RONALD A. BLACK, M.D., and D. ASHLEY HILL, M.D., Florida Hospital family members Practice Residency, Orlando, Florida

Am Fam Physician. 2003 Jun 15;67(12):2517-2524.

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Pregnant women frequently use over-the-counter medications. Although many over-the-counter medicine have fantastic safety profile, some have unproven safety and security or are known to adversely impact the fetus. The security profile that some medications may change according come the gestational age of the fetus. Since an approximated 10 percent or much more of birth defects an outcome from maternal drug exposure, the U.S. Food and Drug management has assigned a risk group to every drug. Numerous drugs have not to be evaluated in controlled trials and also probably will certainly not be because of honest considerations. The the typically used over-the-counter medications, acetaminophen, chlorpheniramine, kaolin and also pectin preparations, and most antacids have a an excellent safety record. Other drugs, such together histamine H2-receptor blockers, pseudoephedrine, and also atropine/diphenoxylate should be used with caution. If usage of cigarette smoking cessation commodities is desired, the intermediate-release preparations minimize the lot of nicotine while preserving efficacy. With all over-the-counter medications used during pregnancy, the benefit of the drug have to outweigh the hazard to the fetus.


A common concern around the treatment of pregnant women requires the usage of over-the-counter (OTC) medications. Nonprescription medicine account for about 60 percent of drugs used in the unified States, and much more than 80 percent that pregnant females take OTC or prescription drugs throughout pregnancy.1,2 of the new OTC medicine marketed in between 1975 and 1994, 30 percent were formerly prescription medications.

It is approximated that up to 60 percent of patient consult a health care professional when choosing an OTC product.1 numerous physicians are cautious in your OTC recommendations because of concern about feasible adverse effects on a occurring fetus. At the very least 10 percent of birth defects space thought to an outcome from maternal drug exposures.3 The worry is facility by the reality that the safety and efficacy file of a given medicine often transforms during the course of a normal pregnancy.2

The clinical community"s approach to the use of medications during pregnancy has readjusted dramatically because the beforehand 1970s, largely due to the fact that of the problems with thalidomide and also diethylstilbestrol. Consequently, extensive trial and error is required before a drug can be labeled for use throughout pregnancy.

Since 1975, the U.S. Food and also Drug administration (FDA) has actually assigned pregnant risk components to all drugs offered in the United says (Table 1).4 Unfortunately, countless drugs have not been adequately researched throughout pregnancy and, due to the fact that of moral considerations, probably will no be in the future.


Pain Medications

The most typically used OTC pain medications are aspirin, paracetamol (Tylenol), and also nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin), ketoprofen (Orudis), and naproxen (Aleve). The safety and security of these medications during pregnancy is outlined in Table 2.5,6

Acetaminophen is widely used throughout pregnancy. Although there is no well-known association v teratogenicity, couple of clinical data are easily accessible to assistance the absence of association.5 The comprehensive use of acetaminophen in pregnancy combined with the paucity of documented adverse effects have served to validate the selection of this medication together the pains reliever of selection during pregnancy.


TABLE 1FDA category of drug Safety during Pregnancy

Category A

Controlled research studies in women fail to demonstrate a risk to the fetus in the very first trimester (and there is no evidence of risk in later trimesters), and the opportunity of fetal harm shows up remote.

Category B

Either animal reproduction studies have not demonstrated a fetal risk yet there space no controlled studies in pregnant women, or animal reproduction researches have displayed an adverse impact (other than a diminish in fertility) that was not confirmed in regulated studies in females in the an initial trimester (and there is no evidence of risk in later on trimesters).

Category C

Either studies in pets have revealed adverse results on the fetus (teratogenic or embryocidal or other) and also there room no managed studies in women, or researches in women and animals are not available. Drugs must be offered only if the potential advantage justifies the potential hazard to the fetus.

