What medications are safe to use during pregnancy?

Medications Safe to Use During Pregnancy

The use of any medications during pregnancy requires careful consideration of maternal benefit versus fetal risk, with priority given to maintaining maternal health while minimizing potential harm to the developing fetus. 1

Safe Medications by Category

Respiratory Medications

• Short-acting beta-agonists (SABAs): Salbutamol (albuterol) and terbutaline are compatible throughout pregnancy and considered safe 1
• Long-acting beta-agonists (LABAs): Salmeterol is preferred due to greater experience during pregnancy, though formoterol is also considered probably safe 1
• Inhaled corticosteroids: Budesonide and beclomethasone have the most safety data and are preferred, but fluticasone and other inhaled corticosteroids are also compatible with pregnancy 1
• Inhaled medications generally have minimal systemic absorption and have been used for many years without documented adverse fetal effects 1

Antirheumatic and Anti-inflammatory Medications

• Conventional DMARDs safe in pregnancy:

  • Hydroxychloroquine and chloroquine 1
  • Azathioprine (up to 2 mg/kg/day) 1
  • Cyclosporine and tacrolimus (at lowest effective dose) 1
  • Sulfasalazine (up to 2 g/day, with folic acid supplementation) 1
  • Colchicine (1-2 mg/day) 1

• NSAIDs: Can be used in first and second trimesters for short periods (7-10 days), with ibuprofen and diclofenac having the most reassuring data 1, 2

  • CAUTION: All NSAIDs should be avoided after 20-30 weeks gestation due to risk of premature closure of the fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios 2

Gastrointestinal Medications

• Mesalamine: Safe during pregnancy for inflammatory bowel disease 1
• Antacids: Most have good safety records during pregnancy 3
• Antibiotics for GI infections: Amoxicillin-clavulanic acid is safe during pregnancy 1
• Metronidazole: Can be given for pouchitis, perianal Crohn's disease, or intra-abdominal abscesses 1

Supplements

• Folic acid: Essential during pregnancy, especially when taking medications like sulfasalazine that interfere with folate metabolism 4
  • Recommended for prevention of neural tube defects 4
  • Excreted in breast milk and generally considered safe during lactation 4

Medications to Avoid During Pregnancy

• Teratogenic medications that should be discontinued before conception:

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

• Antiepileptic drugs such as pregabalin should be avoided in the first trimester when the risk of congenital malformations is greatest 5

• Cardiovascular medications with known risks:

  • Angiotensin II receptor blockers (e.g., valsartan) can cause renal dysplasia, oligohydramnios, growth retardation 1
  • Warfarin and other vitamin K antagonists can cause coumarin-embryopathy and bleeding 1

Special Considerations

Pain Management

• Acetaminophen (Paracetamol): Traditionally considered safe, but recent research suggests cautious use 6, 3
  • Use the lowest effective dose for the shortest possible time 6
  • Consider only when medically indicated 6

Antibiotics

• Generally safe antibiotics: Beta-lactams, vancomycin, nitrofurantoin, metronidazole, clindamycin, and fosfomycin 7
• Antibiotics to avoid: Fluoroquinolones and tetracyclines 7
• Pharmacokinetic changes during pregnancy may require dose adjustments due to increased glomerular filtration rate and total body volume 7

Common Pitfalls to Avoid

• Failing to consider disease activity: Untreated maternal disease can often pose greater risks to pregnancy outcomes than medication exposure 1
• Discontinuing necessary medications: Abrupt discontinuation of effective treatments can lead to disease flares 1
• Not supplementing with folic acid when using sulfasalazine, which inhibits folate absorption 1, 4
• Using NSAIDs after 30 weeks gestation: Can cause premature closure of the ductus arteriosus 2
• Not monitoring for oligohydramnios: When NSAIDs are used after 20 weeks, ultrasound monitoring should be considered if treatment extends beyond 48 hours 2

Remember that medication use during pregnancy should always balance the maternal need for treatment against potential fetal risks, with priority given to maintaining maternal health which ultimately benefits both mother and baby 1.