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   Prescription Drugs of Choice During Pregnancy


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Condition Medication Reference(s)
Asthma Albuterol is rescue therapy of choice
Budesonide is the preferred inhaled corticosteroid
Long-acting b2-agonists salmeterol  is the preferred add-on controller therapy
1
Bacterial Vaginosis Treatment is recommended for all pregnant women with symptoms.
Metronidazole OR
Clindamycin
2
Chlamydia Azithromycin 2
Cholestasis of pregnancy Ursodeoxycholic acid (UDCA) 14
Chronic hypertension Labetalol OR / AND
Methyldopa 
OR / AND
Nifedipine slow-release preparation
3.
Chronic urticaria Cetirizine or loratadine 31
Depression , mild Psychotherapy such as cognitive-behavioral therapy (CBT) OR interpersonal therapy 18
Depression , severe Psychotherapy AND fluoxetine.
Alternative medications: sertraline or  tricyclic antidepressant
18
Depression with psychosis Electroconvulsive therapy OR
Haloperidol AND antidepressant as above
18
Depression mild, postpartum while breast-feeding Psychotherapy with or without antidepressant (sertraline or paroxetine) 18
Depression severe, postpartum while breast-feeding Supportive services AND sertraline
Alternative medication: Paroxetine
18, 19
Diabetes Insulin 4, 30
Epilepsy Monotherapy with lamotrigine or leviteracetam . Monitoring of drug levels and sose adjustments are required. 36,37
Gonorrhea; uncomplicated genital

Ceftriaxone 250 mg as a single intramuscular dose, plus  azithromycin 1 g orally in a single dose
Patients with severe penicillin or cephalosporin allergy  gentamicin 250 mg IM  and 2-g oral azithromycin.

5, 29
Hepatitis B Tenofovir 27,28
Herpes Acyclovir OR
Valacyclovir
6.
Human immune deficiency virus
  • Abacavir and lamivudine is the preferred backbone combination for antiretroviral (ARV) -naive pregnant women
  • Atazanavir/ritonavir and darunavir/ritonavir are the preferred protease inhibitor (PI) drugs for use in ARV-naive pregnant women
  • 32
    See : https://aidsinfo.nih.gov/ for the most up to date guidelines
    Hypothyroidism Levothyroxine 7,15
    Hyperthyroidism Propylthiouracil (PTU). in the first trimester of pregnancy.
    Methimazole  after first trimester
    Beta adrenergic blocking agents, such as propranolol  may be used for controlling hypermetabolic symptoms.
    7

     

    Idiopathic thrombocytopenic purpura (ITP) Prednisone.
    IVIg may be used with corticosteroids when a more rapid increase in platelet count is required, or corticosteroids are contraindicated
    8.
    Inflammatory Bowel Disease (IBD)
    Inflammatory bowel disease (IBD)


    European Crohn’s and Colitis Organization.


    When considered appropriate by the clinician and the patient, to limit the transport of the anti-TNF to fetus, the anti-TNF drug should be discontinued around gestational week 24–26

    Since certolizumab has very limited placental transfer, this agent may be preferred in case of initiation of anti-TNF treatment during pregnancy.

    Mesalazine Low risk Low risk
    Sulfasalazine Low risk Low risk
    Corticosteroids Low risk Low risk, 4h delay before breastfeeding is advised
    Thiopurines Low risk, limited data on 6-TG Low risk
    Anti-TNF agents Low risk, consider stopping around week 24 in patients with sustained remission. See text


    1 . The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease.

    van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders AG, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F; European Crohn’s and Colitis Organization..

    J Crohns Colitis. 2015 Feb;9(2):107-24.

    PMID: 25602023




    IBD in Pregnancy Consensus Group and Canadian Association of Gastroenterology recommend


    . In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy.

    The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy.

    Nguyen GC, Seow CH, Maxwell C, Huang V, Leung Y, Jones J, Leontiadis GI, Tse F, Mahadevan U, van der Woude CJ; IBD in Pregnancy Consensus Group.; Canadian Association of Gastroenterology..

    Gastroenterology. 2016 Mar;150(3):734-757.e1. doi: 10.1053/j.gastro.2015.12.003. Review.

    PMID: 26688268



     
    Malaria Chloroquine , hydroxychloroquine
    For chloroquine-resistant P. falciparum infection, treat with either mefloquine or a combination of quinine sulfate and clindamycin
    16,17
    Nausea and vomiting of pregnancy Doxylamine succinate and pyridoxine hydrochloride.
    Refractory cases add promethazine or dimenhydrate . If still no response add metoclopromide .
    9, 36
    Pediculosis Pubis Permethrin 1% cream  OR
    Pyrethrins with piperonyl butoxide
    2,
    Preeclampsia prevention Low-dose aspirin (81 mg/d) after 12 weeks of gestation in women who are at high risk for preeclampsia. 20-26
    Pyelonephritis
  • Cefriaxone  OR
  • Ampicillin AND  genatmicin OR
  • Cefazolin  OR
  • Cefotetan  OR
  • Aztreonam
    (Several other regimens are also acceptable )
  • 10,11

     

    Seizure , eclamptic Magnesium 21
    Septic shock,  vasoactive therapy Norepinephrine 34
    Scabies Permethrin cream 5% 2
    Sustained* Supraventricular Tachycardia (SVT),  Fetal,  without hydrops or ventricular dysfunction .
    First or second line: Digoxin, Flecainide, Sotalol

    Sustained : occurring the majority of time or >≈50% of time monitored

    35
    Supraventricular Tachycardia (SVT), Maternal, Acute treatment Vagal maneuvers: Valsalva for 10 to 30 seconds, carotid sinus massage (steady pressure for 5 to 10 seconds ) after absence of bruit has been confirmed by auscultation, ice-cold wet towel to the face .

    When vagal maneuvers fail to terminate SVT :
    First line drug: Adenosine .
    Second line:  Intravenous metoprolol , propranolol,
    Third line: Intravenous verapamil or procainamide

    When pharmacological therapy is ineffective or contraindicated:
    Synchronized cardioversion
    33
    Syphilis Benzathine penicillin 2
    Trichomoniasis Metronidazole 2
    Ulcer Sucralfate
    Ranitidine
    13
    Urinary tract infection Nitrofurantoin ( Avoid in first trimester)
    Cephalexin
    11
    Venous thromboembolism (VTE) Low Molecular Weight Heparin
    Enoxaparin  OR
    Dalteparin   OR
    Tinzaparin
    12.
    Vulvovaginal Candidiasis  Only topical azole therapies, applied for 7 days, are recommended
    Terconazole 0.4% cream
    2
     

    Changes may occur, since the last update, which affect the accuracy and availability of the information presented. Visitors are advised to verify the information independently.


      Reviewed by Mark Curran, M.D.

    References

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