Category D

There is positive evidence of person fetal risk, however the services from usage in pregnant women might be acceptable in spite of the threat (e.g., if the drug is essential in a life-threatening case or because that a serious an illness in which more secure drugs can not be supplied or are ineffective).

Category X

Studies in pets or human beings have actually demonstrated fetal abnormalities or over there is evidence of fetal risk based upon human experience, and also the danger of the use of the drug in pregnant women plainly outweighs any possible benefit. The medicine is contraindicated in women who space or may come to be pregnant.


Information from Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation: a reference guide to fetal and also neonatal risk. 5th ed. Baltimore: Williams & Wilkins, 1998:577–8,627–8.


TABLE 1FDA category of drug Safety during Pregnancy

Category A

Controlled researches in ladies fail to show a threat to the fetus in the an initial trimester (and over there is no evidence of threat in later on trimesters), and also the possibility of fetal harm shows up remote.

Category B

Either pet reproduction studies have actually not prove a fetal risk yet there space no controlled studies in pregnant women, or pet reproduction researches have displayed an adverse impact (other than a diminish in fertility) the was not evidenced in managed studies in ladies in the very first trimester (and there is no proof of threat in later on trimesters).

Category C

Either researches in pets have revealed adverse impacts on the fetus (teratogenic or embryocidal or other) and also there are no managed studies in women, or research studies in women and also animals space not available. Drugs should be given only if the potential advantage justifies the potential threat to the fetus.

Category D

There is positive evidence of human being fetal risk, but the services from use in pregnant women might be acceptable regardless of the risk (e.g., if the drug is essential in a life-threatening instance or for a serious condition in which safer drugs can not be used or room ineffective).

Category X

Studies in animals or human being beings have demonstrated fetal abnormalities or over there is proof of fetal risk based upon human experience, and also the hazard of the use of the drug in pregnant women clearly outweighs any possible benefit. The medicine is contraindicated in women who space or may come to be pregnant.


Information from Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation: a reference overview to fetal and also neonatal risk. Fifth ed. Baltimore: Williams & Wilkins, 1998:577–8,627–8.


TABLE 2Use that OTC Pain drugs in PregnancyDrug nameFDA pregnant risk group by about 3 months (1st/2nd/3rd)Drug classCrosses placenta?Use in pregnancy

Acetaminophen (Tylenol)

B/B/B

Non-narcotic analgesic/antipyretic

Yes

Pain reliever of choice

Aspirin

D/D/D

Salicylate analgesic/antipyretic

Yes

Not recommended except for certain indications*

Ibuprofen (Advil, Motrin)

B/B/D

NSAID analgesic

Yes

Use v caution; avoid in 3rd trimester†

Ketoprofen (Orudis)

B/B/D

NSAID analgesic

Yes

Use with caution; protect against in 3rd trimester†

Naproxen (Aleve)

B/B/D

NSAID analgesic

Yes

Use v caution; avoid in third trimester†


OTC = over-the-counter; FDA = U.S. Food and also Drug Administration; NSAID = nonsteroidal anti-inflammatory drug.


*—Associated with enhanced perinatal mortality, neonatal hemorrhage, diminished birth weight, lengthy gestation and also labor, and possible teratogenicity.5


†—Associated through oligohydramnios, premature birth closure the the fetal ductus arteriosus with subsequent persistent pulmonary hypertension that the newborn, fetal nephrotoxicity, and also periventricular hemorrhage.6

Information indigenous Collins E. Maternal and also fetal impacts of acetaminophen and salicylates in pregnancy. Obstet Gynecol 1981;58(5 Suppl):57S–62S, and Macones GA, Marder SJ, Clothier B, Stamilio DM. The dispute surrounding indomethacin for tocolysis. Am J Obstet Gynecol 2001;184:264–72.


