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1. A few symptomes and syndromes
– B up reno rp hine, nalbup hine and p entaz o cine m ust no t be co m bined with m o rp hine,
p ethid ine, tram ad o l o r co d eine because they have co m p etitive actio n. 1
Treatment of nociceptive pain in pregnant and breast-feeding women
Analgesics st nd Pregnancy Breast-feeding
st 1 cho ice
eevLl1 paracetamol 1 and 2 rd
aspirin trim ester
3 trim ester
1st cho ice and term
st1 cho ice
avo id co ntra-ind icated avo id
ibuprofen avo id co ntra-ind icated p o ssible
p o ssible
codeine T he newbo rn infant m ay U se with cautio n, fo r a sho rt
p o ssible
p o ssible d evelo p withd rawal p erio d (2 -3 d ay s), at the
sy m p to m s, resp irato ry lo west effective d o se.
d ep ressio n and d ro wsiness M o nito r the m o ther and the
in the event o f p ro lo nged child : in the event o f
leveL2 ad m inistratio n o f large excessived ro wsiness, sto p
tramadol
d o ses at the end o f the treatm ent.
morphine
resp irato ry 3rd trim ester. C lo sely
vlL3ee m o nito r the newbo rn
infant.
T he child m ay d evelo p d ro wsiness when the m o ther
receives tram ad o l at the end o f thrde 3 trim ester and
d uring breast-feed ing. A d m inister with cautio n, fo r a
sho rt p erio d , at the lo west effective d o se, and m o nito r
the child .
T he child m ay d evelo p withd rawal sy m p to m s,
d ep ressio n and d ro wsinerdss when the m o ther receives
m o rp hine at the end o f the 3 trim ester and d uring
breast-feed ing. A d m inister with cautio n, fo r a sho rt
p erio d , at the lo west effective d o se, and m o nito r the
child .
Neuropathic pain
C o m m o nly used analgesics are o ften ineffective in treating this ty p e o f p ain.
T reatm ent o f neuro p athic p ain is based o n a co m binatio n o f two centrally acting d rugs:
amitriptyline P O
A d ults: start with a d o se o f 1 0 to 2 5 m g/ d ay at nigh t and increase p ro gressively to
reach an effective d o se, with o ut exceed ing 1 5 0 m g/ d ay . R ed uce th e d o se by 1 / 2 in
eld erly p atients.
carbamazepine P O
A d ults: start with a d o se o f 2 0 0 m g o nce d aily at night fo r o ne week , then 4 0 0
m g/ d ay in
2 d ivid ed d o ses (m o rning and night) fo r o ne week , then 6 0 0 m g/ d ay in 3 d ivid ed
d o ses.
G iven its terato g enic risk , carbam az ep ine sh o uld o nly b e used in w o m en o f
ch ild bearing age wh en co vered by no n-ho rm o nal co ntracep tio n ( co p p er intrauterine
d evice).
– B up reno rp hine, nalbup hine and p entaz o cine m ust no t be co m bined with m o rp hine,
p ethid ine, tram ad o l o r co d eine because they have co m p etitive actio n. 1
Treatment of nociceptive pain in pregnant and breast-feeding women
Analgesics st nd Pregnancy Breast-feeding
st 1 cho ice
eevLl1 paracetamol 1 and 2 rd
aspirin trim ester
3 trim ester
1st cho ice and term
st1 cho ice
avo id co ntra-ind icated avo id
ibuprofen avo id co ntra-ind icated p o ssible
p o ssible
codeine T he newbo rn infant m ay U se with cautio n, fo r a sho rt
p o ssible
p o ssible d evelo p withd rawal p erio d (2 -3 d ay s), at the
sy m p to m s, resp irato ry lo west effective d o se.
d ep ressio n and d ro wsiness M o nito r the m o ther and the
in the event o f p ro lo nged child : in the event o f
leveL2 ad m inistratio n o f large excessived ro wsiness, sto p
tramadol
d o ses at the end o f the treatm ent.
morphine
resp irato ry 3rd trim ester. C lo sely
vlL3ee m o nito r the newbo rn
infant.
T he child m ay d evelo p d ro wsiness when the m o ther
receives tram ad o l at the end o f thrde 3 trim ester and
d uring breast-feed ing. A d m inister with cautio n, fo r a
sho rt p erio d , at the lo west effective d o se, and m o nito r
the child .
T he child m ay d evelo p withd rawal sy m p to m s,
d ep ressio n and d ro wsinerdss when the m o ther receives
m o rp hine at the end o f the 3 trim ester and d uring
breast-feed ing. A d m inister with cautio n, fo r a sho rt
p erio d , at the lo west effective d o se, and m o nito r the
child .
Neuropathic pain
C o m m o nly used analgesics are o ften ineffective in treating this ty p e o f p ain.
T reatm ent o f neuro p athic p ain is based o n a co m binatio n o f two centrally acting d rugs:
amitriptyline P O
A d ults: start with a d o se o f 1 0 to 2 5 m g/ d ay at nigh t and increase p ro gressively to
reach an effective d o se, with o ut exceed ing 1 5 0 m g/ d ay . R ed uce th e d o se by 1 / 2 in
eld erly p atients.
carbamazepine P O
A d ults: start with a d o se o f 2 0 0 m g o nce d aily at night fo r o ne week , then 4 0 0
m g/ d ay in
2 d ivid ed d o ses (m o rning and night) fo r o ne week , then 6 0 0 m g/ d ay in 3 d ivid ed
d o ses.
G iven its terato g enic risk , carbam az ep ine sh o uld o nly b e used in w o m en o f
ch ild bearing age wh en co vered by no n-ho rm o nal co ntracep tio n ( co p p er intrauterine
d evice).
