Category C Drugs (My first special snowflake post)

gatorMom2014 · March 2016

I'm upset and trying to decide whether I'm done with this OB or not. I switched at the beginning of this pregnancy to get to the closer hospital. My old Doctor always made it a point to tell you what category of drug they were prescribing. My current situation is that after being told I may have a rare type of UTI that can only be treated with IV meds for 5 days, it turns out the urine sample was contaminated, and instead I just have a yeast infection. They called me today with this result (two weeks after my initial appointment) and said they had called in meds for the YI. I asked the nurse if it is safe for pregnancy, and she said of course.

Tonight I was about to take the meds, when I read the pamphlet and saw that it is a category C drug that has caused low litter number and reduced birth weight in rats. I called the doctor to say I was uncomfortable with Cat C drugs, and ask it there was an alternate treatment. She basically acted like I'm silly for worrying, and came off as annoyed that I had called. She says they have been prescribing this for years and it's fine. She says I don't have to choose to take it if I do t want to, and that a yeast infection will not put me or the baby in any risk of harm.

I think I'm going to call my old midwife tomorrow and see what she has to say.

What do you ladies think? Am I overreacting, or is it not too much to expect to be counseled when being prescribed Category C?

I'm sorry for the special snowflake rant, but I would really appreciate your thoughts!

Edit: typos

joyful08 · March 2016

I don't think I would be comfortable taking category C drugs. I agree that you should get a second opinion and call your old midwife.

MRSCORKER · March 2016

I agree with @joyful08. My OB wasn't even ok with me using a topical gel on my face that's cat B. I realize she may be playing it super safe but still. I would get a second opinion.

nsquaredlife13 · March 2016

Nope. I wouldn't touch it. I'm sorry you're having to deal with such BS. IMO it's just not worth the risk.

TurtleMomma · March 2016

Just curious, in your researching did it describe the dose exposure in rats? Was it consistent with chronic exposure or acute exposure? I ask because many drugs reach their category listings based on chronic dosing (weeks or months) rather than acute use (a week or less) because results from longer term exposure are easier to draw conclusions from than short term use. Not saying that acute use doesn't have risks, but often something that might have gone unnoticed after short use becomes a huge thing with prolonged use.

Do whatever you are comfortable with, that being said.

gatorMom2014 · March 2016

Thanks @joyful08 , @mrscorker , and @nsquaredlife13 , that's pretty much where I'm at too. But it sucks because she said there is no alternate A or B drug to prescribe, but I can try to "eat yogurt or some other natural remedy if you want to." So annoying. But I did eat yogurt right after I got off the phone

gatorMom2014 · March 2016

TurtleMomma said:

Just curious, in your researching did it describe the dose exposure in rats? Was it consistent with chronic exposure or acute exposure? I ask because many drugs reach their category listings based on chronic dosing (weeks or months) rather than acute use (a week or less) because results from longer term exposure are easier to draw conclusions from than short term use. Not saying that acute use doesn't have risks, but often something that might have gone unnoticed after short use becomes a huge thing with prolonged use.

Do whatever you are comfortable with, that being said.

Edited to add-- @TurtleMomma good point.

My doctor said that generally the results are for pills or IV form rather than the internal vaginal cream that was prescribed--she said that the cream does not cross into your bloodstream, so is not worrisome to her. I still do not feel comfortable taking a lower dose which has not been proven safe for a condition I'm being told causes discomfort to me,but does not endanger the baby.

In the end I am actually less concerned with the fact that the doctor has made the educated decision that this category c drug is ok to prescribe, and more concerned that I was not told it was Cat C--and then I was treated with no compassion for my concerns (for example I started by saying I'm sorry to bother you, and she did not say that's ok, that's what we're here for, or anything similar; also she never said she understands that I'm concerned,or gave any sign that she was anything but annoyed that I was bothering her and questioning what she had prescribed.)

br0co1ii · March 2016

The drug being cat c or not doesn't resolve the fact that you feel that you can trust your doctor. Now that you have this hanging in the air, you will likely question many other things that come up over the course of your pregnancy and beyond. I'd switch.

JamieK1882 · March 2016

Speaking as a pharmacist, category C drugs basically mean to only use if the benefits outweigh the risks. Oftentimes there are not cat B options, so I would take a cat C if I felt the risk of not clearing the yeast infection was greater.

There obviously are cat B drugs (I'm sure we all got that list of safe meds from our docs), but in reality there are very very very few category A.

Also, they recently changed the pregnancy risk categories and are phasing out the old A, B, C, D, and X labels.

I'm mobile and can't figure out how to paste the link, but it's all on the FDAs website.

