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Forum Name: Obstetrics

Question: Use of low-dose Topamax (migraine preventive) and Pregnancy


 aarobins - Fri Jan 02, 2009 2:37 pm

I am researching info on Topamax. I've been talking with my docs a bit and they are helping me, but I think I am on the edge of giving one of them an ulcer. I've had horribly severe migraine since a jaw injury and for nine years it seemed nothing we did from radiofrequency ablation to even resetting my jaw helped the migraines.

They were able to fix the jaw pain, but not stop the migraine pain which I just woke up with after a dental procedure with sedation. We tried multiple meds over and over (100+) and re-tried Topamax for the third time about six weeks ago. I had no expectations for it, but had been tracking my migraines and talked with the neuro and he thought I was now getting clusters with migraine together. Unbelievably so it is like they have nearly vanished with this round of Topamax. I had a hard bout with side effects and my neuro really worked with the dosage until he could get me to 100mg or as close to it and we are there and I am so well.

I am marrying in a few short months and my fiance and I just assumed we would not have any children because I was constantly so unwell in and out of hospital vomiting and sick to the point they can not even get IVs they go straight for PICCs and this is really just unbelievable for me to have sustained relief. We so badly want to have a family and I gave up grad school to be an NP because of the migraines, missed out on a career, etc and we would love to shoot for a family.

The ob/gyn said I would need to really coordinate with she and the neuro, but didn't seem comfortable stating much beyond that. All that I am reading states it is a class C drug. Didn't go well with animal studies. I have scanned lots of web pages with personal testimonies some good some bad where for one person it went great another it went poorly and am seeing that it seems folic acid is important I am on a prenatal that the ob/gyn put me on because of ortho evra/topomax interaction for added safety with folic, but would like to hear if someone could weigh in on if these studies were looking at what I assume is really high dosage of topamax in animals and with the women recorded in pharmaceutical studies coming out are these much larger doses than what I am on (100mg)? I feel so excited that I am FINALLY well, and so concerned that I may have now created a catch 22 of sorts!? I also understand that benefit sometimes outweighs risks, but I don't want to be selfish and harm a baby because of the Topamax either. Thank you for your time.
 Debbie Miller, RN - Tue Jan 06, 2009 12:27 am

User avatar Hello,
Risk of problems in pregnancy due to Topamax use is theoretical and there are no red flags, according to teratology resources I contacted about it.

You are correct that this is a low dose which would further reduce any possible risk and the benefits to you will surely outweigh, since they are known, while risks from this medication are not apparent.

Studies are not done on pregnant or breastfeeding women but this information about birth defects and pregnancy history is collected after pregnant women have used a medication, either because they needed it or did not know they were pregnant. So, while these are not studies that would permit the drug manufacturer to state in labeling that it is safe in pregnancy you should be just fine to continue to use it, thereby reducing the risk of your illness which ultimately could be harmful to the baby. You would also be fine to take the medication while lactating which has huge benefits for both mother and baby.

I agree with the folic acid supplementation.

Best wishes

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