Drugs in Pregnancy

[BMBiology]

I thought you guys may find this list useful:

Category X drugs:
Isotretinoin
Thalidomide
Quinine
Statins
Live vaccines
Oral contraception
Misoprostol
Mifepristone
Methotrexate
Finasteride
Medroxyprogesterone
Raloxifine
Ergotamine
Ribavirin

Anti-HTN:
Avoid ACEI/ARBs, most beta blockers
Can use labetalol, methyldopa

Pain:
Avoid ASA, NSAIDs in 3rd trimester
Can use APAP
May use morphine, methadone for short term

Infection:
Avoid chloramphenicol, sulfa drugs, TCN, FQs
Can use amoxicillin, PCN, cephs

CNS:
Avoid ergots, CBZ, BZD hypnotics, MAOIs, Paxil
Can use haloperidol (most data), atypicals, zolpidem, zaleplon
May use with caution lithium, VPA, BZD anxiolytics, PHT/PHB

Pulmonary:
Can use inhaled corticosteroids, theophylline, montelukast
Avoid epinephrine, Beta2 agonists (except emergency)

Diabetes/Endocrine:
Can use insulin
May cause with caution metformin, pioglitazone, oral sterods
Avoid sulfonylureas

GI:
Can use H2 antagonists, antacids, ginger, docusate
May cause with caution simethicone
Avoid: metoclopramide, prochlorperzine, promethazine

Cough/Cold:
Can use dextromethorphan, guaifenesin, loratadine, chlorpheniramine, diphenhydramine
May cause with caution pseudoephedrine for short term
Avoid cyproheptadine, dimenhydrinate

For morning sickness: ginger 1 gram, doxylamine 10mg, pyridoxine 25mg

http://www.perinatology.com/exposures/druglist.htm

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[Aznfarmerboi]

I thought you guys may find this list useful:

Category X drugs:
Isotretinoin
Thalidomide
Quinine
Statins
Live vaccines
Oral contraception
Misoprostol
Mifepristone
Methotrexate
Finasteride
Medroxyprogesterone
Raloxifine
Ergotamine
Ribavirin

Anti-HTN:
Avoid ACEI/ARBs, most beta blockers
Can use labetalol, methyldopa

Pain:
Avoid ASA, NSAIDs in 3rd trimester
Can use APAP
May use morphine, methadone for short term

Infection:
Avoid chloramphenicol, sulfa drugs, TCN, FQs
Can use amoxicillin, PCN, cephs

CNS:
Avoid ergots, CBZ, BZD hypnotics, MAOIs, Paxil
Can use haloperidol (most data), atypicals, zolpidem, zaleplon
May use with caution lithium, VPA, BZD anxiolytics, PHT/PHB

Pulmonary:
Can use inhaled corticosteroids, theophylline, montelukast
Avoid epinephrine, Beta2 agonists (except emergency)

Diabetes/Endocrine:
Can use insulin
May cause with caution metformin, pioglitazone, oral sterods
Avoid sulfonylureas

GI:
Can use H2 antagonists, antacids, ginger, docusate
May cause with caution simethicone
Avoid: metoclopramide, prochlorperzine, promethazine

Cough/Cold:
Can use dextromethorphan, guaifenesin, loratadine, chlorpheniramine, diphenhydramine
May cause with caution pseudoephedrine for short term
Avoid cyproheptadine, dimenhydrinate

For morning sickness: ginger 1 gram, doxylamine 10mg, pyridoxine 25mg

http://www.perinatology.com/exposures/druglist.htm

Great list, going to print it out and put in my office. Concering ACEI, I know it is category D, but I remember hearing/reading that it is X in first trisemester or something. Anyone can input info?

 

[GatorRxGirl]

Great list, going to print it out and put in my office. Concering ACEI, I know it is category D, but I remember hearing/reading that it is X in first trisemester or something. Anyone can input info?

Because of the associations between fetal complications and malformations and ACE inhibitors, the FDA recommended that women avoid taking ACE inhibitors during the second and third trimesters of pregnancy. They are not contraindicated for women in the first trimester of pregnancy.

ACE inhibitors are labeled with a pregnancy category D for the last six months (the second and third trimesters) and C for the first three months. Pregnancy category D means that there have been studies in pregnant women showing that the drug was associated with some risk for the unborn baby (fetus), but the benefit of the drug may still outweigh that risk for some patients.

http://www.fda.gov/cder/drug/advisory/ACEI.htm

 

[GatorRxGirl]

Also, the Washington Manuel has an amazing chart in one of the appendicies for drugs in pregnancy.

