Medication in pregnancy

40 years ago, the thalidomide catastrophe which caused one-third of women taking this agent during the first trimester give birth to infants with limb defects. This tragedy shocked the medical world as thalidomide had been evaluated for safety in several animal species.

Ever wonder your medication is safe to use in pregnancy? Refer to the chart below....

Indication	Use may be justified when indicated	Use may be justified in rare circumstances	Use is not justified at all
Acne	Topical benzoyl, Topical erythromycin (B), clindamycin(B), peroxide(C)	Systemic erythromycin(B), Topical Tretinoin(C)	Isotretinoin(X)
Allergy	Diphenhydramine(B), Dimenhydrinate(B), Cetrizine(B)	Fexofenadine(C), Loratadine(B)
Asthma	Salbutamol(C), Salmeterol(C), Terbutaline(C)	Montelukast(B), Zafirlukast(B),
Behavioral Therapy	Amitriptyline(D), Fluoxetine(C), Escitalopram(C), Citalopram(C), Bupropion(B)	Benzodiazepines(D), Lithium(D) Valproic acid(D), Avoid use in 1st trimester
Constipation	Bisacodyl(C'), Lactulose(B), Psyllium(B),Mineral Oil(B)
Cough	Dextromethorphan(C), Guaifenesin(C)
Diabetes	Insulin	Gluburide(B), Metformin(B)	Chlorpropamide(C), Glipizide(C), Tolbutamide(C)
Diarrhea	Diphenoxylate/ Atropine(C), Loperamide(B)
Dyspepsia (Gastric)	Ranitidine(B), Famotidine(B), Cimetidine(B), Omeprazole(B), Antacid(B)	Lansoprazole(C)	Misoprostol(X)
Headache	Paracetamol(A)	All NSAIDs (B),(C)	Sumatriptan(C), Naratriptan(C), Rizatriptan(C)
Hypertension	Labetalol(C), Methyldopa(B),, Acebutolol(B), Hydralazine(C)	Nifedipine(C) 3rd trimester only, Clonidine(C), Hydrochlorothiazide(B), Prazosin(C)	ACE inhibitors(D)eg. Catopril Enalapril, Angiotensin II Antagonist(D) Candesartan, Irbesartan, V alsartan
Immunization	Diptheria(C), Hepatitis A or B (C), Inactivated polio(C), Influenza(C),Tetanus(C)		Live Vaccines MMR Sabin polio, Varicella
Infection	Valacycolvir(B), Acyclovir(C), Zidovudine(C), Azithromycin(B), Erythromycin except esolate(B), Penicillin(B), Metronidazole(B), Terbinafine(B), Clotrimazole(B), Nystatin(B)		Clartihromycin(C), Doxycycline(C) Fluoroquinolones(C), Tetracycline(D)
Nasal congestion	Nasal cromolyn(B), Ipratropium(B), Nasal Beclomethasone or Budesonide(C)	Pseudoephedrine(C)
Nausea	Dimenhydrinate(B), Metoclorpamide(B), Prochlorperazine(C), Promethazine(C)	Ondansetron(B)
Pain management	Paracetamol(A)	Aspirin(D), All NSAIDs (B)(C)
Pruritus	Calamine lotion, moisturizing cream, Diphenhydramine(B), Hydroxyzine(C')
Seizures	Carbamazepine(C), Phenobarbital(D), Phenytoin(D), Oxycarbazepine(C)	Gabapentin(C), Lamotrigine(C), Valproic Acid(D)	Trimethadione
Thrombosis	Heparin(C)	Streptokinase(C), Alteplase(C)	Warfarin(X)
Thyroid	Levothyroxine(A)		PTU(D)

Pregnancy category
Category A-Controlled studies show no risk
Category B- No evidence of risk in human
Category C-Risk cannot be ruled out
Category D-Positive evidence of risk
Category X-Contraindicated in pregnancy

(Sources:American College of Physicians)

Ask the pharmacist!
1)The chart above is only serve as reference, not to replace medical advise from your healthcare provider. Always consult your health care professionals, eg dr or pharmacist.
2)Ask the doctor what medication are you taking and maybe why?
3)Do not self medicate without the consultation with health professionals.
4)Discuss your medication regimen with your doctor.
5)Consider lifestyle modifications which can help alleviate some symptoms, eg. avoidance of allergen in allergic patient, relaxation in headache.
6)Take note that malformations generally occur in the first trimester (first 3 months).
6)It is ultimate important for woman of childbearing age to consider carefully her use of drugs and discuss with her physician. Take up your own responsibility, as you are the one who take the medication, not your doctor or pharmacist.