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Drugs during pregnancy
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Drugs during pregnancy

I am on long term Nexium (40 mg/twice daily) and Amitriptylin  (25 mg/once daily) with Ativan (0.5 mg) only when necessary for Nausea.

I just recently realized that I am 7 weeks pregnant, something that was unplanned and unexpected since I had problems with ovulation and was under the impression that pregnancy could only occur with ovarian stimulation or specialized intervention.

In any case I was for the duration of pregnancy taking Amitriptylin once daily and took several Lorazepam tablets (10-15) for Nausea which I thought was my usual Nausea that I always complain from and later turned out to be due to pregnancy. Upon my research I found out that the Amitriptylin is a category C drug and Lorazepam is a category D, both that are unsafe during pregnancy. My OB is researching if we need to terminate this pregnancy. However, I would like to know your medical opinion as well to feel more comfortable.
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As you are aware, each of the drugs you described carries some risk to the fetus.
A drug in the C category should be used only if the benefit outweighs the risk, and  in the D category has shown some actual evidence of harm.  From what I can discover, the biggest risk with Lorezepam is the risk to the baby of addiction and withdrawl (withdrawal) syndrome.
Obviously, if you discontinue the medication now that won't be an issue.  The other potential problem is an increased risk of cleft lip and palate associated with its use.
Cleft lip can be ruled in or out by a targeted ultrasound, and is repairable if it occurs.
You are really the only one who can determine whether the risk is high enough for you to consider termination.  Obviously there are other factors that go into making that decision.
If you were my patient, I would advise you to discontinue the medications and I would offer you the option of genetic testing and targeted ultrasound.  If you elected to terminate the pregnancy, I would not be judgemental. Because the risk of birth defects is so small however, I would not recommend termination based only on your exposure.

I hope this is useful and helpful!
Good luck!
Dr B
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