Pregnancy, prescription drugs

Pharmaceuticals

Embryonic period (1st-12th week of gestation)

Fetal period (from 13th week of gestation)

Peripartum period

Lactation period

ACE inhibitors

2

T

T

2

Acetylcysteine

1

1

1

1

Acetylsalicylic acid (low-dose unlimited)

2/E

2/E

2/E

2/E

Aciclovir

2

2

2

2

Acitretin

K

K

K

K

Ambroxol

1

1

1

1

Aminoglycosides

T

T

T

2

Amitryptilin

1

1

T

1

amphotericin B

2

2

2

2

Antidiabetics, oral

K

K

K

K

Atropine

1/E

1/E

1/E

1/E

Benzyl benzoate (external use)

1

1

1

1

ß-receptor blockers

1

1

E

1/2

ß-Sympathomimetics (for inhalation)

1

1

E

1

Biperidine

2

2

2

2

Bromhexine

1

1

1

1

Bromocriptine

2

T

T

T/E

Carbamazepine

T

2

T

T

Carbimazole

2

2

2

2

Cephalosporins

1

1

1

1

Cetirizine

2

2

2

1

Chloramphenicol

T

T

T

T

Chloroquine (antimalarial agent)

1

1

1

1

Chlorphenoxamine (external application)

1

1

1

1

Chlorpromazine

2

2

T

2

Cimetidine

2

2

2

2

Ciprofloxacin

2

2

2

2

Clarithromycin

2

2

2

2

Clemastine

1

1

1

2

Clofibrate

2

2

2

2

Clomethiazole

2

2

2

2

Clonidine

2

2

2

2

Clotrimazole

2

1

1

1

Codeine

1/E

1/E

1/E

1/E

Cotrimoxazole

2

2

2

2

Cromoglicic acid

1

1

1

1

Coumarin derivatives

K

2

K

2

Cyproterone acetate

K

K

K

K

1 = 1st choice product: Generally well tolerated during pregnancy and lactation. Also, these drugs should only be prescribed if their use is superior to a non-drug therapy.

2 = 2nd choice remedy: Only indicated when other therapeutic options fail. Often insufficient testing during pregnancy and lactation.

E = Single dose or low dosage for a maximum of 1-3 days.

K = Contraindicated: Because of embryo-fetotoxic potential, possible intolerance during lactation or because there is no rational indication during pregnancy. Extended prenatal diagnosis may be necessary.

T = Potentially toxic: Concerns embryo, foetus, newborn or breastfed infant. Use only in justified individual cases. In case of use, extended prenatal diagnostics may be necessary.

Pharmaceuticals

Embryonic period (1st-12th week of gestation)

Fetal period (from 13th week of gestation)

Peripartum period

Lactation period

Dextran

2

2

2

2

Diazepam

1

1/E

T

T

Diclofenac

1

T/E

T/E

E

Digoxin/digitoxin

1

1

1

1

Dihydralazine

1

1

1

1

Dihydroergotamine

2

2

T

2

Dimenhydrinate

2

2

2

1

Dimetinden

1

1

1

1

Diphenhydramine

1

1

T

1/E

Doxycycline

2

K

K

2

Doxylamine

1

1

1

1

Ergotamine tartrate

T

T

T

T

Erythromycin

1

1

1

1

Ethambutol

1

1

1

1

Etilefrin

2

2

2

2

Fenbufen

1

T/E

T/E

1

Fentanyl

1

1

T

2

Fluconazole

2

2

2

2

Furosemide

2

2

2

2

Gestagens (used as contact pills during lactation)

K

K

K

1

Glucocorticoids

2

2

2

2

Glycerol trinitrate

2

2

2

2

Gold compounds

2

2

2

2

Griseofulvin

2

2

2

2

Haloperidol

2

2

T

2

Heparins

1

1

T

1

Hydrochlorothiazide

2

2

2

2

Hydroxyethyl starch

1

1

1

1

Ibuprofen

1

T/E

T/E

1

Imipramine

1

1

T

1

Indomethacin

1

T/E

T/E

E

Insulin (human)

