Drugs In Pregnancy

Drugs are taken in more than half of all pregnancies and the prevalence of use increases. The most commonly used drugs include antiemetics, antacids, antihistamines, analgesics, anti-bacterial agents, diuretics, hypnotics, tranquilizers, as well as socially recognized and illegal drugs. Despite this development, secure evidence-based guidelines for drug use during pregnancy are still missing. Regulatory information about drug safety during pregnancy Until recently, the FDA (US Food and Drug Administration) classified OTC and prescription drugs in five safety categories for use during pregnancy (A, B, C, D, X). (N. D. Talk .:’s In Germany, the “Red List” evidence of the nature and extent of the hazard and the degree of probability of occurrence of damage.) However, some were carried out well-controlled studies of therapeutic drugs used with pregnant women. The most knowledgeable about the safety of medications in pregnancy was obtained from animal studies, uncontrolled studies and post-marketing reports. Consequently, the FDA classification system led to confusion and difficulties in the application of information for clinical decisions. In December 2014, the FDA responded by requiring that the pregnancy categories A, B, C, D and X are removed from the labeling of all medications. Instead of categories, the FDA now requires that labeling in a standardized format (called the final rule;. For more information, see the FDA’s announcement) information on the specific drug is. The information requested by the FDA have three subsections: Pregnancy information for use of the drug in pregnant women (for example, dosing, fetal risks.) Are relevant and information about whether a registration exists, collects and manages the data, such as pregnant affected women breast-feeding: information about the drug during lactation (. eg the amount of drug in breast milk, the potential effects on the suckling child) Men and women with reproductive potential: information about pregnancy testing, contraception and infertility, as far as refers to the drug the subsections pregnancy and lactation each comprise three subtitles (risk summary clinical considerations and data), which provide more details. Effect of medication during pregnancy During pregnancy, drugs are often required to treat certain disorders. In general, if a potential benefit outweighs the known risks, drugs for treating disorders during pregnancy are contemplated. Not all drugs the mother come about through the placenta to the fetus. Through the placenta overflowed medicines can have a direct toxic or teratogenic effect. Those that do not cross the placenta, can the fetus still hurt by having a contracting effect on the placental vessels that hinder the gas and nutrient exchange trigger A threatening uterine hypertension, which leads to lack of oxygen damages Physiological mother reactions change (eg. B . triggering a blood pressure drop). For a list of some drugs with adverse effects during pregnancy see Table: Some drugs with adverse effects during pregnancy. Drugs cross the placenta in a similar way, as they overcome other Epithelschranken (absorption, absorption of the drug). Whether and how fast a drug passes through the placenta, the extent of its binding to other substances (eg. As a carrier protein) depends on the molecular weight of the drug, the available area for the replacement by the villi of the placenta and of the placenta from the converted in the metabolism of the drug amount. Most drugs with a molecular weight <500 Dalton cross the placenta easily and get into the fetal circulation. Substances having a high molecular weight (for. Example, protein-bound drugs), the placenta is normally not happen. An exception is the immunoglobulin G, which is sometimes used to treat diseases such as fetal alloimmune thrombocytopenia. In general, a balance between maternal blood and fetal tissues takes at least 30-60 minutes. The effect of the drug on the fetus is largely determined by the fetal age at the time of exposure, the efficacy of the drug and its dosage. The effect of the drug depends on the age of the fetus: Before the 20th day after fertilization: drugs usually have at this time an all-or-nothing effect, d. H. kill the embryo or not affecting him. A teratogenic effect is unlikely at this stage. During organogenesis (between 20th and 56th day after fertilization): A teratogenicity is likely at this stage. Drugs that reach the embryo at this stage can lead to a spontaneous miscarriage, a near-fatal anatomical defect (a true teratogenic effects), or a hidden Embryopathie lead (a permanent, underlying metabolic or functional disorder that can manifest in life later) or the drugs have no noticeable effect. After completion of organogenesis (the 2nd and 3rd trimester): It is unlikely that the drug teratogenic, but they can change the size and function of a normally formed organs and tissues. With increasing metabolism of the placenta, the doses need to be higher to have toxic effects on the fetus. Although the concern about drug safety is widespread, only 2-3% of all fetal congenital malformations go but at the expense of a therapeutic drug exposure. Most abnormalities are due to genetic, environmental or unknown causes. Some drugs with adverse effects during pregnancy Examples side effects Comments antibiotics aminoglycosides ototoxicity (. Eg damage to the labyrinth of the fetus), leads to deafness - chloramphenicol gray baby syndrome hemolysis in women or fetuses with G6PD deficiency - Fluoroquinolones may arthralgia; theoretically musculoskeletal defects (. eg disturbed bone growth), this effect is not proven - nitrofurantoin hemolysis in women or fetuses with G6PD deficiency contraindicated during the first trimester, during the 