Can injection Anafortan (camylofin and paracetamol) be given in the first trimester of pregnancy?

Anafortan Injection Use in First Trimester

Injection Anafortan (camylofin + paracetamol) can be used cautiously in the first trimester, but only when medically necessary, at the lowest effective dose for the shortest possible duration. The paracetamol component is considered acceptable for pregnancy, while camylofin (an antispasmodic) has limited safety data but has been studied in labor without major adverse effects.

Component Analysis

Paracetamol (Acetaminophen) Component

The paracetamol component is considered reasonable for first-trimester use when medically indicated:

• The Society for Maternal-Fetal Medicine advises that acetaminophen should be used at the lowest effective dose for the shortest possible duration during pregnancy 1
• Paracetamol is the most widely used medication during pregnancy, with 40-65% of pregnant women using it at some point 1
• Paracetamol crosses the placenta relatively easily and has been detected in umbilical cord blood after maternal administration 1

Important safety considerations for paracetamol:

• Recent observational studies suggest associations between prenatal paracetamol exposure and neurodevelopmental outcomes, including 12-25% increased risk of ADHD symptoms and 12.9% increased risk of autism spectrum disorder 1
• However, the FDA and SMFM have determined that "the weight of evidence is inconclusive regarding a possible causal relationship between acetaminophen use and neurobehavioral disorders" 1
• The risk appears dose-dependent, particularly for exposure ≥28 days, so short-term use is preferred 1

Camylofin Component

The camylofin (antispasmodic) component has limited first-trimester safety data:

• Camylofin dihydrochloride has been studied as an antispasmodic during labor in randomized controlled trials, where it reduced the duration of first stage of labor by an average of 65.80 minutes 2
• The main maternal adverse event reported with antispasmodics including camylofin was tachycardia, with no serious neonatal adverse events reported in labor studies 2
• However, these studies were conducted during labor (term pregnancy), not specifically in the first trimester 2

Clinical Recommendations

When considering Anafortan injection in the first trimester:

• Use only when medically indicated for pain or spasm that could harm the mother or fetus if left untreated 1
• The first trimester is the period of highest risk for medication-induced teratogenicity, and if possible, all medications should be avoided during this time 3
• Communication regarding risks versus benefits should occur between patient and provider 1
• Use the lowest effective dose for the shortest possible time to minimize fetal exposure 1

Key Precautions

Avoid prolonged or excessive use:

• Long-term paracetamol exposure (≥28 days) shows stronger associations with neurodevelopmental risks compared to short-term use 1
• Pregnant women who use paracetamol should be closely monitored across all trimesters 1

Monitor for maternal side effects:

• Watch for maternal tachycardia, which is the main adverse event associated with antispasmodic components 2

Consider alternatives when appropriate:

• For simple constipation or mild discomfort, non-pharmacological approaches should be tried first 3
• Ensure adequate hydration and rest as supportive measures 3