More on Medications in Pregnancy

/ April 1st, 2012/ Posted in Women's Health / Comments Off on More on Medications in Pregnancy

Last week, I talked about drugs and medications in pregnancy including over-the-counter remedies, birth control pills accidentally taken while pregnant, and epilepsy medicine. This week I will touch on high blood pressure medications, psychiatric drugs and herbal remedies. As I’ve said before, there are many books devoted to this topic and each medication comes with a packet of information, including facts about its effects in pregnancy.
High blood pressure is pretty common in pregnancy and there are a number of medications used to treat it. A category of drugs called ACE inhibitors should not be taken at any time during pregnancy. When taken in the first trimester, ACE inhibitors may cause malformation of the baby’s kidneys. Taken in the second and third trimester, it can cause the baby’s kidneys to shut down entirely.

Relatively safe high blood pressure drugs include the calcium channel blockers such as Procardia® and beta-blockers like Labetolol®. I’ll talk more about high blood pressure in a future column.

Accutane®, used to treat severe, cystic acne, is one of the most teratogenic drugs around. It is so dangerous in pregnancy that doctors prescribing it are advised to recommend a strict protocol of birth control after first checking a pregnancy test, and have patients sign informed consent agreements before taking it. It is fat-soluble, so it can be stored in the body for up to three months after the last dose is taken. If you have used Accutane®, I recommend using contraception for three months after you stop taking it to make sure all of it is out of your body before you try to conceive.

Diuretics are another thing to be careful of in pregnancy. So-called “water pills” may be used by non-pregnant women for bloating or swelling, and you may have some in the house. Don’t use these when you are pregnant, unless prescribed by your doctor. Bloating and swelling are common in pregnancy, and diuretics can cause dehydration and other problems.

Psychiatric medications like Prozac®, an anti-depressant, and Xanax® an anti-anxiety drug, are generally safe in pregnancy. That said, remember that Prozac® and other drugs from the SSRI class affect brain chemistry and have not been used long enough to study their effects on the developing brain fully. They are to be used judiciously.

Lithium, used to treat bi-polar disorder, may have a small risk of causing heart defects in the fetus and should be avoided during pregnancy. If you need lithium to stay healthy, don’t stop taking it on your own if you find out you are pregnant, but if you’re thinking of trying to get pregnant, talk to your psychiatrist about alternatives.

As for herbal remedies: These substances aren’t regulated by the government and the amounts of the agents, like St. John’s Wort and echinacea, vary from formula to formula.

Since we really don’t have clear evidence that echinacea lessens cold symptoms or that St. John’s Wort cures depression, why use them at all?

Lastly, be sure to tell your midwife or doctor whether you are taking any medication at all, including cold remedies and things you may buy in the health food store. It is important to note all medications, as well as any allergies to medications, in your prenatal record in case you need to receive other treatment later on in the pregnancy.

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