sandilands E: Codeine and breastfeeding. Lancet 2008; 372:625.

21. Madadi P, Chitayat D, Koren G: Codeine and breastfeeding - Authors' reply. Lancet 2008; 372:626.

Hi Fissa

First of all i have to say a huge thank you for going to so much trouble to help me with this. I was over the moon to discover i was pregnant. However, that was soon replaced by constant worry because i felt my doctor offered very little info or help with my condition in pregnancy. I went to see another doctor yesterday. She was very helpful and actually went onto the internet and brought up the studies and info that you have provided me with here. To have it confirmed by 2 people now that the loperamide is considered pretty safe during pregnancy is very reasuring. Although it still brings worries to be on anything, it is my only option of staying healthy whilst pregnant. I am now able to start enjoying the fact that i am going to be a mum for the very first time.

I also asked my doctor about the anti depressant Citalopram. She said she was reluctant to take me off them yet but will reduce it over the pregnancy depending on how i feel. She did also tell me that this anti depressant was considered one of the first and safer options they would provide for women during pregnancy which has also given me some peace of mind.

Thank you once again for all your help. It is very much appreciated and being so hormonal i was quite emotional to be on the recieving end of such a kind act. All the very best to you.

Victoria