Medications and Pregnancy

pregnant2By some reports 70 – 90% of women are taking some medication during pregnancy, and most of these are prescription medications.  There are a few medications that are so dangerous to an unborn child that you should stop these medications if you even might become pregnant.  One of the most detrimental being accutane (isotretinoin), commonly used for severe cystic acne.  Women of child bearing age, who are being considered for accutane, should have pregnancy tests and be on birth control or otherwise be absolutely certain they cannot get pregnant. Some may remember the horrors of children being born with malformed arms or missing limbs that resulted from thalidomide used in the 1950’s for pain and sleep. Isotretinoin, a synthetic derivative of Vitamin A, is listed as category X for pregnancy, meaning studies demonstrated fetal abnormalities and the drug is contraindicated (should never be used) in pregnant women. This medication is likewise contraindicated for breast feeding being in the L5 category for breast feeding.

 

Pregnancy Risk Categories:

A: Controlled studies fail to demonstrate risk to the fetus in any trimester and harm to the fetus is remote.

B: There are no controlled studies in women first trimester to prove safety, but there is no evidence of risk in later trimesters.

C: There are either animal studies that revealed adverse effects on the fetus or studies are not available.  Only use these drugs if the potential benefits justify the potential risk to the fetus.

D: There is positive risk to the fetus but if the medication were to be life-saving to the mom and safer alternatives do not exist it can be considered.

X: Studies demonstrate fetal abnormalities and this drug is contraindicated in pregnancy.

 

Among medications a woman should be certain to avoid, even in some cases starting to avoid three months before becoming pregnant, are  isotretinoin (Accutane and others) for acne,  valproic acid for seizure disorders, lithium for bipolar disorder, tetracycline for infections, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor antagonists for hypertension.  Categories of medicine that you should always double and triple check for safety are the female hormone medications, anti-cancer (chemotherapy), anti-inflammatory medications or immuno-supression medications, and the statins used to lower cholesterol. The following list is not intended to be the definitive and absolute authority on the topic and I do not guarantee that some of these designations may have changed.  If however you find that you are on a medication that you find on this list, please consider finding a better alternative and do discuss this with your doctor and health providers and consult with a pharmacist who may have access to complete and up to date information.

 

Category X medications (absolutely avoid) are:
Acitretin (Soriatane) used for psoriasis
Lipitor (Atorvastatin)
Black Cohosh (herbal estrogen products)
Blue cohosh (uterine stimulant)
Borage
Bosetan 
Calendula
Castor oil
Chorionic gonadotropin
Clomiphene
Cocaine 3rd trimester
Comfrey
Dnazol
Desogestrel + ethinyl estradiol
Diesthylstilbestrol
Dinoprostone  1st and 2nd trimesters
Drospirenone (yasmin)
Eprosartan 2nd and 3rd trimester
Ergonovine maleate
Ergotamine tartrate
EstazolamEstrogen – Estradiol
Etonogestrel + ethinyl estradiol
Etonogestrel implant
Etretinate
Fluorescein – IV
Fluorouracil 3rd trimeter
Flurazepam
Folicle Stimulating Hormones
Formaldehyde
Ganirelix
Goserelin acetate implant
Iodinated glycerol
Leflunomide
Levonorgestrel (planB)
Lovastatin
Medroprogesterone
Medroprogesterone + estgradiol cypionate
Menotropins
Methotrexate
Mifepristone
Misoprostol
Norethindrone
Norethynodrel
Oral contraceptives
Osotretinoin (acutane)
Phencyclidine
Prevastatin
Quazepam
Raloxifene
Simvastatin
Tazarotene
Temazepam
Triazolam
Triptorelin pamoate
Warfarin (coumadin)

 

Category D medications (only use if life saving and no better alternatives):
Amikacin (Amikin) – antibiotic 
Amiodarone (Cordarone) – for arythmias
Aspirin (in the 3rd trimester)
Atenolol 
Azathioprine (imuran)
Benazepril (lotensin, lotrel)
Pepto-Bismol (2nd and 3rd trimester) – has aspirin
Bromides
Busulfan
Butabarbital
Butalbital
Butorphanol 3rd trimester
Candesartan  2nd and 3rd trimesters
Catopril  2nd and 3rd trimesters
Carbamazepine
Carbimazole
Chlordiazepoxide
Clonazepam
Clorazepate
Cyclophosphamide
Cytarabine
Diazepam
Diclofenac 3rd trimester
Diflunisol 3rd trimester
Dothiepin
Doxorubicin
Doxycycline
Enalapril Maleate 2nd and 3rd trimesters
Ethanol (alcohol)
Ethotoin
Etodolac  3rd trimester
Fenoprofen 3rd trimester
Flunitrazepam
Fosphenytoin
Halazepam
Hydroxyurea
Imipramine
Indomethacin 3rd trimester
Irbesrtan  2nd and 3rd trimester
Kanamycin
Ketorolac
Letrozole
Leuprolide Acetate
Lisinopril 2nd and 3rd trimesters
Lithium carbonate
Lorazepam
Losartan 2nd and 3rd trimesters
Mepindolol sulfate 2nd and 3rd trimesters
Meprobamate
Mercaptopurine
Methimazole
Midazolam (Versed)
Minocycline
Mitoxantrone
Nabumetone 3rd trimester
Nebivolol 2nd and 3rd trimesters
Netilmicin
Nicotine (patches, gum, inhalers) 3rd trimester or if OD
Nortryptyline
Olmesartan medoxomil 2nd andn 3rd trimesters
Oxazepam
Paclitaxel (taxol)
Pamidronate
Paroxetine (paxil)
Penicillamine
Pentobarbital
Phenobarbital
Phenytoin (dilantin)
Potasium iodide
Povidone iodide
Propylthiouracil
Quinapril 2nd and 3rd trimesters
Quinine
Ramipril  2nd and 3rd trimesters
Ribavirin + Interferon alpha + 2B
Rosuvastatin calcium (crestor)
Rubella virus vaccine
Salsalate 
Secobarbital
Streptomycin
Strontium-89 chloride
Tomoxifen
Telmisartan 2nd and 3rd trimesters
Tigecycline
Tobramycin
Tolmetin 3rd trimester
Tretinoin oral
Valproic acid 
Valsartan 2nd and 3rd trimesters

 

I use “Medications and Mothers’ Milk” by Thomas Hale, as a resource and highly recommend this book.  Dr. Hale has done the research and put together information that is easy to follow, and easy to find.  Realize that this information can change.  The medications that you should not take while pregnant are sometimes fine to take when nursing.  This book has sections in the back covering; radiological agents, contraceptives, drugs to avoid when breast feeding, and cold remedies.

 

Dr. Paul

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