Dexamphetamine appears safe to treat narcolepsy in pregnancy, cases show
Use of stimulant not linked to harmful outcomes for moms or babies
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Use of the stimulant dexamphetamine during pregnancy to treat narcolepsy is not linked to harmful outcomes for mothers or their newborns, according to a small case series in Australia.
The researchers reported that, among 10 pregnant women with narcolepsy or idiopathic hypersomnolence — excessive daytime sleepiness due to unknown causes — six continued treatment with dexamphetamine, also called dextroamphetamine, during pregnancy. All but one of their babies were born late in the third trimester, in line with the expected pregnancy timeline, and did not require additional support. All five of those children also showed normal growth. The woman whose baby was born early had a pregnancy complicated by a viral infection, the team noted.
Overall, the results of this case series, while limited by the small number of patients, show that use of this drug may be safe during pregnancy for women with narcolepsy, the researchers noted.
“Our findings suggest that therapeutic dexamphetamine use for narcolepsy may not be associated with adverse obstetric or neonatal outcomes,” the team wrote, adding that “individualised counselling is essential to balance maternal functional needs against potential pregnancy risks.”
The study detailing these results, titled “The use of dexamphetamine for narcolepsy during pregnancy: A case series and literature review,” was published in the journal Obstetric Medicine.
Narcolepsy affects the brain’s ability to regulate sleep-wake cycles, resulting in symptoms such as excessive daytime sleepiness and cataplexy, or a sudden loss of muscle tone.
Looking into the use of dexamphetamine for narcolepsy in pregnancy
Dexamphetamine is a central nervous system stimulant that increases the levels of wake-promoting molecules in the brain. The medication, approved to treat narcolepsy and attention deficit hyperactivity disorder, has been increasingly prescribed to women of childbearing age. However, data on its safety to treat narcolepsy during pregnancy is limited, according to the researchers.
Now, to learn more, the team analyzed pregnancy outcomes in 10 women with narcolepsy type 1 or type 2, or idiopathic hypersomnolence, who were prescribed dexamphetamine during pregnancy. All of the expectant mothers were followed at the Royal Brisbane and Women’s Hospital.
The six women who continued the treatment throughout pregnancy had been prescribed dexamphetamine in the prior three years. The mean daily dose was 20 mg, with a range of 5-35 mg. Three of the women chose to reduce the dose to 5 mg as needed during maternity leave, due to a lesser need for the medication, per the researchers.
Untreated narcolepsy can cause significant functional impairment, and this study describes outcomes during pregnancy when medicated that can inform clinical decision making. … This narcolepsy case series supports the safety profile of continued dexamphetamine use during pregnancy.
All babies with available data were born with normal scores on the Apgar scale — a rapid, standardized assessment method to evaluate a newborn’s condition in the first minutes after birth — and did not require breathing support at birth.
One pregnancy was complicated by a viral infection and fetal growth restriction, and the baby was born early, at 32 weeks of pregnancy, and required admission to the neonatal intensive care unit, the data showed.
Although one woman was diagnosed with high blood pressure during pregnancy, there were no cases of pre-eclampsia, a serious complication of pregnancy marked by high blood pressure and signs of organ damage, usually affecting the kidneys, the researchers noted.
No delivery complications related to dexamphetamine use were reported. Three women required emergency cesarean section, and four continued the treatment while breastfeeding.
“Untreated narcolepsy can cause significant functional impairment, and this study describes outcomes during pregnancy when medicated that can inform clinical decision making,” the researchers wrote. “This narcolepsy case series supports the safety profile of continued dexamphetamine use during pregnancy.”