TABLE 2Use that OTC Pain drugs in PregnancyDrug nameFDA pregnant risk classification by trimester (1st/2nd/3rd)Drug classCrosses placenta?Use in pregnancy

Acetaminophen (Tylenol)

B/B/B

Non-narcotic analgesic/antipyretic

Yes

Pain reliever the choice

Aspirin

D/D/D

Salicylate analgesic/antipyretic

Yes

Not recommended except for certain indications*

Ibuprofen (Advil, Motrin)

B/B/D

NSAID analgesic

Yes

Use with caution; stop in 3rd trimester†

Ketoprofen (Orudis)

B/B/D

NSAID analgesic

Yes

Use with caution; protect against in 3rd trimester†

Naproxen (Aleve)

B/B/D

NSAID analgesic

Yes

Use v caution; stop in 3rd trimester†


OTC = over-the-counter; FDA = U.S. Food and Drug Administration; NSAID = nonsteroidal anti-inflammatory drug.


*—Associated with enhanced perinatal mortality, neonatal hemorrhage, lessened birth weight, lengthy gestation and labor, and possible teratogenicity.5


†—Associated with oligohydramnios, premature closure that the fetal ductus arteriosus with succeeding persistent pulmonary hypertension that the newborn, fetal nephrotoxicity, and also periventricular hemorrhage.6

Information native Collins E. Maternal and fetal impacts of acetaminophen and also salicylates in pregnancy. Obstet Gynecol 1981;58(5 Suppl):57S–62S, and also Macones GA, Marder SJ, Clothier B, Stamilio DM. The controversy surrounding indomethacin because that tocolysis. Am J Obstet Gynecol 2001;184:264–72.


TABLE 3OTC Decongestants, Expectorants, and Nonselective Antihistamines in PregnancyDrug nameFDA pregnancy hazard classificationDrug classCrosses placenta?Use in pregnancy

Chlorpheniramine (Chlor-Trimeton)

B

Antihistamine

Not known

Antihistamine of choice

Pseudoephedrine hydrochloride (Novafed)

B

Sympathomimetic decongestant

Not known

Oral decongestant the choice10, feasible association with gastroschisis9

Guaifenesin (Humibid L.A.)

C

Expectorant

Not known

May be unsafe in an initial trimester*

Dextromethorphan hydrobromide (Benylin DM)

C

Non-narcotic antitussive

Not known

Appears come be for sure in pregnancy

Diphenhydramine (Benadryl)

B

Antihistamine/antiemetic

Yes

Possible oxytocin-like effects at high dosages

Clemastine fumarate (Tavist)

B

Antihistamine

Not known

Unknown safety profile


Information from Werler MM, Mitchell AA, Shapiro S. An initial trimester maternal medication usage in relation to gastroschisis. Teratology 1992;45:361–7, and also The usage of more recent asthma and allergy medications throughout pregnancy. The American university of Obstetricians and also Gynecologists (ACOG) and also the American university of Allergy, Asthma, and Immunology (ACAAI). Ann Allergy Asthma Immunol 2000;84:475–80.


TABLE 3OTC Decongestants, Expectorants, and also Nonselective Antihistamines in PregnancyDrug nameFDA pregnancy danger classificationDrug classCrosses placenta?Use in pregnancy

Chlorpheniramine (Chlor-Trimeton)

B

Antihistamine

Not known

Antihistamine that choice

Pseudoephedrine hydrochloride (Novafed)

B

Sympathomimetic decongestant

Not known

Oral decongestant the choice10, feasible association through gastroschisis9

Guaifenesin (Humibid L.A.)

C

Expectorant

Not known

May be unsafe in first trimester*

Dextromethorphan hydrobromide (Benylin DM)

C

Non-narcotic antitussive

Not known

Appears come be safe in pregnancy

Diphenhydramine (Benadryl)

B

Antihistamine/antiemetic

Yes

Possible oxytocin-like results at high dosages

Clemastine fumarate (Tavist)

B

Antihistamine

Not known

Unknown safety and security profile


Information from Werler MM, Mitchell AA, Shapiro S. First trimester maternal medication use in relation to gastroschisis. Teratology 1992;45:361–7, and The usage of more recent asthma and allergy medications throughout pregnancy. The American college of Obstetricians and also Gynecologists (ACOG) and also the American university of Allergy, Asthma, and also Immunology (ACAAI). Ann Allergy Asthma Immunol 2000;84:475–80.


