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A |
B |
C |
D |
X |
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Acid folic Fier Vit B6 |
Aciclovir Adenozina Adrenalina evitat in primul trimestru) Amoxicilina Ampicilina Ateplaza Atropina Augmentin Azitromicina Bromhexin Cefaclor Cefalexin Ceftriaxon Clindamicina Clorfeniramin Clotrimazol (uz vaginal) Codeina Dexametazona Digoxin Dobutamina Eritromicina Famotidina Hidroclorotiazida Hidrocortizon Insulina ISDN Ketamina Lactuloza Loratadina Metoclopramid Metronidazol(de Mexiletina Paracetamol Prednison( nu in primul trimestru) Preparate de Al si Mg (Maalox) Ranitidina(nici un antiH2 nu e recomandat in primul trimestru) Salbutamol Suxametoniu Teofilina Urokinaza |
Amiodarona Amlodipina Barbiturice Benzodiazepine Biseptol Bismut Ciprofloxacin Claritromicina Clotrimazol Diclofenac Diltiazem Dopamina Ergotamine Felodipina Fluconazol Fortral Furosemid Glibenclamid Glipizid Heparina Hidralazina Ibuprofen Indometacin Indapamid Izoniazida Metformin Mialgin Miconazol Morfina Nifedipina Nimodipine Nizatidina Omeprazol Piroxicam Propofol Rifampicina Simeticon Spironolactona Streptokinaza Tramal Trimetoprim Verapami |
Alcoolul Aminoglicozide Aspirina Atenolol Carbamazepina Colchicina Doxiciclina Fenitoina IEC Sartani Tetraciclina Unii agenti chimioterapici Vitamina A |
Misoprostol Unii agenti chimioterapici Statine Warfarina |
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ADMINISTRAREA MEDICAMENTELOR IN SARCINA |
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A |
Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. |
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B |
Animal studies have revealed no evidence of harm to the fetus, however there are no adequate and well-controlled studies in pregnant women.orAnimal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus. |
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C |
Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. or No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. |
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D |
Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. |
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X |
Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant. |
The FDA system ranks drugs as:
Paracetamol at normal dose is safe and useful for headaches, backache, and other aches and pains that may occur during pregnancy.
Most medications, though, have not been
studied or shown to be safe to this extent. For these, we are left with this
guideline: Medications that are considered safe in pregnancy are those that
have been used extensively in humans and don't appear to cause any major
birth defects or other problems (they also have been shown not to cause birth
defects in animals). The FDA classifies these drugs as Category B. Treatment
with Category B medications is considered "probably safe." This group
includes ampicillin, acetaminophen (Tylenol is a
common brand), ibuprofen (such as Motrin) before third trimester, aspartame,
caffeine in moderation, hydrochlorothiazide (HCTZ), metoclopramide
(Reglan), famotidine (Pepcid), loperamide (Imodium),
and insulin.
Category C medications are somewhat more likely to have some complications for
mother or fetus, or there isn't enough research to draw conclusions about their
safety. These medications come with the warning that they should be used only
if the potential benefits outweigh the possible risks. These include prochlorperazine (Compazine),
Sudafed, fluconazole (Diflucan),
and ciprofloxacin (Cipro). Most prescription
medications are classified in Category C.
Category D medications are those that clearly have some health risks for the
fetus, including ethanol (alcohol), lithium, phenytoin
(Dilantin), and most chemotherapy agents, which still
may be used under certain circumstances.
Category X drugs have been shown to cause birth defects and are not to be used
in pregnancy under any circumstances. This category includes isotretinoin (Accutane),
thalidomide, ribavirin (a treatment for hepatitis C)
and diethylstilbestrol (DES).
For a list of treatments that are considered safe in pregnancy, go to our
article about the specific condition or symptom in which you're interested, or
see the article on antibiotics
in pregnancy.
Category A
Only a few medications fall into category A, which means that human studies
have shown no evidence of fetal harm in the first trimester or later in the
pregnancy.
