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OB Pharmacopoeia
Prescription Drugs of Choice During Pregnancy

Prescription Drugs of Choice During Pregnancy

Educational summary – individual treatment decisions must be based on the full clinical context and current guidelines.

The table below summarizes commonly recommended medications for selected maternal and fetal conditions during pregnancy, based on expert guidelines and reviews. Individual patient factors, comorbidities, gestational age, local resistance patterns, and evolving evidence should be considered before prescribing. Consult the linked OB Pharmacopoeia monographs and primary references when making treatment decisions.

Condition Medication Reference(s)
Asthma Albuterol is rescue therapy of choice.
Budesonide is the preferred inhaled corticosteroid.
Long-acting beta2-agonist 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 (breast-feeding) Psychotherapy with or without antidepressant (sertraline or paroxetine). 18
Depression, severe postpartum (breast-feeding) Supportive services AND sertraline.
Alternative medication: paroxetine. 		18, 19
Diabetes Insulin 4, 30
Epilepsy Monotherapy with lamotrigine or levetiracetam. Monitoring of drug levels and dose 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 immunodeficiency virus (HIV)
  • Abacavir and lamivudine are 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.
  • See also https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new for the most up to date guidelines.
32
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) “In general, women on 5-ASA, thiopurine, or anti–tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy. Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy.” 38
Malaria Chloroquine or 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 dimenhydrinate. If still no response, add metoclopramide. 		9, 36
Pediculosis pubis Permethrin 1% cream OR
Pyrethrins with piperonyl butoxide. 		2
Preeclampsia prevention Low-dose aspirin (81 mg/day) after 12 weeks of gestation in women who are at high risk for preeclampsia. 20–26
Pyelonephritis
  • Ceftriaxone OR
  • Ampicillin AND gentamicin OR
  • Cefazolin OR
  • Cefotetan OR
  • Aztreonam
Several other regimens are also acceptable. 		10, 11
Rheumatoid arthritis (RA) Prednisolone, hydroxychloroquine ≤ 400 mg/day, sulfasalazine (with folic acid 5 mg/day in first trimester), azathioprine, ciclosporin (cyclosporine), certolizumab, intravenous immunoglobulin. 40
Seizure, eclamptic Magnesium. Levetiracetam may be preferable in patients with myasthenia gravis, a condition that may be exacerbated by phenytoin. 21, 41
Septic shock, vasoactive therapy Norepinephrine 34
Scabies Permethrin 5% cream 2
Supraventricular tachycardia (SVT), maternal, acute treatment Vagal maneuvers: Valsalva for 10–30 seconds, carotid sinus massage (steady pressure for 5–10 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 or propranolol.
Third line: intravenous verapamil or procainamide.

When pharmacological therapy is ineffective or contraindicated:
Synchronized cardioversion. 		33
Syphilis Benzathine penicillin 2
Systemic lupus erythematosus (SLE) Hydroxychloroquine, nonfluorinated corticosteroids, azathioprine not exceeding 2 mg/kg/day, cyclosporine A, certolizumab. 39
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.
Example: 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.  12/11/2025

References