Salicylates have been linked with boosted perinatal mortality, neonatal hemorrhage, decreased birth weight, an extensive gestation and labor, and feasible birth defects.5 However, one study7 uncovered that low-dose aspirin is not associated with an raised risk that abruptio placentae or boosted rates that perinatal mortality. Pregnant women have to use salicylates just under the indict of a clinical professional.

Indomethacin (Indocin) is the most studied NSAID the is frequently used during pregnancy. Physicians may employ indomethacin throughout pregnancy come treat ache from devolving leiomyomata, or together a tocolytic agent. Unfortunately, indomethacin use throughout pregnancy may result in oligohydramnios, premature closure of the fetal ductus arteriosus with subsequent persistent pulmonary hypertension the the newborn, fetal nephrotoxicity, and also periventricular hemorrhage.6

Other NSAIDs, such as ibuprofen, have actually been studied less often during pregnancy. However, an analysis8 of 50 pregnant patients who overdosed on ibufrofen revealed no evidence of fetal abnormalities. Since of the possibility of adverse impacts of NSAIDs on the fetus, it is ours opinion the these medications should be offered sparingly during pregnancy.


Decongestants, Expectorants, and Antihistamines

Women typically use cold medications throughout pregnancy. This medications, like many of the various other OTC drugs, have not to be studied well in pregnant (Table 3).9,10 together a result, some doctors are disinclined come recommend any type of treatment because that the typical cold. The most frequently used cold medications include decongestants and also expectorants such together pseudoephedrine (Novafed), guafenesin (Humibid L.A.), and dextromethorphan (Benylin DM), and also the antihistamines diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), and also clemastine fumarate (Tavist).

The usage of vasoconstrictive agents such as pseudoephedrine might activate alpha-adrenergic receptors, elevating blood pressure or causing vasoconstriction in the uterine arteries, and potentially adversely affecting blood flow to the fetus. This process could describe the report association in between the use of pseudoephedrine in the very first trimester and also the development of gastroschisis.9 This theory is debatable; evidence says that this impact is negligible at common dosages.11

Diphenhydramine is widely supplied in pregnant as a sedative, an antihistamine, and an anti-nausea drug, although couple of data check its safety throughout pregnancy. The drug has actually been shown to have oxytocin-like effects, especially in high dosages.12 In addition, adverse drug interactions that do not take place in nonpregnant patients may occur in pregnant patients. Because that example, one study13 verified a far-reaching increase in fetal morbidity once diphenhydramine was taken in combination with temazepam (Restoril).

In 2000, the American university of Obstetricians and also Gynecologists and also the American college of Allergy, Asthma, and also Immunology exit a place statement10 concerning the use of asthma and also allergy medications, consisting of antihistamines and oral decongestants. Chlorpheniramine and also tripelennamine (PBZ) were recommended together antihistamines that choice. Pseudoephedrine to be recommended together the oral decongestant of choice, based on pet studies and a large prospective person experience through the drug throughout pregnancy. However, since pseudoephedrine may be connected with gastroschisis and also because other choices are available, it might be way to prevent using this medication throughout the first trimester uneven the advantage outweighs the risk.

Dextromethorphan has been linked with birth defects in chicken embryos. The cooperation Perinatal Project14 monitored 50,282 pregnant women, 300 the whom were exposed to dextromethorphan in the very first trimester. Bear defects did no increase over the baseline rate. Another study15 that 59 women who had used dextromethorphan in the first trimester documented one malformation. Thus, enough evidence suggests a lack of adverse results of dextromethorphan use throughout pregnancy.

