Drugs that should be avoided or used with caution during pregnancy

Drugs/drug classes (at risk episodes)

Comment

Acarbose

The manufacturer recommends avoiding the use

Acyclovir

There is not much experience with this drug. Manufacturers recommend using only when potential benefits outweigh risks; the low amount of drug absorbed from related pharmaceutical products

Albendazole

The manufacturer warns of teratogenicity in animal studies

amantadine

Avoid use; drug toxicity in animal studies

Androgen (1, 2, 3)

Causing virilization in female foetuses

Aspirin (3)

Decreased platelet function and risk of bleeding; delaying the onset of labour and prolonging labour and causing massive blood loss.

Avoid pain relievers if possible, for the last few weeks (low doses may be harmless);

In high doses, it causes closure of the ductus arteriosus of the foetus in utero and may lead to a prolonged increase in pulmonary arterial pressure in the neonate; causes kernicterus in neonates with jaundice

Barbiturate (3)

Smoking withdrawal symptoms in infants

Benzodiazepine

Avoid if possible (in late pregnancy or during delivery, high doses can cause hypothermia, hypotonia and respiratory depression in the new-born);

Neonatal withdrawal syndromes may occur after prolonged use

Vaccines (live)

(1)

Theoretically, there is a risk of birth defects; but if the need for vaccination is greater than the possible risk to the foetus, it is still used

MMR (Measles, Mumps, and Rubella) and measles-rubella vaccines should be avoided.

Cephalosporin

Don't know the harm

Chloramphenicol (3)

Causing "grey syndrome" in new-borns

Cimetidine

Manufacturer recommends avoiding unless necessary

Clarithromycin

Harm is unknown but the manufacturer advises to avoid unless the benefit outweighs the risk

Clindamycin

Don't know the harm

Corticosteroid

Use only when benefits outweigh risks, for example in the treatment of asthma; Systematic high doses may cause foetal and neonatal adrenal suppression; risk of intrauterine growth retardation with prolonged or repeated systemic therapy; continuing to administer corticosteroids to the mother during delivery; Close monitoring is required if
fluid retention is present

Co-trimoxazole

 (1)

 (3)

Theoretically teratogenic (antibacterial, folate antagonists)

Causes neonatal haemolysis and methemoglobinemia; No risk of nuclear jaundice has been observed in neonates

Cyclophosphamide

Avoid (manufacturer recommends effective birth control during and for at least 3 months after treatment with this medicine for both men and women)

Ergotamine

The effect of assisted childbirth on the uterus of pregnant women

Heparin (1, 2, 3)

There are reports of osteoporosis after prolonged use

Mebendazole

The manufacturer recommends toxicity in animal studies

Metformin (1, 2, 3)

Avoid using

Methotrexate

Avoid (teratogenic; may reduce fertility during treatment but is reversible);

The manufacturer recommends effective contraception during and for at least 6 months after taking the pill for both men and women

Metoclopramide

The harmful effects are unknown, but the manufacturer recommends using it only for force majeure reasons

Metronidazole

The manufacturer recommends avoiding high doses

Naloxone

The manufacturer recommends using only when the benefits outweigh the risks

aminoglycoside group

(2, 3)

Damage to the auditory or vestibular nerve; highest risk with streptomycin; There may be very little risk with gentamicin and tobramycin but should be avoided unless necessary (if necessary, plasma concentrations should be monitored).

Nicotine (1, 2, 3)

Avoid using

Nitrofurantoin (3)

May cause neonatal haemolysis if used near the time of delivery

Omeprazole

The manufacturer recommends toxicity in animal studies

Paracetamol

Don't know the harm

Penicillin

Don't know the harm

Phenytoin (1, 3)

Congenital malformations described (screening recommended); adequate maternal folate supplementation (eg, folic acid 5mg/day). Tendency to neonatal bleeding - vitamin K prophylaxis should be provided to the mother before delivery (and also to the new-born)

Care should be taken when interpreting plasma concentrations – binding may be reduced but free (effective) rate unchanged.

Propylthiouracil (2, 3)

Causes goitre and hypothyroidism in new-borns

Quinine (1, 2, 3)

High doses are teratogenic; But in patients with malaria, the benefits of treatment outweigh the risks

Quinolones (1, 2, 3)

Avoid - there was joint disease in animal studies

Ranitidine

The manufacturer advises avoiding unless necessary

Rifampicin (1)

                 (3)

Manufacturers recommend that high doses are teratogenic in animal studies

May increase risk of neonatal bleeding

Alcohol (1, 2)

(3)

If taken daily, it will cause teratogenicity (foetal alcohol syndrome) and may cause developmental delay; it is safe to drink occasionally and drink sparingly

Smoking withdrawal syndrome may occur in children of alcoholic mothers

Sulphonamide (3)

Causes neonatal haemolysis and methemoglobinemia; No high risk of neonatal jaundice has been found

Sulphonyl (3)

Causes neonatal hypoglycaemia; insulin is commonly substituted in all diabetes medications; If taking oral drugs, treatment must be stopped immediately at least 2 days before delivery

Tetracycline

(1)

(3)

Affects skeletal development in animal studies.

Causes discolouration of tooth enamel; Maternal liver toxicity if high doses are taken orally

Theophylline (3)

There are reports of stimulant effects and apnoea

Beta-blockers

May inhibit foetal growth in utero, cause hypoglycaemia and bradycardia; higher risk shown in severe hypertension

Oral anticoagulants (1, 2, 3)

Causes deformities; foetal and neonatal haemorrhage

Non-steroidal anti-inflammatory drugs (NSAIDs)

(3)

Most manufacturers recommend avoiding (or avoiding unless the potential benefit outweighs the risk); Ketorolac is contraindicated during pregnancy, labour and delivery.

If used regularly, it causes closure of the foetal ductus arteriosus in utero and may cause persistent pulmonary hypertension in the neonate. Delays the onset of labour and prolongs labour.

Anaesthetics, general (3)

Causes neonatal respiratory depression

Anaesthesia, topical

(3)

In large doses, neonatal respiratory depression, hypotonia, and bradycardia after lateral cervical or epidural obstruction; neonatal methemoglobinemia with prilocaine and procaine

Opioids (3)

neonatal respiratory depression; induce withdrawal effects in the neonates of drug-dependent mothers; causing gastric retention and aspiration pneumonia (inhalation pneumonia) in the mother during labour and delivery

Diuretic

(1)

(3)

Do not use to treat high blood pressure during pregnancy

Manufacturers recommend avoiding acetazolamide and torsemide

Thiazides can cause neonatal thrombocytopenia

Metabolic steroids
   (anabolic steroids) (1, 2, 3)

Causing virilization for female foetuses

Angiotensin-converting enzyme inhibitors (1, 2, 3)

Avoid use; harmful effects on the foetus, blood pressure and renal function of the neonate; can also cause skull defects and oligohydramnios; have drug poisoning through animal studies

Trimethoprim (1)

Theoretically teratogenic (folate antagonist)

Vancomycin

The manufacturer advises avoidance unless the potential therapeutic benefit outweighs risk - little other information currently available

Vitamin A (1)

Overdose can be teratogenic.