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medications during pregnancy

Medications generally regarded as safe during pregnancy* Analgesics: [5] - acetaminophen (A) - ibuprofen (B) - naproxen (B) - ketoprofen (B) - diclofenac (B) - flurbiprofen (B) - phenazopyridine (B) - pentosan polysulfate (B) Anesthetic - lidocaine (B) - propofol (B) - methohexital (B) - glycopyrrolate (B) Antihypertensive agents: - methyldopa (B) - guanfacine (B) - acebutolol (B) - pindolol (B) Antiarrhythmic agents: - sotolol (B) - moricizine (B) Antifungal agents: - nystatin (B), topical (A) - clotrimazole (B) - terbinafine (B) - amphotericin (B) Antibiotics: - amoxicillin clavulanate (safe) [7] - azithromycin (B) - erythromycin (B) - ciprofloxacin (safe) [7] - clindamycin (B) - sulfadiazine (B) - sulfisoxazole (B) - cephalosporins (B) - penicillins (B) - carbapenem (B) - spectinomycin (B) - mupirocin (B) - metronidazole (B) (avoid in 1st trimester) - fosfomycin (B) - ethambutol (B) - rifabutin (B) - nitrofurantoin (B) - nalidixic acid (B) Antiviral agents: - famciclovir (B) - penciclovir (B) - valacyclovir (B) - imiquimod (B) Antiretroviral agents: - didanosine (B) - saquinavir (B) - ritonavir (B) - nelfinavir (B) Antiparasitic agents: - lindane (B) - permethrin (B) Antihelminthics: - praziquantel (B) Antineoplastic agents: - altretamine (B) Disease-modifying anti-rheumatic agents: - hydroxychloroquine (C); safe in pregnancy [6] - sulfasalazine (B) - TNF-alpha inhibitors (B) - ustekinumab (B) - anakinra (B) Gastrointestinal agents (inflammatory bowel disease) - 5-aminosalicylates are safe [7] - mesalamine - thiopurines are safe (do not initiate during pregnancy) [7] Antidepressants - imipramine (B) - amitriptyline (B) - doxepin (B) - maprotiline (B) - bupropion (B) Antipsychotics: - clozapine (B) Antianxiety agents/sedatives - buspirone (B) - zolpidem (B) - zaleplon (B) Analeptics: pemoline (B) Antihistamine: - H1-receptor antagonists - diphenhydramine (B) - chlorpheniramine (B) - azatadine (B) - clemastine (B) - cyproheptadine (B) - loratadine (B) - H2 antagonists - cimetidine (B) - ranitidine (B) - famotidine (B) Antiplatelet: - ticlopidine (B) - dipyridamole (B) Antiasthmatic agents: - cromolyn (B) - terbutaline (B) - ipratropium (B) - nedocromil (B) - zafirlukast (B) Antidiarrheal agents: - loperamide (B) Antiemetics: - granisetron (B) - metoclopramide (B) - ondansetron (B) - meclizine (B) Antacids: - calcium carbonate - lansoprazole (B), see adverse effects of PPI Diuretics: - ethacrynic acid (B) - torsemide (B) - amiloride (B) - triamterene (B) - chlorothiazide (B) - hydrochlorothiazide (B) - indapamide (B) - metolazone (B) - chlorthalidone (B) - epleronone (B) Endocrine agents: - cabergoline (B) - desmopressin (B) - glucagon (B) - octreotide (B) Hypoglycemic agents: - acarbose (B) - glyburide (B) - metformin (B) - troglitazone (B) - miglitol (B) - insulin (B) Metabolic agents: - vitamins (A) - thyroxine (A) - magnesium sulfate (A) - carnitine (A) - probenecid (B) Mucolytic: - acetylcysteine (B) - dornase alfa (B) Neuromuscular blocking agents: - rocuronium (B) - cisatracurium (B) Neurologic agent: - glatiramer (B) - rivastigmine (B) - memantine (B) Ophthalmic agents: - brimonidine (B) - dipivefrin (B) - lodoxamide (B) Parasympatholytics: - flavoxate (B) - oxybutynin (B) Other - prostacyclin (B) - guanadrel (B) - naloxone (B) - nalmefene (B) - masoprocol (B) - cyclobenzaprine (B) - ursodiol (B) - nedocromil (B) - ritodrine (B) - urokinase (B) * pregnancy category in parentheses Contraindications: - statins - ACE inhibitors, ARBs - SSRIs sertraline & fluoxetine are pregnancy category C, but benefit of continuation may outweigh risk [6]

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pregnancy (gestation) pregnancy category

Specific

analgesics during pregnancy

General

pharmacy

References

  1. Prescriber's Letter 13(11): 2006 Cough and Cold Medication use In Pregnancy Detail-Document#: 221112 (subscription needed) http://www.prescribersletter.com
  2. Prescriber's Letter 16(6): 2009 Antibiotic and Antifungal Use During Pregnancy and Breastfeeding Detail-Document#: 250620 (subscription needed) http://www.prescribersletter.com
  3. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006 Apr;24(2):167-97, vi. PMID: 16677965
  4. Prescriber's Letter 21(4): 2014 Analgesics in Pregnancy and Lactation Detail-Document#: 300404 (subscription needed) http://www.prescribersletter.com
  5. Kelley KJ, Sadoughi S, Sofair A FDA: Not Enough Data to Make New Recommendations on Pain Meds During Pregnancy. Physician's First Watch, Jan 12, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - FDA MedWatch safety alert. Jan 15, 2015 Prescription and Over-the-Counter (OTC) Pain Medicines: Drug Safety Communication - FDA Review of Possible Risks of Pain Medicine Use During Pregnancy. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm429604.htm
  6. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  7. Mahadevan U et al. Drug safety and risk of adverse outcomes for pregnant patients with inflammatory bowel diseases. Gastroenterology 2016 Oct 18 PMID: 27769809