Nystatin vaginal (Mycostatin
Category B
Most antibiotics are Category B, which means that there is no known association
with birth defects or other pregnancy-related complication and the drug is
probably safe. These include:
Amoxicillin
Ampicillin
Augmentin (amoxicillin-clavulanate)
Dicloxicillin
Macrobid (nitrofurantoin)
Flagyl (metronidazole)
(although there is some controversy about taking it by mouth in the first
trimester)
Cephalosporins including: Keflex
(cephalexin), Ceclor (cefaclor), Duricef (cefadroxil)
Cleocin (clindamycin)
Erythromycin (all forms)
Zithromax (azithromycin)
Sulfa drugs (until near term)
Famvir (famciclovir)
Zovirax (acyclovir)
Valtrex (valacyclovir)
Clotrimazole-vaginal (Mycelex, Lotrimin)
Category C
Others are Category C, meaning that either there isn't enough information or
there are some concerns arising from animal studies, but no confirmation of
problems like birth defects in humans. These include:
Bactrim
Trimethoprim
Biaxin (clarithromycin)
Cipro (ciprofloxacin)
Diflucan (fluconazole)
Monistat (miconazole)
Terazol (terconazole)
Isoniazid
Rifampin
Vermox (mebendazole)
Tetanus booster (tetanus toxoid)
Vaccines: hepatitis A, hepatitis B, influenza, meningococcus,
pneumonia (pneumococcus), polio
Vaccines: Measles, Mumps, Rubella (in this category because there is no proof
that the MMR vaccine causes birth defects, but it is never purposefully used
during pregnancy because there is some fear that the rubella component could
adversely affect an unborn child)
Category D
Category D medications have clear-cut problems in pregnancy and should not be
used unless there are no better alternatives. Category D includes:
Tetracycline derivatives, which can cause discoloration of teeth: tetracycline,
doxycycline (Vibramycin), Minocin (minocycline)
Sulfa drugs - if near delivery (because they can increase the chance of serious
newborn jaundice)
Anti-histamines. Older anti-histamines, such as chlorpheniramine and tripelennamine, are the preferred agents to treat allergic rhinitis during pregnancy, and are both category B medications. Newer anti-histamines such as over-the-counter loratadine (Claritin®/Alavert® and generic forms) and prescription cetirizine (Zyrtec®) are also pregnancy category B medications.
Decongestants. Pseudoephedrine (Sudafed®, many generic forms) is the preferred oral decongestant to treat allergic and non-allergic rhinitis during pregnancy, although should be avoided during the entire first trimester, as it has been associated with infant gastroschisis. This medication is pregnancy category C.
Medicated nasal sprays. Cromolyn nasal spray (NasalCrom®, generics) is helpful in treating allergic rhinitis if it is used before exposure to an allergen and prior to the onset of symptoms. This medication is pregnancy category B and is available over-the-counter. If this medication is not helpful, one nasal steroid, budesonide (Rhinocort Aqua®), recently received a pregnancy category B rating (all others are category C), and therefore would be the nasal steroid of choice during pregnancy.
Immunotherapy. Allergy shots can be continued during pregnancy, but it is not recommended to start this treatment while pregnant. Typically the dose of the allergy shots is not increased, and many allergists will cut the dose of the allergy shot by 50% during pregnancy. Some allergists feel that allergy shots should be stopped during pregnancy, given the risk of anaphylaxis and possible danger to the fetus as a result. Other than anaphylaxis, there is no data showing that the allergy shots themselves are actually harmful to the fetus.
Sources:
Category A: Controlled studies in pregnant women demonstrate no fetal risk (eg, folic acid, levothyroxine);
Category B: Controlled animal studies have not shown a fetal risk but there are no studies done on women OR controlled studies in animals have shown a fetal risk that was not reproduced in controlled human studies (eg, amoxicillin, ceftriaxone);
Category C: Controlled animal studies have demonstrated adverse fetal effects and there are no human studies or there are no controlled studies in humans or animals (eg, nifedipine, omeprazole);
Category D: Controlled studies in humans demonstrate adverse fetal effects but the benefits of using the drug are greater than the risks (eg, propylthiouracil); and
Category X: Controlled studies in animals and humans have demonstrated adverse fetal effects or there is evidence of fetal risk based on human experience. The risk of using these drugs outweighs any possible benefit. The drug is absolutely contraindicated in pregnancy (eg, misoprostol, warfarin, isotretinoin).
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