What are safe medications for anxiety and Gastroesophageal Reflux Disease (GERD) during pregnancy?

From the Guidelines

During pregnancy, it is recommended to manage anxiety with selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) at 25-200 mg daily or escitalopram (Lexapro) at 10-20 mg daily, and to manage GERD with lifestyle modifications and medications like antacids, H2 blockers, and proton pump inhibitors, under the guidance of an obstetrician. When considering medications for anxiety during pregnancy, SSRIs are generally considered first-line options due to their established safety profiles 1. For GERD management, lifestyle modifications such as eating smaller meals, avoiding trigger foods, and not lying down after eating are initial steps, with medications like antacids containing calcium carbonate (Tums) or aluminum hydroxide being typically safe if needed 1. H2 blockers like famotidine (Pepcid) 20 mg twice daily can be used if symptoms persist, and for more severe GERD, proton pump inhibitors such as omeprazole (Prilosec) 20-40 mg daily may be considered, preferably in the second or third trimester 1. Some key points to consider include:

• The goal is to use the lowest effective dose for the shortest duration needed to control symptoms while minimizing potential risks to the developing baby.
• Individual risk factors may influence recommendations, making consultation with an obstetrician crucial before starting any medication during pregnancy.
• Recent guidelines and studies support the use of SSRIs for anxiety and a stepped approach to GERD management, starting with lifestyle changes and progressing to medications as necessary 1. It's also important to note that while there are various medications and approaches available, the primary concern should always be the health and safety of both the mother and the developing baby, guiding the choice of treatment 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Medications for Anxiety and GERD during Pregnancy

• The treatment of GERD during pregnancy typically involves a step-up approach, starting with lifestyle modifications and progressing to medication if necessary 2, 3.
• For patients with anxiety, some antidepressants may exacerbate GERD symptoms due to their anticholinergic effects 4.
• Antacids, alginates, and sucralfate are recommended as first-line therapeutic agents for GERD during pregnancy 2, 3.
• Histamine-2 receptor antagonists (H2RAs) can be used if symptoms persist, except for nizatidine due to potential fetal teratogenicity 3.
• Proton pump inhibitors (PPIs) are reserved for women with intractable symptoms or complicated GERD, and most are FDA category B drugs, except for omeprazole which is a category C drug 3.

Safe Medications for Anxiety during Pregnancy

• There is limited information available on safe medications for anxiety during pregnancy that also consider GERD.
• However, it is essential to discuss the risks and benefits of any medication with a healthcare provider, especially during pregnancy 3.

Management of GERD during Pregnancy

• Lifestyle modifications, such as dietary changes and avoiding trigger foods, can help alleviate GERD symptoms 5, 2, 3.
• Medications should be used under the guidance of a healthcare provider, and the suitability of each treatment for use during pregnancy and lactation must be considered 5, 2, 3.