Is pheniramine maleate (Intravenous Fertilization) contraindicated in IVF (In Vitro Fertilization)?

Pheniramine Maleate in IVF: Safety Considerations

Pheniramine maleate is not specifically contraindicated in IVF (In Vitro Fertilization) procedures, but caution is warranted as there are no dedicated studies on its safety in this context, and antihistamines generally should be used with caution during fertility treatments.

Safety Profile of Pheniramine Maleate

Pheniramine maleate is an antihistamine commonly used for allergic conditions. When considering its use in the context of IVF, several important factors must be evaluated:

• Pheniramine maleate is not specifically listed among medications contraindicated during IVF procedures in current reproductive medicine guidelines 1, 2
• It belongs to the first-generation antihistamine class, which has anticholinergic and sedative properties 3
• While pheniramine maleate has been associated with toxicity in overdose cases (including CNS effects, rhabdomyolysis, and cardiotoxicity), these effects are primarily seen with supratherapeutic doses 4

Antihistamine Use During Fertility Treatments

The British Journal of Dermatology guidelines note that for antihistamines in general:

• It is best to avoid all antihistamines during pregnancy, especially during the first trimester, although none has been shown to be teratogenic in humans 3
• For women undergoing fertility treatments who may become pregnant, caution is advised with antihistamine use 3

Recommendations for IVF Patients

When considering pheniramine maleate use in IVF patients:

1. Medication timing: If antihistamine treatment is necessary, consider using it after egg retrieval but before embryo transfer, or after confirmation of failed implantation

2. Alternative options: If antihistamine therapy is necessary during IVF:

   • Chlorphenamine (chlorpheniramine) may be preferred due to its longer safety record 3
   • Loratadine and cetirizine are classified as FDA Pregnancy Category B drugs, implying no evidence of harm to the fetus during pregnancy 3

3. Consultation approach: Discuss with both the allergist/immunologist and reproductive endocrinologist before using pheniramine maleate during IVF treatment

Important Considerations

• The EULAR recommendations (2024) emphasize that medications with limited safety data should be avoided until further evidence is available 3
• The primary focus during IVF should be on medications that have established safety profiles in reproductive settings 2
• The standard medications used in IVF protocols (gonadotropins, GnRH agonists/antagonists, progesterone) have well-documented safety profiles 1, 2

Conclusion

While pheniramine maleate is not absolutely contraindicated in IVF, the lack of specific safety data in this context suggests caution. When possible, alternative antihistamines with better-established safety profiles should be considered, or treatment should be timed to minimize potential impact on the IVF process.