Medicines

Safe drugs in pregnancy: Which medicine is best?

safe drugs in pregnancy Posted On
Posted By SUMIT SHARMA

Overview

Pregnancy is a very complex and sensitive condition. During this condition, the safe drugs in pregnancy are constantly an arising concern because many medications are generally teratogenic that harmful to your baby. 

Sometimes your doctor gets in a dilemma while prescribing medicine to pregnant women. 

The reason is that very few medicines are considered safe for use during pregnancy. 

Another reason is that the pharmacokinetic activity of many drugs changes during pregnancy. It affects the pharmacokinetic parameters like – 

  • Absorption – Decrease absorption of the drug due to slower gastric emptying during pregnancy.
  • Distribution – Decrease drug concentration in the blood due to increase blood volume during pregnancy
  • Metabolism – Alteration of drug metabolism during pregnancy
  • Elimination – Decrease half-life and increased clearance because GFR (glomerular filtration rate) becomes higher during pregnancy. 

 

This article will get to know about drugs that can be used safely during pregnancy to treat disease. 

Let’s know which medicines are safe in different medical conditions during pregnancy.  

 

 

What are the different pregnancy categories of drugs, and which are safe? 

In 1979, FDA (Food and drug administration) launched the five main pregnancy categories of drugs. These categories determine the benefit-risk ratio in pregnancy. 

Category A – Human studies have shown no risk 

Animal and human-controlled studies have shown no evidence of risk to the fetus. E.g. – thyroxine or levothyroxine, folic acid etc.

 

Category B – No evidence of risk in the fetus 

Animal studies have shown no evidence of risk to the fetus, but there are no controlled studies in pregnant women. E.g., paracetamol, metformin, amoxicillin, methyldopa, etc.

 

Category C – Risk can’t be ruled out 

Animal studies have shown risk to the fetus, but there are no controlled studies in pregnant women.

However, the benefits of drugs may compensate for the potential risk. It means these drugs can be used in a life-threatening situation if there is no alternative. E.g., nifedipine, fluoxetine, desipramine, etc.

 

Category D – Positive evidence of risk 

Adequate well-controlled, or observational studies have revealed positive human fetal risk in pregnant women. 

However, the benefits of drugs may compensate for the potential risk. E.g., valproate, phenytoin, carbamazepine etc.

 

Category X – Contraindicated in pregnancy

Both animal and human studies have shown positive evidence of fetal abnormalities in pregnancy. These drugs should be strictly contraindicated during pregnancy. E.g., thalidomide, ribavarin, statins etc.

Category A and Category B drugs are considered safe in pregnancy. 

 

 

Which vitamin and mineral supplements are often recommended during pregnancy?

As per US-FDA, every pregnant woman should take adequate nutrition, vitamin, and mineral supplements to grow her fetus. 

Whenever you get pregnant and plan for pregnancy, you should start a folic acid supplement earlier as much as possible.

Folic acid is absolutely safe, which falls in category A. Folic acid helps in normal embryonic development, specifically the neural tube complex. Many studies have shown folic acid decrease the risk of neural tube defects. 

Brand name of folic acid supplements – Folitas, Folera, Foliwell

Safe drugs in pregnancy

 

Along with that, you may start calcium supplements from 1st trimester. It is also an essential nutrient for normal physiological function like fetal bone growth and teeth development. It would be best if you take calcium supplements up to lactation. 

The recommended dose for calcium supplements in pregnant women = 1.5 to 2g/day.

Brand name of calcium supplements – Shelcal, Methycal, Aminocal, Supracal, Ezorb forte, Caldikind plus

Safe drugs in pregnancy

 

You may also need an iron supplement because a regular diet cannot supply the required amounts. It is necessary for the development of the embryo.

Iron supplements may cause gastric disturbances like nausea, vomiting, constipation, or diarrhea. Instead of 1st trimester, you can start an iron supplement from 2nd trimester (or after 12 weeks). 

Brand name of iron supplement – Astyfer XT, Hemfer XT, Feronia XT, Softeron capsule

Safe drugs in pregnancy

 

You must consult your doctor before taking any vitamin and mineral supplements.

 

 

Which medicine is best for vomiting in pregnancy?

Morning sickness (nausea and vomiting) is a widespread problem during pregnancy, especially in 1st trimester. It mostly happens due to an increased level of hCG (Human chorionic gonadotropins), progesterone and estrogen hormones. 

This morning sickness problem may be controlled by following safer drugs. 

  • Doxylamine + pyridoxine – This combination of drug fall in category A. So, it is the safest and best antiemetic medicine during pregnancy. It is available in the market in the brand name of normodox, goodmorn, doxinate, and sysfol plus.

Safe drugs in pregnancy

  • Ondansetron (category B) – ondem, emset, and zofran
  • Metoclopramide (category B) – maxeron, perinorm, and vominorm, reglan

Safe drugs in pregnancy

 

 

What is the best medicine to take for heartburn while pregnant?

