Drugs in Pregnancy & Lactation PDF

Drugs in pregnancy and lactations.  Drugs in pregnancy Any drug taken by the pregnant or breastfeeding woman has the potential to reach the fetus by way of maternal circulation or neonate by way of breast milk. Drug classification according to their safety during pregnancy : The...

Drugs in pregnancy and lactations.  Drugs in pregnancy Any drug taken by the pregnant or breastfeeding woman has the potential to reach the fetus by way of maternal circulation or neonate by way of breast milk. Drug classification according to their safety during pregnancy : The FDA has categorized the potential teratogenic risk of medications by an A, B, C, D, X system. CategoryA: Controlled studies in women have failed to demonstrate a risk to the fetus in the first trimester and there is no evidence of risk in later trimesters. The possibility of fetal harm appears remote. Medications in this class are considered safe to use in pregnancy. Examples of medications in this class are vitamins and levothyroxine, folic acid ,magnesium sulfate , liothyronine. Category B: Either animal‐reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal studies have demonstrated risk to the fetus that was not confirmed in controlled studies in pregnant women in the first trimester and there is no evidence of a risk in later trimesters. Medications in this class are generally considered safe. Examples of medications in this class are metformin , hydrochlorothiazide , cyclobenzaprine and amoxicillin. Category C: Studies in animals have revealed adverse effects on the fetus and there are no controlled studies in women, or studies in women and animals are not available. Drugs from this class can be given to pregnant women if the benefit to the mother outweighs the risk to the fetus. Examples of medications in this class are tramadol ,gabapentin , amlodipin, trazodone, perdnison. Category D: Evidence of human fetal risk has been documented, but the benefits to the mother may be acceptable despite the risk to the fetus. Drugs in this class may be used in pregnancy if the benefits to the mother outweigh the risk to the fetus (i.e. a life threatening situation or a serious disease for which safer drugs cannot be used or are ineffective). Examples of medications in this class are lisinopril, alprazolam , lorazepam, clonazepam, lozartan. Category x: Adequate well-controlled or observational studies in animals or pregnant women evidence of fetal abnormalities.the use of the product is contraindicated in women who are or may become pregnant ex : atrovastastatin , simvastatin , warfarin , methotrexate ,finasteride.  Drugs considered safe in pregnancy ⁕ Some antibiotics namely ; Amoxicillin , Ampicillin, cephalosporin , erythromycin. ⁕ Levothyroxine ⁕Folic acid and vitamin B6 ⁕ Methyl dopa and hydralazine (anti hypertensive agent) ⁕Insulin ⁕Heparin  Drugs in lactation Drugs are classified for breastfeeding ; as follows: 1- Compatible with breastfeeding : Drugs are classified as compatible with breastfeeding if there no known or theoretical contraindication for their use and it is considered safe for the mother to take the drug and continue breastfeeding. 2- Compatible with breastfeeding.Monitor infant for side - effects : Drugs are classified in this way if they could theoretically caused mild side effects in the infant but have either not been observed to do so or have only occasionally caused mild side effects. inform the mother about any possible side effects. 3- Avoid if possible. monitor infant for side effects. Drugs are classified in this way if they have been reported to cause side effects in the infant especially if the side effects Could be serious. use these drugs only when they are really essential for the mothers treatment and when no safer alternative is available.  4- Avoid if possible. may inhibit lactation Drugs classified this way may reduce breast milk production and if possible they should be avoided. 5- Avoid : Drugs are classified in this way if they can have dangerous side effects on the baby.They should not be given to a mother while she is breastfeeding. if they are essential for treating the mother she should stop breast feeding until treatment is completed there are very few drugs in this category apart from anticancer drugs and radioactive substances. Infant-oral Bioavailability physiological factors that could protect him from side effects - The infants stomach is quite acidic and can denature many drugs. - Some drugs are poorly absorbed when ingested with calcium rich foods and particularly milk. - In addition , many drugs are metabolized in the liver. These absorption problems tend ultimately to reduce the overall effect of many drugs.e.g. of poor oral bioavailability; Gentamycin. But the local effect of antibiotic in the GIT can be profound e.g. diarrhea, constipation and pseudo membranous colitic. Avoid if possible e.g. Chloramphenicol , ciprofloxacin, doxycycline , metronidazole (anti biotic). Aspirin is compatible with breastfeeding in occasional doses. Aspirin : avoid long-term therapy , if possible , Monitor infant for side effects. (Aspirin might cause hemolysis ,prolonged bleeding time and metabolic acidosis). Thank you