What medications are safe to take during pregnancy?

Medications Safe During Pregnancy

During pregnancy, the safest medications include hydroxychloroquine, chloroquine, azathioprine, cyclosporine, tacrolimus, sulfasalazine, colchicine, and certain antihypertensives like methyldopa, nifedipine, and labetalol. 1 These medications have established safety profiles and can be continued throughout pregnancy when medically necessary.

Pregnancy-Compatible Medications by Category

Anti-Rheumatic Medications

• Safe to continue during pregnancy:

  • Hydroxychloroquine and chloroquine
  • Azathioprine (up to 2 mg/kg daily)
  • Cyclosporine and tacrolimus (at lowest effective dose)
  • Sulfasalazine (up to 2 g/day with folic acid supplementation)
  • Colchicine (1-2 mg/day)
  • TNF inhibitors (generally safe in early pregnancy) 1, 2

• Must be discontinued before pregnancy:

  • Methotrexate (discontinue 1-3 months before conception)
  • Mycophenolate (discontinue 1.5 months before conception)
  • Cyclophosphamide (discontinue 3 months before conception) 1

Cardiovascular Medications

• Safe during pregnancy:

  • Methyldopa (preferred for hypertension)
  • Nifedipine, labetalol, diltiazem
  • Clonidine, prazosin 1

• Contraindicated:

  • ACE inhibitors and angiotensin receptor blockers
  • Statins
  • Atenolol (other beta-blockers may be used if necessary) 1

Pain Medications

• Limited use during pregnancy:
  • NSAIDs: Safe in first and second trimester for short-term use (7-10 days)
    • Ibuprofen has most reassuring data
    • Must be discontinued after 28 weeks gestation due to risks of oligohydramnios and premature closure of ductus arteriosus 1

Asthma Medications

• Safe during pregnancy:
  • Albuterol (preferred SABA)
  • Inhaled corticosteroids (budesonide has most safety data)
  • Cromolyn or nedocromil 1

Supplements

• Recommended during pregnancy:
  • Folic acid (essential before conception and during pregnancy)
    • Required supplementation with sulfasalazine (2 mg daily) 1, 3
  • Iron supplements (may interact with certain medications like methyldopa) 4

Important Considerations for Medication Use

First Trimester Concerns

• The first trimester is the most critical period for potential teratogenic effects
• Many medications considered safe can be continued, but teratogenic medications must be discontinued before conception 1, 2
• Self-medication is particularly risky during this period 5

Medication Management Algorithm

1. Pre-conception planning:

   • Discontinue teratogenic medications with appropriate washout periods
   • Transition to pregnancy-compatible alternatives
   • Begin folic acid supplementation

2. First trimester:

   • Continue only medications with established safety profiles
   • Prioritize disease control as untreated conditions may pose greater risks

3. Second and third trimesters:

   • Adjust medications as needed based on disease activity
   • Discontinue NSAIDs after 28 weeks
   • Monitor for pregnancy-specific complications

Special Situations

• Rheumatic diseases: Disease control is essential as active disease poses greater risks than most medications 1, 2
• Diabetes: Insulin is preferred; oral agents generally not recommended 1
• Hypertension: Target BP 110-135/85 mmHg using safe antihypertensives 1
• Asthma: Maintaining control is critical for maternal and fetal oxygenation 1

Common Pitfalls to Avoid

1. Abruptly discontinuing all medications upon pregnancy diagnosis

   • Uncontrolled maternal disease often poses greater risks than medication exposure

2. Continuing teratogenic medications into pregnancy

   • Methotrexate, mycophenolate, and cyclophosphamide must be discontinued before conception

3. Failing to supplement folic acid

   • Essential for preventing neural tube defects
   • Higher doses (2 mg daily) needed with sulfasalazine 1, 6

4. Using NSAIDs in late pregnancy

   • Must be discontinued after 28 weeks due to fetal cardiovascular risks 1

5. Assuming all medications in a class have equal safety profiles

   • Within medication classes, specific agents often have more safety data (e.g., budesonide among inhaled corticosteroids) 1

By following these guidelines and consulting with healthcare providers, pregnant women can safely manage medical conditions while minimizing risks to themselves and their developing babies.