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Chapter 113: Drugs in Pregnancy

Natalie Kostelecky; Stephen M. Pastores

DRUGS IN PREGNANCY

The Food and Drug Administration (FDA) has established 6 categories (A, B, C, D, X, and N) to indicate the potential of a drug to cause birth defects if used during pregnancy.† The categories are determined by the reliability of documentation and the risk to benefit ratio. They do not take into account any risks from pharmaceutical agents or their metabolites in breast milk.

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Class of Medication FDA Pregnancy Category Risk
Analgesics and sedative agents
Acetaminophen C
Acetylsalicylic acid* D
Fentanyl* C
Hydromorphone* C
Ibuprofen* C (first and second trimester); D (third trimester)
Indomethacin* C (first and second trimester); D (third trimester)
Ketorolac* C (first and second trimester); D (third trimester)
Meperidine* C
Methadone* C
Morphine* C
Oxycodone* C
Oxymorphone* C
Midazolam D
Lorazepam D
Propofol B
Dexmedetomidine C
Anesthetic agents
Halothane C
Isoflurane C
Ketamine N
Lidocaine (local) B
Propofol B
Antiarrhythmic agents
Adenosine C
Amiodarone D
Digoxin C
Diltiazem C
Esmolol C
Flecainide C
Metoprolol C
Antimicrobial agents
Penicillins B
Cefazolin B
Cefepime B
Ceftriaxone B
Imipenem-cilastatin C
Meropenem B
Amikacin D
Gentamicin D
Tobramycin D
Erythromycin B
Levofloxacin C
Clarithromycin C
Ciprofloxacin C
Vancomycin C
Linezolid C
Aztreonam B
Clindamycin B
Metronidazole B
Trimethoprim-sulfamethoxazole D
Tetracyclines D
Polymyxin B B
Acyclovir B
Famciclovir B
Valacyclovir B
Foscarnet C
Ganciclovir C
Oseltamivir C
Amantadine C
Rimantadine C
Amphotericin B B
Lipid Amphotericin (AmBisome) B
Fluconazole D
Ketoconazole C
Caspofungin C
Micafungin C
Voriconazole D
Posaconazole C
Rifampin C
Isoniazid C
Ethambutol C
Streptomycin D
Atazanavir B
Didanosine B
Emtricitabine B
Ritonavir B
Tenofovir B
Efavirenz D
Indinavir C
Lamivudine C
Lopinavir C
Nevirapine B
Zidovudine C
Anticoagulant and antithrombotic agents
Unfractionated heparin C
Warfarin X
Enoxaparin B
Dalteparin B
Fondaparinux B
Rivaroxaban C
Apixaban B
Edoxaban C
Argatroban B
Aminocaproic acid C
Alteplase C
Streptokinase C
Dabigatran C
Tinzaparin B
Bivalirudin B
Desirudin C
Tranexamic acid B
Clopidogrel B
Anticonvulsant agents
Phenytoin D
Phenobarbital D
Carbamazepine D
Valproic acid X
Levetiracetam C
Lamotrigine C
Gabapentin C
Topiramate D
Antidepressant, anxiolytic and antipsychotic agents
Lorazepam D
Clonazepam D
Midazolam D
Diazepam D
Alprazolam D
Aripiprazole C
Chlordiazepoxide C
Chlorpromazine C
Haloperidol C
Olanzapine C
Quetiapine C
Risperidone C
Ziprasidone C
Bupropion C
Buspirone B
Zolpidem C
Lithium D
Antihistaminic agents
Cetirizine B
Chlorpheniramine B
Diphenhydramine B
Fexofenadine C
Hydroxyzine C
Loratadine B
Meclizine B
Promethazine C
Antihypertensive agents
Labetalol C
Nicardipine C
Esmolol C
Atenolol D
Clonidine C
Methyldopa B
Hydralazine C
Sodium nitroprusside C
Captopril D
Enalapril D
Irbesartan D
Candesartan D
Gastrointestinal agents
Cimetidine B
Docusate N
Famotidine B
Lactulose B
Lansoprazole B
Loperamide C
Mesalamine C
Metoclopramide B
Omeprazole C
Ondansetron B
Opium tincture B
Pantoprazole B
Prochlorperazine C
Promethazine C
Ranitidine B
Senna C
Simethicone N
Sucralfate B
Ursodiol B
Respiratory agents
Acetylcysteine B
Albuterol C
Budesonide B
Corticosteroids C
Dextromethorphan C
Guaifenesin C
Ipratropium B
Montelukast B
Salmeterol C
Theophylline

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