When used during the an initial trimester in the existence of a febrile illness, guaifenesin has been associated with an boosted risk the neural tube defects.16 it is unclear even if it is this increased risk derives indigenous the medicine use, the illness, or both.

A MEDLINE search utilizing the keywords “clemastine,”“clemastine and also pregnancy,” and “clemastine and teratogen” discovered no research studies addressing the security or potential teratogenicity of clemastine fumarate in pregnancy.


Antidiarrheal Agents

The most frequently used antidiarrheal medications incorporate kaolin and pectin preparations (such as Kaopectate), bismuth subsalicylate (Pepto Bismol), loperamide (Imodium),4 and atropine/diphenoxylate (Lomotil). The safety of the miscellaneous agents is outlined in Table 4.4 Kaolin and pectin preparations room not absorbed. A feasible association has been identified in between the ingestion of clays containing kaolin and the advance of steel deficiency anemia.17 use of bismuth subsalicylate can result in absorption of salicylate and also should it is in avoided in pregnancy. Loperamide has not been uncovered to be teratogenic in animals. However, at the very least one study4 including first-trimester exposure in human beings showed a possible increase in fetal cardiac malformation. Atropine/diphenoxylate has actually been discovered to it is in teratogenic in animals; however, over there is insufficient evidence of teratogenicity in person pregnancy.18


TABLE 4OTC Antidiarrheal drugs in PregnancyDrug nameFDA pregnancy risk classification by about 3 months (1st/2nd/3rd)Drug classCrosses placenta?Use in pregnancy

Kaolin and also pectin (Kaopectate)

B/B/B

Antidiarrheal

No

Antidiarrheal of an option (not absorbed)

Bismuth subsalicylate (Pepto Bismol)

C/C/D

Antidiarrheal

Yes

Not recommended (salicylate absorption)

Loperamide (Imodium)

B/B/B

Antidiarrheal

Not known

Probably safe*

Atropine/diphenoxylate (Lomotil)

C/C/C

Antidiarrheal

Not known

Not recommended (adverse pet studies)


Information native Briggs GG, Freeman RK, Yaffe SJ, eds. Drugs in pregnancy and lactation: a reference overview to fetal and also neonatal risk. 5th ed. Baltimore: Williams & Wilkins, 1998:577–8,627–8.


TABLE 4OTC Antidiarrheal drugs in PregnancyDrug nameFDA pregnant risk category by trimester (1st/2nd/3rd)Drug classCrosses placenta?Use in pregnancy

Kaolin and pectin (Kaopectate)

B/B/B

Antidiarrheal

No

Antidiarrheal of an option (not absorbed)

Bismuth subsalicylate (Pepto Bismol)

C/C/D

Antidiarrheal

Yes

Not encourage (salicylate absorption)

Loperamide (Imodium)

B/B/B

Antidiarrheal

Not known

Probably safe*

Atropine/diphenoxylate (Lomotil)

C/C/C

Antidiarrheal

Not known

Not recommended (adverse pet studies)


Information from Briggs GG, Freeman RK, Yaffe SJ, eds. Medicine in pregnancy and lactation: a reference overview to fetal and also neonatal risk. Fifth ed. Baltimore: Williams & Wilkins, 1998:577–8,627–8.


Antacid Preparations

Several antacids are obtainable in OTC forms, consisting of preparations that contain alginic acid, aluminum, magnesium, and also calcium. All of these preparations normally are pertained to as for sure in pregnant (Table 5). There have been sparse reports the fetal maldevelopment and injury linked with prolonged use the high dosages of aluminum-containing antacids during pregnancy.19 Data are inadequate to identify if these associations room significant. Magnesium compounds save magnesium sulfate, a known tocolytic agent. In spite of the minimal magnesium absorption that occurs with antacid ingestion, some clinicians choose the usage of calcium-containing preparations. Simethicone (Mylanta Gas) is no absorbed.