1

1

1

1

isoniazid + vitamin B6

1

1

1

1

Isotretinoin

K

K

K

K

Itraconazole

2

2

2

2

Iodide (iodine substitution)

1

1

1

1

Ketoconazole

2

2

2

2

Lithium salts

T

T

T

T

Local anaesthetics

Loratadine

2

2

2

1

Mebendazole

2

1

1

1

Meclizine

1

1

1

1

Mefloquine (malaria prophylaxis and therapy)

2

2

2

2

Metamizole

2

T

T

T

Methimazol

2

2

2

2

α-Methyldopa

1

1

1

1

Methylergometrin

K

K

T

T/E

Metoclopramide

2

2

2

2

Miconazole (local)

2

2

2

2

1 = 1st choice product: Generally well tolerated during pregnancy and lactation. Also, these drugs should only be prescribed if their use is superior to a non-drug therapy.

2 = 2nd choice remedy: Only indicated when other therapeutic options fail. Often insufficient testing during pregnancy and lactation.

E = Single dose or low dosage for a maximum of 1-3 days.

K = Contraindicated: Because of embryo-fetotoxic potential, possible intolerance during lactation or because there is no rational indication during pregnancy. Extended prenatal diagnosis may be necessary.

T = Potentially toxic: Concerns embryo, foetus, newborn or breastfed infant. Use only in justified individual cases. In case of use, extended prenatal diagnostics may be necessary.

Pharmaceuticals

Embryonic period (1st-12th week of gestation)

Fetal period (from 13th week of gestation)

Peripartum period

Lactation period

Nifedipine

2

2

2

1

Nitrendipine

2

2

2

2

Nitrofurantoin

2

2

2

2

Norfenefrin

2

2

2

2

norfloxacin

2

2

2

2

Nystatin

1

1

1

1

Estrogens

K

K

K

2

Ofloxacin

2

2

2

2

Opium alkaloids

1/E

1/E

T/E

T/E

Oxytocin

K

K

1

1

Paracetamol

1

1

1

1

Penicillamine (except M. Wilson)

K

K

K

K

Penicillin

1

1

1

1

Pentazocin

2

2

T

2

Pethidine

2

2

T

2

Phenobarbital (as an anticonvulsant)

T

2

T

T

Phenylbutazone

2

T

T

2

Phenytoin

T

T

T

1

Polyvidon iodine (except small areas)

K

K

K

K

Prazosin

2

2

2

2

Primidone

T

2

T

T

Probenecid

1

1

1

1

Proguanil (malaria prophylaxis)

1

1

1

1

Promethazine

2

2

T

2

Propylthiouracil

1

1

1

1

Prostaglandins

K

K

E

K

Pyrethrum (external)

1

1

1

1

Pyrimethamine

2

2

T

1

Pyrvinium Emboat

1

1

1

1

Ranitidine

2

2

2

2

Radiopharmaceuticals

K

K

K

K

Rifampicin

1

1

1

1

Spironolactone

2

2

2

2

Sulfonamides

2

2

T

2

Terfenadine

2

2

2/E

2/E

Testosterone

K

K

K

K

Tetracyclines

2

K

K

2

Theophylline

1

1

1

1

Thiamazole

2

2

2

2

Thyroxine (L-)

1

1

1

1

Tinidazole

2/E

2/E

2/E

2/E

Tramadol

2

2

T/E

2/E

Tretinoin (external)

K

K

K

2

Valproic acid

T

T

T

1

Verapamil

2

2

2

1

Vitamin A (> 10,000 IU/day)

K

K

K

K

1 = 1st choice product: Generally well tolerated during pregnancy and lactation. Also, these drugs should only be prescribed if their use is superior to a non-drug therapy.

2 = 2nd choice remedy: Only indicated when other therapeutic options fail. Often insufficient testing during pregnancy and lactation.

E = Single dose or low dosage for a maximum of 1-3 days.

