see: - [Royal Womens Pregnancy and breastfeeding medicines guide](https://thewomenspbmg.org.au/medicines) - via [Clinicians health channel](https://www.clinicians.vic.gov.au/) — public employees in Victoria can register - [Rosen Drug therapy in pregnancy](x-devonthink-item://5542BB90-2454-4451-AC15-8D92E4370C0E) - [Dunn Drugs in pregnancy and lactation](x-devonthink-item://7212DDAB-0AC4-4860-B1A4-68DC3783E110) - [Rosen Medical emergencies during pregnancy](x-devonthink-item://07AC335F-A2F0-4AEE-816F-4A674AC53E80) - [Better health victoria - drugs in pregnancy](cubox://card?id=7166825891559902681), also : [Alcohol in pregnancy](cubox://card?id=7166825337152602267) - [Pregnancy medications database](https://avicennamd.org/pregnancyMedications/) - requires password See also: [[Hyperemesis gravidarum]], [[Cardiac arrest#pregnancy|Cardiac Arrest in pregnancy]] # TGA Categories: A - drugs taken by a large number of prengnant women without any known harmful effects: - penicillin - paracetamol - metoclopramide  C - drugs which have caused or may cause harmful effects, without malformations: - prochlorperazine - metoprolol - benzos - morphine D - drugs which have caused or may be expected to cause and increased incidence of human foetal malformations - ACE inhibitors -renal damage - doxycycline - bone and teeth abnormalities - phenytoin - cleft lip and palate - gentamicin - ototoxicity  X - drugs very high risk - methotrexate - chemotherapy  - roaccutane  # drugs to avoid and when ## abx - sulphonamides - haemolysis and kernicterus - gent - ototoxicity - tetracyclines -teeth and bone issues - flagyl - facial issues ## analgesia - opiates - avoid near birth - salicylates - still birth ,bleeding - NSAIDs - PDA closure, oligohydramnios ## cardiovascular drugs - amiodarone, ACEi, ARBs - unsafe - metaraminol class C ## antidepressants - lithium - congenital heart defects - SSRI - may get withdrawn in neonate ## anticoagulants - warfarin - Warfarin embryopathy occurs in approximately 5% of fetuses exposed to warfarin between 6-13 weeks gestation. Warfarin embryopathy is variable in severity and ranges from mild nasal flattening to severe mid face flattening with shortened limbs (dwarfism). Exposure in the second or third trimester carries an additional 5% risk of fetal intracerebral haemorrhage - change to LMWH atweight adjusted dose BD if already on warfarin. - give 10mg oral vitamin K if woman on warfarin to reverse effect # anticoagulants - warfarin - crosses placenta ----- # Safe Drugs: - Abx - penicillin - cephalospirins - erythromycin - analgesia - paracetamol - opiates make depress resp system at birth, otherwise safe - Headache / migraine see : [[Headache#migraine in pregnancy]] - Paracetamol - Magnesium - Metoclopramide - Sumatriptan (few data on other triptans) - Prednisolone 50mg for 2 days - antiemetics - metoclopramide - doxylamine - ondansetron (B1) - +/- prochlorperazine Cat C (may cause neurological disurbance when given in high doses late in pregnany) - anticoagulations - heparin/ LMW heparin safest (cat C) - don't give warfarin because warfarin crosses placenta (cat D) 35% incidence adverse effects in first trimester - anticonvulsants - note that uncontrolled epilepsy is more dangerous than drugs - keppra probably safest anticonvulsant - lamotrigine also safe - antihistamines - topical as much as possible - chlorpheniramine cat A - loratadine B1 - antipsychotics - limited data; likely safe except for risperidone - Asthma all safe except for fludrocortisone - Cardiovascular - adenosine - lignocaine - verapamil - digoxin - adrenaline - Antihypertensives - Labetalol - Methyldopa - Hydralazine (not as safe as labetalol) - Nifedipine ## Safe antiarrhythmics in pregnancy adenosine, lignocaine, verapamil, digoxin, adrenaline - adenosine - drug of choice for terminating SVT - safe in lactation - digoxin and quinidine - safe during pregnancy and lactation - not linked to congenital defects - first-line for tx significant maternal dysrhythmias - procainamide - safe for tx stable wide-complex tachycardia during pregnancy - a/w high incidence of maternal antinuclear abs and lupus-like reaction - goes into breast milk; can be used for short duration in breast feeding > - no amiodarone > - don't forget left lateral tilt position to avoid aortocaval compression