The histamine H2-receptor blockers are reliable in dealing with symptoms the heartburn and also gastroesophageal reflux an illness in pregnancy,20 yet these drugs easily cross the placenta.21 Their use is recommended in pregnant ladies whose symptoms can not be adequately managed with lifestyle modification and antacids.22 The most studied H2 blockers room cimetidine (Tagamet) and ranitidine (Zantac). Research studies of these agents normally have shown far-reaching improvement that symptoms through no significant adverse effects. Animal studies likewise fail to present an raised fetal risk with the use of these medicines in pregnancy, the notable exception being nizatidine (Axid).22 Nizatidine has been connected with an increased risk the fetal death, voluntarily abortion, and also decreased fetal weight in rabbits.22 these studies used the usual prescription-strength doses. The OTC doses space one half of the prescription strength. Return studies have actually indicated that there is most likely no increased risk the fetal morbidity or mortality, couple of studies have evaluated first-trimester use of H2 blockers. Therefore, most investigators recommend preventing these medicine in the first trimester.22,23


TABLE 5OTC Antacids, Simethicone, and also H2-Receptor Selective Antihistamines in PregnancyDrug nameFDA pregnancy hazard classificationDrug classCrosses placenta?Use in pregnancy

Aluminum hydroxide/magnesium hydroxide (Maalox)*

B

Antacid

Not known

Generally related to as safe

Calcium carbonate (Tums)

C

Antacid

Not known

Generally pertained to as safe

Simethicone (Mylanta Gas)

C

Antiflatulent

No

Generally concerned as safe

Cimetidine (Tagamet)

B

Antihistamine

Yes

Preferred after ~ antacids; generally regarded together safe

Ranitidine (Zantac)

B

Antihistamine

Yes

Preferred after ~ antacids; typically regarded together safe

Nizatidine (Axid)

C

Antihistamine

Yes

Not recommended (adverse pet studies)

Famotidine (Pepcid)

B

Antihistamine

Yes

Probably safe, data needed


TABLE 5OTC Antacids, Simethicone, and also H2-Receptor Selective Antihistamines in PregnancyDrug nameFDA pregnancy risk classificationDrug classCrosses placenta?Use in pregnancy

Aluminum hydroxide/magnesium hydroxide (Maalox)*

B

Antacid

Not known

Generally related to as safe

Calcium carbonate (Tums)

C

Antacid

Not known

Generally regarded as safe

Simethicone (Mylanta Gas)

C

Antiflatulent

No

Generally concerned as safe

Cimetidine (Tagamet)

B

Antihistamine

Yes

Preferred after ~ antacids; usually regarded as safe

Ranitidine (Zantac)

B

Antihistamine

Yes

Preferred after ~ antacids; usually regarded together safe

Nizatidine (Axid)

C

Antihistamine

Yes

Not encourage (adverse animal studies)

Famotidine (Pepcid)

B

Antihistamine

Yes

Probably safe, data needed


Antifungals

The most usual antifungal medications accessible as OTC drugs include the imidazole agents clotrimazole (Mycelex), butoconazole (Femstat), miconazole (Monistat), and also tioconazole (Vagistat-1). Table 623,24 explains the safety of assorted OTC antifungal agents in pregnancy. One of the biggest studies24 to day investigated the teratogenicity of clotrimazole. The population-based, case-control examine of 18,515 instance pregnancies and 32,804 manage pregnancies did not show an association in between fetal malformations and the use of clotrimazole.

Several little trials have actually indicated that butoconazole and miconazole are most likely to be safe throughout the 2nd and third trimesters. Insufficient data room available regarding the safety of tioconazole in pregnancy.25

Many clinicians use oral fluconazole (Diflucan) to treat vulvovaginal candidiasis. A study26 of 226 ladies exposed to fluconazole throughout the first trimester of pregnant revealed the patients taking fluconazole were no more likely than unexposed control patients to endure miscarriage, stillbirth, or congenital anomalies. Ketoconazole (Nizoral), flucytosine (Ancobon), and griseofulvin (Grisactin) might be teratogenic or embryotoxic in animals.25

The Centers for disease Control and also Prevention recommends using just topical vaginal antifungal agents (including butoconazole, clotrimazole, miconazole, and also the prescription drugs terconazole and also nystatin ) in pregnancy.27 because imidazole agents are most likely to be safe as soon as used throughout pregnancy and may be an ext effective than nystatin,28 they need to be thought about as first-line treatment in pregnant patients.