Heartburn or pyrosis is also a ubiquitous symptom in early pregnancy. If you are having heartburn and acidity problems during pregnancy, your doctor may prescribe you certain drugs like – 

  • Antacid – It contains aluminum hydroxide, calcium carbonate, magnesium hydroxide, magaldrate, and sodium bicarbonate. Brand name – Mylanta, Gelucil, Ulpan, Tums

Safe drugs in pregnancy

 

 

What is safe to take for constipation while pregnant?

Constipation generally happens in pregnancy due to lack of physical activity and increases progesterone levels. As a result, it causes decrease peristalsis of the intestine.  

In this condition, you need to take proper fluid intake and increase fiber diet, e.g., vegetables, fruits, pulses, etc. 

As far as the concern of medicines, Lactulose syrup is the safest drug in pregnancy. It is available in a brand of Duphalac, Livoluk, evict, etc. 

The other alternative options are Isabgol and psyllium husk. 

Safe drugs in pregnancy

 

Which antibiotics are not contraindicated in pregnancy?

Bacterial infections are a prevalent problem during pregnancy as they can affect your unborn baby. There are certain drugs which considered safe in pregnancy. 

1. Penicillin

Although all penicillin can cross the placenta readily, there is no evidence to date that they are teratogenic.

Penicillin falls in Category B. Your doctor may use penicillin for treating bacterial infections. 

It includes – 

  • Penicillin G, Penicillin V
  • Amoxicillin, Ampicillin, Bucampicillin 
  • Cloxacillin, Dicloxacillin, Methicillin, Nafcillin, Oxacillin 
  • Azlocillin, Carbenicillin, Mezlocillin, Piperacillin, Ticarcillin 
  • Combinations – Amoxicillin plus clavulanic acid (Augmentin), Ampicillin plus sulbactam (Unasyn), Piperacillin plus tazobactam (Zosyn), Ticarcillin plus clavulanic acid (Timentin)

Safe drugs in pregnancy

 

2. Cephalosporins 

Cephalosporins are the most commonly used antibiotics in pregnancy. All cephalosporins cross the placenta but do not affect the fetus. 

According to a published article in the American journal of obstetrics and gynecology have suggested cephalosporins are safe antibiotics in pregnancy that do not cause teratogenic effects.

Cephalosporins are generally recommended in urinary tract infections (like acute pyelonephritis and asymptomatic bacteriuria) during pregnancy. It includes – 

  • First-generation – Cephalothin, Cephaprin, Cephradine, Cefazolin 
  • Second generation – Cefamandole, Cefoxitin, Cefotetan, Cefonicid, Cefaclor 
  • Third generation – Cefotaxime, Ceftizoxime, Cefoperazone, Ceftriaxone, Moxalactam, Cefmenoxime, Cefmetazole, Cefuroxime (Cetil), Cefixime (Taxim O), Ceftazidime, Cefpodoxime proxetil (cepodem), Cefprozil

Safe drugs in pregnancy

 

The uncomplicated gonococcal infections are a common sexually transmitted disease encountered during pregnancy. Ceftriaxone and cefixime are mainly used for the treatment of gonorrhea infection in pregnancy. 

 

3. Macrolides 

Macrolides are one of the best choices of your gynecologist for treating bacterial infections.

A study published in antimicrobial agents and chemotherapy 2013 observed that macrolides do not increase the risk of fetal defects during pregnancy. It includes major antibiotics like 

  • Azithromycin (Azee)
  • Erythromycin (Erythrocin, althrocin)
  • Roxithromycin (Roxid)

 

Erythromycin is mainly recommended for chlamydia trachomatis during pregnancy. 

 

 

Which antifungal is safe during pregnancy?

Fungal infections are also a challenging issue during pregnancy. Candida vaginitis is most commonly occurring in pregnancy. 

A published article in a journal of antimicrobial chemotherapy 2015 reviewed that topical azole (category C) is generally safe in pregnancy because of limited absorption in the blood. 

It includes the following drugs – 

  • Clotrimazole (clozole, canesten) 
  • Miconazole (daktarin, dermizole)
  • Sertaconazole (onabet), 
  • Ketoconazole (Nizoral 
  • Terbinafine – category B (Lamifil)

Suppose you expose to systemic fungal infection during pregnancy. In that case, Amphotericin B is a drug of choice (DOC). 

 

 

Which painkiller is safe during pregnancy?

Suppose you are having fever, headache, toothache, or body pain during pregnancy. There is only one drug safe in all stages of pregnancy in these conditions, i.e., Paracetamol (or Acetaminophen)

Paracetamol is the first-line drug for fever and pain in pregnancy. 

Many studies suggest paracetamol does not cause congenital disabilities. 

You may take paracetamol 500 or 650 mg. It would be best if you do not take paracetamol more than 2500 mg in a day.

Brand name – Calpol, Dolo 650, crocin advance etc. 

 

 

Is it safe to take thyroxine/levothyroxine during pregnancy?

If you already have a hypothyroidism problem before pregnancy. You must consult your gynecologist. Your doctor may increase the dose of levothyroxine tablets. 

