Trusted medical expertise in seconds.

Access 1,000+ clinical and preclinical articles. Find answers fast with the high-powered search feature and clinical tools.

Try free for 5 days
Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer.

Pharmacotherapy during pregnancy

Last updated: June 4, 2021

Summarytoggle arrow icon

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
Trimethoprim/sulfonamide combinations
  • 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
  • Embryotoxic
  • 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.


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

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


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

Ketoconazole, flucytosine, and griseofulvin

Itraconazole, fluconazole (> 300 mg)


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


Interferon α
Ribavirin and interferon α combination
Didanosine and stavudine combination

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


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


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.


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

Thyroid agents

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

Methimazole (first trimester)




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



  • Individualized treatment based on seizure type and most tolerated drug

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
  • Fetal and maternal hemorrhage


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
5α-reductase inhibitor

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!

  1. Podymow T, August P. Update on the use of antihypertensive drugs in pregnancy. Hypertension. 2008; 51 (4): p.960-969. doi: 10.1161/HYPERTENSIONAHA.106.075895 . | Open in Read by QxMD
  2. Cauldwell M, Dos Santos F, Steer PJ, Swan L, Gatzoulis M, Johnson MR. Pregnancy in women with congenital heart disease. BMJ. 2018; 360 : p.k478. doi: 10.1136/bmj.k478 . | Open in Read by QxMD
  3. Kubota-Sjogren Y, Nelson-Piercy C. Fulminant antenatal pulmonary oedema in a woman with hypertension and superimposed preeclampsia.. BMJ case reports. 2015; 2015 . doi: 10.1136/bcr-2015-212751 . | Open in Read by QxMD
  4. Cooper WO, Hernandez-diaz S, Arbogast PG, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med. 2006; 354 (23): p.2443-2451. doi: 10.1056/NEJMoa055202 . | Open in Read by QxMD
  5. King CT, Rogers PD, Cleary JD, Chapman SW. Antifungal therapy during pregnancy. Clin Infect Dis. 1998; 27 (5): p.1151-1160.
  6. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Updated: October 26, 2016. Accessed: February 22, 2017.
  7. Kang SH, Chua-gocheco A, Bozzo P, Einarson A. Safety of antiviral medication for the treatment of herpes during pregnancy. Can Fam Physician. 2011; 57 (4): p.427-428.
  8. Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza. Updated: November 3, 2016. Accessed: February 22, 2017.
  9. Ribavirin. Updated: November 1, 2017. Accessed: October 24, 2018.
  10. Peginterferon Alfa-2b (HCV). Updated: May 1, 2018. Accessed: October 24, 2018.
  11. Chersich MF, Urban MF, Venter FW, et al. Efavirenz use during pregnancy and for women of child-bearing potential. AIDS Res Ther. 2006; 3 : p.11. doi: 10.1186/1742-6405-3-11 . | Open in Read by QxMD
  12. Practice Advisory on Low-Dose Aspirin and Prevention of Preeclampsia: Updated Recommendations.
  13. Beyer-Westendorf J, Marten S, Michalski F. Outcome of Noac Exposure during Pregnancy (and the problem of event reporting). Blood. 2015; 126 (23): p.1125.
  14. Babb M, Koren G, Einarson A. Treating pain during pregnancy. Can Fam Physician. 2010; 56 (1): p.25, 27.
  15. Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol. 2011; 164 (6): p.871-876. doi: 10.1530/eje-10-1030 . | Open in Read by QxMD
  16. Schellack G, Schellack N, Kriel M. Pharmacotherapy during pregnancy, childbirth and lactation: points and principles to consider (a 2015 update). S Afr Fam Pract. 2015; 57 (6).
  17. Schaefer C, Peters PWJ, Miller RK. Drugs During Pregnancy and Lactation. Academic Press ; 2014
  18. Hibbard J. Update on Medical Disorders in Pregnancy, An Issue of Obstetrics and Gynecology Clinics - E-Book. Elsevier Health Sciences ; 2010
  19. Quinlan JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003; 68 (1): p.121-128.
  20. Auffret M, Bernard-Phalippon N, Dekemp J, et al. Misoprostol exposure during the first trimester of pregnancy: Is the malformation risk varying depending on the indication?. Eur J Obstet Gynecol Reprod Biol. 2016; 207 : p.188-192. doi: 10.1016/j.ejogrb.2016.11.007 . | Open in Read by QxMD
  21. Hirshburg JM, Kelsey PA, Therrien CA, Gavino AC, Reichenberg JS. Adverse Effects and Safety of 5-alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review.. The Journal of clinical and aesthetic dermatology. 2016; 9 (7): p.56-62.
  22. Kolnick L, Harris BD, Choma DP, Choma NN. Hypercalcemia in pregnancy: a case of milk-alkali syndrome.. Journal of general internal medicine. 2011; 26 (8): p.939-42. doi: 10.1007/s11606-011-1658-0 . | Open in Read by QxMD
  23. Hillier K. Magnesium Sulfate. Elsevier ; 2007 : p. 1-5
  24. Editors of LactMed. Magnesium Hydroxide. Drugs and Lactation Database (LactMed). 2006 .
  25. So M, Bozzo P, Inoue M, Einarson A. Safety of antihistamines during pregnancy and lactation. Can Fam Physician. 2010; 56 (5): p.427-429.
  26. Mathew JL. Effect of maternal antibiotics on breast feeding infants. Postgrad Med J. 2004; 80 (942): p.196-200. doi: 10.1136/pgmj.2003.011973 . | Open in Read by QxMD
  27. Rennie JM. Rennie & Roberton's Textbook of Neonatology E-Book. Elsevier Health Sciences ; 2012
  28. Koss CA, Baras DC, Lane SD, et al. Investigation of metronidazole use during pregnancy and adverse birth outcomes. Antimicrob Agents Chemother. 2012; 56 (9): p.4800-4805. doi: 10.1128/AAC.06477-11 . | Open in Read by QxMD
  29. Karow T, Lang-Roth R. Allgemeine und Spezielle Pharmakologie und Toxikologie. Dr. med. Thomas Karow (2012 und 2013) ; 2010
  30. Karow T, Lang-Roth R. Pharmakologie und Toxikologie. undefined ; 2012
  31. Schaefer C, Peters PWJ, Miller RK. Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment. Elsevier ; 2015