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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.
Antibiotics during pregnancy![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Drugs of choice
- Penicillin group : ampicillin, amoxicillin, flucloxacillin, penicillin V, propicillin
- Cephalosporins
- Macrolides: erythromycin, azithromycin
- Metronidazole
- Fosfomycin (see also: “UTI in pregnancy”)
Drugs to avoid
Overview of antibiotics to avoid during pregnancy [1][2][3] | |
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Harmful side effects | |
Tetracycline |
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Aminoglycoside |
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Trimethoprim/sulfonamide combinations |
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Chloramphenicol |
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Clarithromycin |
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Fluoroquinolones |
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“Teethracycline:” teeth discoloration with tetracycline.
“A mean guy stepped on baby's ear:” Aminoglycoside can cause ototoxicity.
Other medical therapy during pregnancy![toggle arrow icon](https://manus-media.amboss.com/icons/chevron_up.svg)
Antihypertensives
Drugs of choice
- Methyldopa in arterial hypertension and hypertensive crisis
-
Beta blockers (particularly metoprolol and labetalol)
- Especially in the first and second trimesters
- Avoid during the third trimester
- Dihydralazine in uncontrolled hypertension
- Nifedipine
- See also: “Treatment of hypertension in pregnancy”.
“Moms Love Healthy Newborns:” Methyldopa, Labetalol, Hydralazine, Nifedipine are safe to use during pregnancy.
Drugs to avoid
Overview of antihypertensives to avoid during pregnancy [4][5] | |
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Harmful side effects | |
Diuretics |
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ACE inhibitors [6] |
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Angiotensin-receptor blockers |
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Atenolol |
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Antifungals
Drugs of choice
- Topical: imidazoles
- Vaginal: nystatin
- Systemic: amphotericin B
Drugs to avoid
Overview of antifungals to avoid during pregnancy [8] | |
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Harmful side effects | |
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Itraconazole, fluconazole (> 300 mg) | |
Iodides |
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Antivirals
Drugs of choice
- Acyclovir and valacyclovir for herpes
- Oral oseltamivir and zanamivir for influenza
- Zidovudine PLUS lamivudine PLUS nevirapine PLUS atazanavir for HIV infection (see “HIV in pregnancy”)
Drugs to avoid
Overview of antivirals to avoid during pregnancy [9][10][11][12][13] | |
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Harmful side effects | |
Efavirenz [14] |
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Interferon α | |
Ribavirin and interferon α combination | |
Didanosine and stavudine combination |
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Nevirapine |
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Nevirapine should not be used as first-line therapy if avoidable!
Anticoagulants
Drugs of choice
- Heparin: anticoagulant of choice (does not cross the placental barrier)
-
Aspirin (ASA)
- Low doses may be prescribed for high-risk preeclampsia.
- High doses should be especially avoided in the third trimester
Drugs to avoid
Overview of anticoagulants to avoid during pregnancy [15][16] | |
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Drugs to avoid | Harmful side effects |
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Phenprocoumon | |
Non-vitamin K oral anticoagulants (apixaban, rivaroxaban, dabigatran) |
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“Don't Warry, be Heppy:” warfarin should be replaced with heparin during pregnancy.
Analgesics
Drugs of choice
-
Non-opioid analgesics
- Acetaminophen, especially in the third trimester
- NSAIDs in the first trimester only
- Opioid analgesics (e.g., fentanyl, codeine) for moderate to severe pain
Drugs to avoid
Overview of analgesics to avoid during pregnancy [17] | |
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Harmful side effects | |
NSAIDs (in the second and third trimesters) |
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Metamizole |
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Thyroid agents
Drugs of choice
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Antithyroid drugs
- First trimester: propylthiouracil
- Second and third trimester: methimazole
- L-thyroxine
Drugs to avoid
Overview of thyroid agents to avoid during pregnancy [18] | |
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Harmful side effects | |
Radioiodine therapy (absolutely contraindicated) |
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Thiamazole |
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Antiepileptics
Drugs of choice
Individualized treatment based on seizure type and most tolerated drug
Drugs to avoid
Overview of antiepileptics to avoid during pregnancy [2][19][20] | |
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Harmful side effects | |
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Valproate |
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Antiemetics during pregnancy [21]
Other drug classes to avoid during pregnancy [2][19][20]
Overview of other drugs to avoid during pregnancy | ||
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Drugs to avoid | Harmful effects | |
Steroid therapy (especially as antiallergenics) |
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Oral antidiabetic agents | ||
Methotrexate | ||
Cholestyramine |
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Antineoplastic drugs (specifically antifolate metabolites and alkylating agents) |
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Isotretinoin and excessive intake of vitamin A (> 8,000 IU vitamin A per day as retinol/retinyl esters) |
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Misoprostol |
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5α-reductase inhibitor |
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Antacids |
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“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. [27]
Type 2 diabetes during pregnancy or gestational diabetes requires insulin therapy!