Thyroxine or levothyroxine is the absolutely safe and best medicine for hypothyroidism in pregnancy because it falls in category A. As per the study, levothyroxine does not cause fetal birth effects. 

It is available in the brand of eltroxin, thyronorm, and thyroxSafe drugs in pregnancy

 

 

What diabetes medications are safe during pregnancy?

Insulin is the preferable choice for diabetes treatment during pregnancy. Insulin is also considered the gold standard treatment for treating diabetes in pregnant women. 

It does not cross the placenta. So, it is absolutely safe. There are some examples of Insulin types – Regular insulin, insulin aspart, insulin lispro, and NPH. 

However, there are certain oral antidiabetic drugs (metformin and glyburide) which safe in pregnancy. 

According to published literature in the North American Journal of Medical Sciences, metformin and glyburide do not harm the unborn baby. It is also a better alternative for the treatment of diabetes in pregnancy. 

 

 

What high blood pressure medications are safe to take during pregnancy?

High blood pressure may also cause serious complications in your pregnancy

Due to this, you may have a high risk of intracerebral hemorrhage and eclampsia. It is also associated with the risk to your unborn baby. 

Therefore, it is necessary to control high blood pressure in pregnancy. 

According to NHBEP (National High Blood Pressure Education Program), methyldopa is a drug of choice (DOC) or preferable drug for treating hypertension during pregnancy because it falls in category B. 

There are certain alternative options or second-line agents for treating hypertension during pregnancy – 

  • Clonidine (category B) – Central sympatholytic
  • Labetalol (category C) – Beta-blocker
  • Nifedipine (category C) – Calcium channel blocker
  • Hydralazine (category C) – Direct vasodilator  
  • Hydrochlorothiazide (category C) – Diuretic  

 

These second-line agents do not have sufficient safety data because they fall in category C, which states that human studies are lacking. But animal studies are having positive for fetal risk. 

 

 

What can I take for cough and common cold while pregnant?

The cough and common cold are the most frequent upper respiratory problem encountered in pregnant women. 

The best choice is nasal spray or drops to prevent your common cold. It may include – 

  • Normal saline nasal spray (Nasoclear)Safe drugs in pregnancy
  • Decongestant (relief from the blocked or stuffy nose) – oxymetazoline, xylometazoline, naphazoline, pseudoephedrine Safe drugs in pregnancy

 

A reviewed article published in the journal of pharmacology and pharmacotherapeutics, 2012 observed that first-generation antihistaminic drugs such as chlorpheniraminehydroxyzine, and dexchlorpheniramine are the preferred and safest medicine during pregnancy. 

Brand name of cough and cold medications – 

  • Chorpheniramine (Cadistin tab, CPM SR), 
  • Dexchlorpheniramine (DCM SR tab, Polaramine syrup), 
  • Hydroxyzine (Atarax syrup, Hydil syrup)Safe drugs in pregnancySafe drugs in pregnancy

 

 

 

Which Antitubercular drug is safe in pregnancy?

According to a published article in a journal of Immunology and allergy clinics of North America, 2006 have suggested that there are certain antituberculosis drugs which safe in pregnancy – 

  • Isoniazid
  • Rifampicin
  • Ethambutol
  • Pyrazinamide

 

 

Which psychotropic drugs are considered OK during pregnancy?

Psychotic disorders (like depression, hallucination, anxiety, schizophrenia, etc.) are also one of the most common complications while you get pregnant. 

It often happened due to the fluctuation of hormones in pregnancy. 

Antidepressant drugs – 

Although antidepressant drugs are not entirely safe, your doctor may use these medicines if benefit of the drug compensates for the potential risk to the fetus.

According to a study, SSRI (Selective Serotonin Reuptake Inhibitor) such as citalopram and sertraline are considered first-line drugs during pregnancy. 

Other alternatives are 

  • SNRI (serotonin-norepinephrine reuptake Inhibitors) – venlafaxine(category C) and Duloxetine (category C)
  • TCA (Tricyclic antidepressant) – Nortriptyline (category C) and desipramine (category C)

 

Antipsychotic drugs – 

As per a study, some atypical antipsychotic drugs (olanzapine, risperidone, quetiapine, and clozapine) can be used in pregnancy as there is no clear association with birth defects. 

 

 

Which seizure medications are safe in pregnancy?

Seizure is also the most common serious medical condition that happened during pregnancy. 

Lamotrigine and levetiracetam are the only options to treat seizures during pregnancy. 

These are newer antiepileptic medications. A considerable amount of post-marketing data suggest that they do not cause any congenital disabilities. 

So, these medications can be used during pregnancy if clinically needed.

  

 

Takeaway 

Although above mention drugs are safe in pregnancy. But it would be best if you tried to avoid or limit the use of medicines as much as possible. 

Always consult your doctor before taking any medicine during pregnancy. 

The purpose of this article is to provide accurate and evidence-based information on safe drugs in pregnancy. I do not recommend taking any medications in pregnancy without consulting your gynecologist.  

If you found this post informative, please share it on social media. 

 

Source – 

Bertis B Little. Drugs and pregnancy – A Handbook. Hodder Arnold publication 2006.

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