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Pharmacotherapy during pregnancy

Last updated: June 4, 2021

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Pharmacotherapy during pregnancy is an important concern for a medical professional because there are only a limited number of drugs that can be safely administered during this period. Many drugs can cause harm to the fetus in the form of defects in organogenesis, growth retardation, and functional deficits. The aim of drug selection in this period is to prescribe an agent that effectively alleviates the mother's medical complaints while ensuring the safety of the unborn fetus. This article provides a brief overview of drugs that can be used for common conditions in pregnant women. It also lists the substances that should be avoided during pregnancy.

Overview of antibiotics to avoid during pregnancy [1][2][3]
Harmful side effects Drugs of choice
Tetracycline
Aminoglycoside
Trimethoprim/sulfonamide combinations
Chloramphenicol
  • Gray baby syndrome: a syndrome associated with chloramphenicol accumulation in the body, leading to ashen gray color of the skin, cardiovascular collapse, and abdominal distention
Clarithromycin
  • Embryotoxic
Fluoroquinolones
Metronidazole
  • Even though studies in humans show no increase in congenital defects, avoiding the drug during the first trimester and during breastfeeding is recommended, if possible. [4]

Teethracycline:” teeth discoloration with tetracycline.
A mean guy stepped on baby's ear:” Aminoglycoside can cause ototoxicity.

Antihypertensives

Overview of antihypertensives to avoid during pregnancy [5] [6]
Harmful side effects Recommended drugs
Diuretics
ACE inhibitors [7]
Angiotensin-receptor blockers
Atenolol

Moms Love Healthy Newborns:” Methyldopa, Labetalol, Hydralazine, Nifedipine are safe to use during pregnancy.

Antifungals

Overview of antifungals to avoid during pregnancy [9]
Harmful side effects Recommended drugs

Ketoconazole, flucytosine, and griseofulvin

Itraconazole, fluconazole (> 300 mg)
Iodides

Antivirals

Overview of antivirals to avoid during pregnancy [10][11][12][13][14]
Harmful side effects Recommended drugs
Efavirenz [15]

Ribavirin

Interferon α
Ribavirin and interferon α combination
Didanosine and stavudine combination
Nevirapine
  • Potentially fatal hepatotoxicity

Nevirapine should not be used as first-line therapy if avoidable!

Anticoagulants

Overview of anticoagulants to avoid during pregnancy [16][17]
Drugs to avoid Harmful side effects Recommended drugs

Warfarin

Phenprocoumon
Non-vitamin K oral anticoagulants (apixaban, rivaroxaban, dabigatran)
  • The data available do not suggest a high risk of embryopathy, but, because of significant data gaps, they are to be avoided in pregnancy.

Don't Warry, be Heppy:” warfarin should be replaced with heparin during pregnancy.

Analgesics

Overview of analgesics to avoid during pregnancy [18]
Harmful side effects Recommended drugs
NSAIDs (in the second and third trimesters)
Metamizole

Thyroid agents

Overview of thyroid agents to avoid during pregnancy [19]
Harmful side effects Recommended drugs
Radioiodine therapy (absolutely contraindicated)

Methimazole (first trimester)

Carbimazole

Thiamazole

Antiepileptics

Overview of antiepileptics to avoid during pregnancy [2][20][21]
Harmful side effects Recommended drugs

Phenytoin

Carbamazepine

  • Individualized treatment based on seizure type and most tolerated drug
Valproate

Antiemetics during pregnancy [22]

Other drug classes [2][20][21]

Overview of other drugs to avoid during pregnancy
Drugs to avoid Harmful effects
Steroid therapy (especially as antiallergenics)
  • Reduced birth weight
  • Increased risk of preeclampsia
  • Increased risk of oral and lip clefts
Oral antidiabetic agents
Methotrexate
Cholestyramine
  • Fetal and maternal hemorrhage

Lithium

Antineoplastic drugs (specifically antifolate metabolites and alkylating agents)
Isotretinoin and excessive intake of vitamin A (> 8,000 IU vitamin A per day as retinol/retinyl esters)
  • High risk of miscarriage
  • Multiple congenital malformations, including cardiac anomalies, facial cleft, and skeletal abnormalities
Misoprostol
5α-reductase inhibitor
Antacids

Calcium carbonate

Magnesium hydroxide

  • Inhibition of uterine contractions [26]
  • Might delay the onset of lactation [27]

“IsoTERATinoin” is a TERrible TERATogen.”

First-generation antihistamines (e.g., chlorpheniramine) may be used as antiallergenics during pregnancy. Second-generation antihistamines (e.g., loratadine, fexofenadine, cetirizine) may be considered if chlorpheniramine is not tolerated. Loratadine is the best-studied second-generation antihistamine. [28]

Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!

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