UponAStar16 · March 2016

I think this is the link
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm

Blonde1817 · March 2016

I agree that the worst part is that the doctor was not very transparent with you about what she was prescribing and was not very compassionate about your concerns. That's not how you want a doctor to respond!

However, I would try not to worry too much if you have to take the meds. I was accidentally still using flonase the first few weeks of pregnancy, which is category C as well. I googled it and the same results about "birth defects in rats" came up and I freaked the F out. Once I'd calmed down a bit and looked into it further, I came to the conclusion that if these drugs were definitively harmful to the baby, they would not be prescribed in pregnancy and it would be common knowledge to avoid them. In these studies, rats are injected with massive amounts of these drugs directly into the bloodstream, far more than humans would ever use. Same thing with those studies on salicylic acid... the rats are injected with tons of the stuff... how can that compare with putting a teeny bit of face wash with 1% salicylic acid on your skin only?

So try not to freak out like I did lol and take these studies in context. I would still avoid class C meds unless, as PP said, the benefits outweigh the risks. But if there is no class A or B drug and you are suffering, listen to your doctor (or get another doctor you like more and listen to them).

stephanieslush · March 2016

gatorMom2014 said:

Thanks @joyful08 , @mrscorker , and @nsquaredlife13 , that's pretty much where I'm at too. But it sucks because she said there is no alternate A or B drug to prescribe, but I can try to "eat yogurt or some other natural remedy if you want to." So annoying. But I did eat yogurt right after I got off the phone

Try coconut oil too. I get YI semi-frequently and to treat I mix coconut oil and 3 drops of tea tree oil and either put it on a tampon(obviously don't use a tampon now) or wait until it resolidifies and insert it. Coconut oil Has anti fungal properties and the tea tree oil also has healing effects. It's totally safe and effective. I always clear up in a day or two

gatorMom2014 · March 2016

Update: the doctor called and left a message before 8 am this morning saying she feels badly about how we left things last night, knows that I was anxious, and encouraged me to call her back today if I want to talk some more. I wasn't expecting that, and it actually makes me feel a little better about the situation. So that is something at least.

@UponAStar16 thanks for the link, I'm definitely going to check it out. I didn't know they were changing the labeling system, and I appreciate your opinion as a pharmacist.

@Blonde1817 thanks for the advice. And I'm also sorry that you had to go through that freak out! It is really hard to say whether the risks outweigh the benefits for my situation--since they are saying there is no harm to the baby or me if I don't use the meds, just irritation and discomfort for me (a mother's guilt starts early y'all). At this point I may see if my body can fight it off with yogurt and apple cider vinegar before revisiting the medicine. I don't have a history of yeast infections, but this appears to be mild. I am still planning on calling my old midwife today, and then calling back the OB after that. Thanks so much!

JamieK1882 · March 2016

@gatorMom2014 glad she called back!

jillianpardo · March 2016

I had a similar experience at my post partum check up. I specifically asked if it was OK while bf and she said, I'm sure it's fine. I was uneasy about it. She called me right after I picked up the script and said not to use it. I was pretty annoyed. She recommended a live culture yogurt douche and to drink apple cider vinegar. I think I just ended up ignoring it till it went away.

LizaKate1213 · March 2016

@gatorMom2014, glad she called back! I think what many patients forget is that doctors are human and they have long, hard days sometimes. It can be exhausting and patience often wears thin if it has been a hard day or week. But it sounds like she has a good head on her shoulders and realized her error, which is a great quality because not all doctors would re-think themselves! To your original question, I wouldn't expect my doctor to necessarily review the category, but to go over potential harmful side effects, if any. Pregnant women get YI's and are treated with topical antifungals frequently. I would be comfortable using it just because the studies done with rats are typically at higher doses for extended periods of time, and injected or injected instead of just applied topically. Though, it is not true that it will not enter your bloodstream as your skin does absorb some measure of medications (that is why birth control such as nuvaring and the patch exist, and nicotine and pain patches, estrogen and progesterone creams, etc.) I think in the end you have to do what you are comfortable with, but I would give this doctor another chance based on her attempt to reconcile her mistake.

Michi1382 · March 2016

br0co1ii said:

The drug being cat c or not doesn't resolve the fact that you feel that you can trust your doctor. Now that you have this hanging in the air, you will likely question many other things that come up over the course of your pregnancy and beyond. I'd switch.

This. Cat C is fishy to begin with but now I would question every single decision the OB makes. And what's with that tone of voice? She doesn't need to be patronizing when you call to ask about a medication. Bedside manner is a biggie for me but I'd want to bitch slap a bitch for that. I would change OBs at this point for exactly what @br0co1ii said.

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