38th to 42nd week, during labor and birth and shortly before the beginning of labor primaquine hemolysis in women or fetuses with G6PD deficiency - streptomycin ototoxicity - Sulfonamides (except sulfasalazine, which carries a minimum fetal risk) In drug intake after about 34 weeks, neonatal jaundice and without treatment kernicterus hemolysis in women or fetuses with G6PD deficiency - Tetracycline Slowed bone growth, Zahnschmelzhypoplasie, permanent yellowing of the teeth and increased susceptibility of tooth decay in the offspring occasionally liver failure in pregnant women - trimethoprim Increased risk of neural tube defects by folic acid antagonism - Low molecular weight heparin anticoagulants thrombocytopenia and maternal bleeding Compatible with pregnancy Unfractionated Heparin thrombocytopenia and maternal bleeding - Warfarin When warfarin-taking in the first trimester fetal warfarin syndrome (eg. B. hypoplasia of the nose, Knochentüpfelung, bilateral Optikusatrophe, various degrees of mental retardation) For warfarin-taking in the second or third trimester optic atrophy, cataracts, mental retardation, microcephaly, microphthalmia and fetal and maternal bleeding Absolute contraindication in the first trimester of pregnancy anticonvulsants carbamazepine Hemorrhagic disease of the newborn increased risk of congenital malformations including neural tube defects - lamotrigine No significantly increased risk at doses up to 600 mg / day Compatible with pregnancy Levetiracetam Light skeletal malformations in animal studies, but no significantly increased risk in humans compatible with pregnancy phenobarbital Hemorrhagic disease of the newborn Increased risk of congenital malformations - phenytoin Congenital malformations (eg. As cleft lip, urogenital defects such as hypospadias, cardiovascular defect formation) Hemorrhagic disease of the newborn Persistent risk of congenital despite intake of folic acid trimethadione High risk of congenital malformations (eg. As cleft palate, defects of the heart, face skull, hands and abdomen) and risk of spontaneous abortion almost always contraindicated during pregnancy valproate Larger congenital malformations (eg neural tube defects such as myelomeningocele;. cardiac, facial and limb defects) Persistent risk of congenital despite intake of folic acid Antidepressants bupropion Conflicting data on the risk of congenital malformations from the exposure in the first trimester. The dosage is affected by hepatic or renal impairment Citalopram If citalopram is given during the first trimester, an increased risk of congenital malformations (especially heart) If the drug is administered during the third trimester, abortion syndrome and persistent pulmonary hypertension of the newborn considering a Dosiszuspitzung during the third trimester in consultation with a psychosocial specialist. Escitalopram Escitalopram When given during the third trimester, abortion syndrome and persistent pulmonary hypertension of the newborn considering a Dosiszuspitzung during the third trimester, in consultation with a mental health professional. Fluoxetine is given during the third trimester fluoxetine, demolition syndrome and persistent pulmonary hypertension of the newborn long half-life; Drug interactions can potentially occur for weeks after the drug was discontinued consideration of Dosiszuspitzung during the third trimester, in consultation with a mental health professional. Paroxetine When paroxetine is given during the first trimester, an increased risk of congenital malformations (especially heart) If the drug during the third trimester, abortion syndrome and persistent pulmonary hypertension of the newborn, where the use during pregnancy is not recommended by some experts * considering a Dosiszuspitzung during the third trimester, in consultation with a mental health professional. If sertraline sertraline is given during the third trimester, abortion syndrome and persistent pulmonary hypertension of the newborn considering a Dosiszuspitzung during the third trimester, in consultation with a mental health professional. When Venlafaxine Venlafaxine is given during the third trimester, demolition syndrome The dosage is greatly by affecting the liver or kidney affected whereas a Dosiszuspitzung during the third trimester in consultation with a psychosocial specialist. Antiemetics doxylamine and pyridoxine (vitamin B6) No evidence of an increased risk of congenital malformations - Ondansetron No Significant teratogenic risk in animal studies, when ondansetron is taken during the first trimester, Possible risk of congenital heart disease (evidence weak) Will only hyperemesis gravidarum during pregnancy used when other treatments are ineffective promethazine No significant teratogenic risk in animal studies as a rule, no increased Ri siko of congenital malformations may decreased platelet aggregation in newborns - antifungal amphotericin B No Significant teratogenic risk in animal studies, the monitoring of systemic toxicities (electrolyte disturbances, renal dysfunction) is recommended when the mother fluconazole teratogen at high doses in animal studies no apparent increased risk of congenital malformations after single dose of 150 mg / day after taking higher doses (> 400 mg / day) during most of the first trimester or gan zen trimester, increased risk of various birth defects. – Miconazole For oral use adverse effects in animal testing application on the skin, no increased risk of congenital malformations Not intravaginally during the first trimester, unless it is essential for the well-being of the mother terconazole Adverse effects in animal studies No significant risk of congenital abnormalities should not be used intravaginally during the first trimester, unless the benefit to the