K = Contraindicated: because of embryo-fetotoxic potential, possible intolerance during lactation or because there is no rational indication during pregnancy. Extended prenatal diagnosis may be necessary.

T = Potentially toxic: Concerns embryo, foetus, newborn or breastfed infant. Use only in justified individual cases. In case of use, extended prenatal diagnostics may be necessary.

Pharmaceuticals

Indication during pregnancy

Antimycotics

Amorolfin

3

amphotericin B

1

Bifonazole

2

Ciclopirox

3

Clotrimazole

1

Croconazole

2

Econazole

2

Fenticonazole

2

Fluconazole

2

Isoconazole

2

Ketoconazole

2

Naftifin

3

Nystatin

1

Sertaconazole

2

Terbinafine

3

Tioconazole

2

Tolciclat

3

Tolnoftat

3

Glucocorticoids

Glucocorticoids (topical application forms of various active substance classes such as ointments/creams/sg./gels)

No objections to local therapy limited in time and space

Antiparasitosa

Allethrin I

2

Benzyl benzoate

1

Crotamiton

2

Coconut oil

1

Lindane

banned in Germany since 2008!

Pyrethrin

2

Pyrethrum extract

1

vitamin D3 analogues

Calcipotriol

Repeated applications over large areas should be avoided, especially if the effect is favourable to absorption

Dithranol

Repeated applications over large areas should be avoided, especially if the effect is favourable to absorption

Other

5-fluorouracil

Contraindicated (Exception: therapy of single verrucae. In principle, however, an attempt should be made to postpone the therapy until after delivery)

aluminium aceticum

1

Ammonium bituminosulfonate

No objections to local therapy limited in time and space

Ethanol

1

Benzoyl peroxide

May be used for acne treatment of limited areas (e.g. face)

Bufexamac

No objections to local therapy limited in time and space

Quinolinol

Should not be used

Clioquinol

No objections to local therapy limited in time and space

Diethyltoluamide (DEET, Autan)

No safe large-scale application during pregnancy. In malaria areas, the risk associated with the use of DEET is less than the risk of malaria infection

Haemorrhoid remedies

Harmless. The application has been proven safe during pregnancy

Urea

No objections to local therapy limited in time and space

Isopropyl alcohol

1

Camphor

Allowed

Crystal Violet

Small and short-term topical applications are possible

Menthol

Allowed

Methylrosanilinium chloride (gentian violet)

Small and short-term topical applications are possible

pix lithanthracis

Do not use if possible

Polidocanol

Allowed

PUVA therapy (PUVA bath, cream-PUVA)

Not recommended due to possible mutagenic effects

Pyoctanin

Small and short-term topical applications are possible

Mercury compounds

Contraindicated

Retinoids

Contraindicated

Salicylates

No objections to local therapy limited in time and space

Tannin

1

1 = 1st choice product: Generally well tolerated during pregnancy. Also, only prescribe these drugs if their use is superior to a non-drug therapy.

2 = 2nd choice remedy: Only indicated if other therapeutic options fail. Often insufficient testing during pregnancy and lactation.

3 = Agents which should not be used during pregnancy due to insufficient data or for other reasons.

Largely harmless

After risk-benefit analysis

Contraindicated

Pregnancy

Penicillins, cephalosporins, erythromycin (except estolate), fusidic acid

Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, fosfomycin

Tetracyclines, chloramphenicol, clarithromycin, TMP/sulfonamides (1st trimester and from 28th week), metronidazole, aminoglycosides, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, tigecyclin

Breastfeeding period

penicillins, cephalosporins

Clavulanic acid, sulbactam, tazobactam, meropenem, imipenem, ertapenem, azithromycin, roxithromycin, clindamycin, vancomycin, teicoplanin, linezolid, aminoglycosides, fosfomycin

Tetracyclines, chloramphenicol, TMP/sulfonamides, erythromycin, metronidazole, fluoroquinolones, nitrofurantoin, rifampicin, telithromycin, ertapenem, tigecyclin