 

[PharmaSynergy]

the FDA recommended that women avoid taking ACE inhibitors during the second and third trimesters of pregnancy. They are contraindicated for women in the first trimester of pregnancy.

ACE inhibitors are labeled with a pregnancy category D for the last six months (the second and third trimesters) and C for the first three months.
http://www.fda.gov/cder/drug/advisory/ACEI.htm

Good link! Just to clarify, that statement in bold should read, "They are NOT contraindicated for women in the first trimester of pregnancy".

In spite of the study that showed an increased risk of birth defects if ACEIs are taken in the first trimester, the FDA is still keeping the pregnancy category at "C" for the first trimester. From a clinical standpoint, it would probably be prudent to consider discontinuing the ACEI and switching to an alternative antihypertensive med if a woman does become pregnant ... unless a compelling reason (benefit outweighs the risk) exists to continue the ACEI. Anyway, that's the gist of what I got from reading the FDA advisory.

 

[GatorRxGirl]

Methyldopa would probably be the safest bet in general. Not making any recommendations, just pointing out what I learned in class.

 

[GatorRxGirl]

Good link! Just to clarify, that statement in bold should read, "They are NOT contraindicated for women in the first trimester of pregnancy".

In spite of the study that showed an increased risk of birth defects if ACEIs are taken in the first trimester, the FDA is still keeping the pregnancy category at "C" for the first trimester. From a clinical standpoint, it would probably be prudent to consider discontinuing the ACEI and switching to an alternative antihypertensive med if a woman does become pregnant ... unless a compelling reason (benefit outweighs the risk) exists to continue the ACEI. Anyway, that's the gist of what I got from reading the FDA advisory.

Changed it. Thanks! That's what happens when I post half asleep.

 

[tompharm]

I thought you guys may find this list useful:

Category X drugs:
Isotretinoin
Thalidomide
Quinine
Statins
Live vaccines
Oral contraception
Misoprostol
Mifepristone
Methotrexate
Finasteride
Medroxyprogesterone
Raloxifine
Ergotamine
Ribavirin

Anti-HTN:
Avoid ACEI/ARBs, most beta blockers
Can use labetalol, methyldopa

Pain:
Avoid ASA, NSAIDs in 3rd trimester
Can use APAP
May use morphine, methadone for short term

Infection:
Avoid chloramphenicol, sulfa drugs, TCN, FQs
Can use amoxicillin, PCN, cephs

CNS:
Avoid ergots, CBZ, BZD hypnotics, MAOIs, Paxil
Can use haloperidol (most data), atypicals, zolpidem, zaleplon
May use with caution lithium, VPA, BZD anxiolytics, PHT/PHB

Pulmonary:
Can use inhaled corticosteroids, theophylline, montelukast
Avoid epinephrine, Beta2 agonists (except emergency)

Diabetes/Endocrine:
Can use insulin
May cause with caution metformin, pioglitazone, oral sterods
Avoid sulfonylureas

GI:
Can use H2 antagonists, antacids, ginger, docusate
May cause with caution simethicone
Avoid: metoclopramide, prochlorperzine, promethazine

Cough/Cold:
Can use dextromethorphan, guaifenesin, loratadine, chlorpheniramine, diphenhydramine
May cause with caution pseudoephedrine for short term
Avoid cyproheptadine, dimenhydrinate

For morning sickness: ginger 1 gram, doxylamine 10mg, pyridoxine 25mg

http://www.perinatology.com/exposures/druglist.htm

I know you post on here a lot BMBiology and I was wondering how you got that list from the source you provided because I cannot find it

 

[trailerpark]

nifedipine for pregnancy too, right? along with methyldopa and labetalol

 

[eagles22]

Some of those drugs have changed to being acceptable in pregnancy such as some sulfonylureas being used. Better to check against data that is 6 years old.

 

[Ackj]

New Pharmacist's letter has an article, just read it yesterday.

 

[radio frequency]

I'd like to mention a fantastic information source, www.reprotox.org, from the Reproductive Toxicology Center. They have tons of information on specific medications, and students can get a free subscription by contacting them. They also have a very helpful app that students with a free subscription can use!

Info for students is here: http://www.reprotox.org/ResidentProgram.aspx