Smoking Deterrents

Nicotine replacement therapy presents an interesting clinical dilemma. Researchers believe that nicotine and its metabolic byproduct, cotinine, space harmful come the arising fetus due to the fact that smoking is well-known to cause harmful fetal effects, including intrauterine expansion retardation, premature birth, hyperviscosity in the newborn, voluntarily abortion, fetal neurotoxicity, and pulmonary defects, and an enhanced risk of suddenly infant fatality syndrome.29 because that these reasons, the FDA classifies nicotine as a Pregnancy group D drug. The major mechanism of these deleterious impacts is thought to it is in uteroplacental insufficiency. Reduced perfusion the oxygenated blood with the placenta at miscellaneous stages of advance may cause the various manifestations of fetal maldevelopment and also injury.


TABLE 6OTC Topical quality Antifungal medicines in PregnancyDrug nameFDA pregnancy threat classificationDrug classCrosses placenta?Use in pregnancy

Butoconazole (Femstat)

C

Imidazole antifungal

Not known

Probably safe

Clotrimazole (Lotrimin)

C

Imidazole antifungal

Not known

Safe in second and third trimesters (human trials),24 first trimester probably safe23

Miconazole (Monistat)

C

Imidazole antifungal

Not known

Probably safe

Tioconazole (Vagistat-1)

C

Imidazole antifungal

Not known

No data


Information native Lagace E. Security of first trimester exposure come H2 blockers. J Fam Pract 1996;43:342–3, and also Czeizel AE, Toth M, Rockenbauer M. No teratogenic effect after clotrimazole therapy during pregnancy. Epidemiology 1999;10:437–40.


TABLE 6OTC Topical vaginal Antifungal medicines in PregnancyDrug nameFDA pregnancy hazard classificationDrug classCrosses placenta?Use in pregnancy

Butoconazole (Femstat)

C

Imidazole antifungal

Not known

Probably safe

Clotrimazole (Lotrimin)

C

Imidazole antifungal

Not known

Safe in 2nd and third trimesters (human trials),24 first trimester most likely safe23

Miconazole (Monistat)

C

Imidazole antifungal

Not known

Probably safe

Tioconazole (Vagistat-1)

C

Imidazole antifungal

Not known

No data


Information from Lagace E. Safety of first trimester exposure come H2 blockers. J Fam Pract 1996;43:342–3, and Czeizel AE, Toth M, Rockenbauer M. No teratogenic result after clotrimazole therapy throughout pregnancy. Public health 1999;10:437–40.


Physicians must educate pregnant patients around the harmful results of smoking cigarettes to themselves and the arising fetus, and assist these patients develop a setup for cigarette smoking cessation. The security of nicotine replacement assets in pregnancy has not to be adequately studied. However, cigarette smoking is most likely to be much more harmful than nicotine instead of therapy, particularly because tobacco smoke contains an ext than 3,000 different chemicals that deserve to potentially harm humans, and one that the main components of tobacco smoke is carbon monoxide, a recognized fetal toxin. Therefore, that is reasonable to think about the usage of nicotine replacement assets in patients who cannot keep smoking abstinence without pharmacologic intervention.

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If pregnant women call for nicotine instead of to battered smoking, the amount of nicotine administered have to be decreased as much as feasible while still preserving efficacy. Until additional research is available, medical professionals should consider recommending the intermediate-release nicotine prepare (nicotine gum, nicotine spray, and nicotine inhaler) quite than the continuous-release technique (nicotine patches).30


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