mother outweighs the risk to the fetus antihistamines / anticholinergic Meclizine teratogen in rodents, but this effect has not been demonstrated in humans – antihypertensives, ACE inhibitors (see table: Oral ACE inhibitors and angiotensin II receptor antagonists for hypertension) For drug intake in the 2nd or 3rd trimester hypoplastic skull and hypoperfusion (which can cause kidney damage), kidney failure and the consequences of Oligohydramnions (oligohydramnios, craniofacial deformities, limb contractures and development of hypoplastic lungs) – Beta blockers Fetal bradycardia, hypoglycemia and possibly fetal growth and preterm birth – wear thiazide diuretics prevent normal increase maternal fluid volume, thus reducing the blood flow to the placenta and – calcium channel blockers When taking drugs in the first trimester may phalangeal deformities In drug intake in the 2nd or 3rd trimester fetal growth so for fetal growth retardation in neonatal hyponatremia, hypokalemia and thrombocytopenia – Cytostatics † actinomycin teratogen in animals, but this effect has not been demonstrated in humans – busulfan Congenital malformations (eg. B. fetal growth, mandibular hypoplasia, cleft palate, craniosynostosis, spine and ear defects, clubfoot) – chlorambucil disorders as busulfan – colchicine may congenital malformations and sperm abnormalities – cyclophosphamide disorders as busulfan – doxorubicin teratogen in animals and Men rule possibility of a dose-related cardiac failure use during pregnancy is not recommended, it is recommended effective contraception during pregnancy and for 6 months after treatment of the male or female partner. Mercaptopurine disorders as busulfan – methotrexate disorders as busulfan contraindicated during pregnancy. Effective contraception is for 8 weeks after the last dose recommended vinblastine teratogen in animals, but this effect has not been demonstrated in humans – vincristine teratogen in animals, but this effect has not been demonstrated in humans – antipsychotics and mood stabilizers Haloperidol Adverse effects in animal testing haloperidol is given in the first trimester, may malformations of extremi would do if haloperidol is given in the third trimester have an increased risk of extrapyramidal symptoms or withdrawal symptoms in newborns – lurasidone No evidence of adverse effects in animals If lurasidone is given during the third trimester, an increased risk of extrapyramidal symptoms or withdrawal symptoms in newborns – Lithium adverse effects in animal testing taking lithium in the first trimester, teratogenic (cardiac malformations) If lithium is given later in pregnancy, lethargy, hypotension, nutritional disorders, hypothyroidism, goiter, and nephrogenic diabetes insipidu s in the newborn – no increased teratogenic risk when risperidone is given during the third trimester risperidone Adverse effects in animal studies based on limited data – Olanzapine Adverse effects in animal studies when olanzapine is given during the third trimester, an increased risk of extrapyramidal symptoms or withdrawal symptoms in newborns an increased risk of extrapyramidal symptoms or withdrawal symptoms in newborns – anxiolytics Benzodiazepines may cause benzodiazepine ingestion in late pregnancy respiratory depression or withdrawal syndrome, the increased excitability, tremor and hyperreflexia of the newborn – Hypoglycemic drug (oral) chlorpropamide neonatal hypoglycemia – glibenclamide neonatal hypoglycemia – Metformin Neonatal hypoglycemia – tolbutamide neonatal hypoglycemia – NSAIDs aspirin and other salicylates Fetal kernicterus At high doses may spontaneous abortions in the first trimester, delayed onset of labor, premature closure of the fetal ductus arteriosus, jaundice and occasionally maternal (intra- or postpartum) and / or neonatal bleeding , necrotizing enterocolitis and oligohydramnios acetylsalicylic At low doses (81 mg), no significant teratogenic risk – Nichtsalicylat NSAIDs disorders like salicylate NSAIDs contraindicated in the third trimester opioids and partial agonist buprenorphine Adverse reactions, but no teratogenicity in animal studies risk of neonatal opioid withdrawal syndrome (neonatal abstinence syndrome) Improved fetal results compared with those when pregnant women use illegal substances codeine hydrocodone (Editor’s note: in Germany not permitted!) Hydromorpho n meperidine (Editor’s note: not approved in Germany!) morphine In newborns of opiate addicts women withdrawal symptoms 6 hours to 8 days after birth At high doses in the hours before birth may neonatal CNS depression and bradycardia – methadone Adverse effects in animal experiments the specific effects of methadone in pregnant women may be difficult to distinguish from the effects of concomitant drugs (eg. As illegal drugs) risk of neonatal opioid withdrawal syndrome Improved fetal results compared (for which, if pregnant women illegal substances use Possible need for acute short-acting analgesics, to supplement the maintenance dose during labor and birth retinoids isotretinoin High teratogenic risk. B . multiple congenital malformations), spontaneous abortion and mental retardation contraindicated during pregnancy and in women who may become pregnant. Sexualhormone Danazol Bei Arzneimitteleinnahme in den ersten 14 SSW Virilisierung der Genitalien eines weiblichen Feten (z. B. Pseudohermaphroditismus) Während der Schwangerschaft kontraindiziert. Synthetisches Gestagen (aber nicht die niedrigen Dosen oraler Kontrazeptiva) Störungen wie bei Danazol Während der Schwangerschaft kontraindiziert. Schilddrüsen-Arzneimittel Methimazol Fetale Struma und Kopfhautdefekte (Aplasia cutis) Sollte im 1. Trimester der Schwangerschaft vermie

Health Life Media Team

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