A thirty year old patient with an uncomplicated 5-month pregnancy presents with migraine headaches. Three drugs have been proposed, Imitrex®, Acetominophen and motrin®.
Imitrex is a Sumatriptan which is a selective serotonin receptor agonist. Common side effects include pain or chest tightness, weakness and stomach discomfort (Stoppler, 2012). While not specifically contraindicated in pregnancy, animal studies have shown damage to the foetus, but there have not been sufficient human studies to ascertain their effects on the human foetus with any certainty. According to Multum Information Services (2008) the FDA has categorised Imitrex® under pregnancy category C which indicates that while animal studies have shown harm to the foetus, it can be used in humans where benefits outweigh risks.
According to its monograph, Acetaminophen is classified as an analgesic and antipyretic. In oral and rectal form, acetaminophen has not formally been assigned a pregnancy category by the FDA. It is one of the safest analgesics to be used in pregnancy as an analgesic for mild to moderate pain and an antipyretic. It is safe when used in intermittent durations for short periods of time. There is danger of hepatotoxicity with overdosage. Intravenous Acetaminophen has been assigned to pregnancy category C according to Multum (2008).
Motrin® is an Ibuprofen which has been assigned to category C by the FDA before 30 weeks of gestation and moves to category D after week 30. The patient has intermittent migraines that may continue into her third trimester and for that reason, I would rule out Motrin® completely as there is increased risk of non-closure to the ductus arteriosus if taken in the third trimester. Since animal studies have shown foetal damage in the case of Imitrex, I would administer Acetaminophen to be taken as an effervescent tablet due to the reduced peristalsis usually experienced during migraines, dosage 1g every 4-6 hours as needed.