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Wednesday, April 17, 2024

Medications that you should say no when planning pregnancy

Debe leer

One of the most important things that we take advantage of in the preconception consultation is to advise the use of medications during pregnancy, so good communication with your doctor is imperative regarding the medications you are currently taking.

One of the great benefits of going to a preconception consultation is that from before pregnancy we can make adjustments to the medications that a patient takes for their chronic diseases (diabetes, hypertension, rheumatoid arthritis, kidney failure, etc.) and thus decrease the negative impact on a future pregnancy. If the patient does not take medication, we can advise on which medications to avoid. A WHO classification recommendation on drugs during pregnancy is used for this.  

These are classified, A, B, C, D, and X, with the last two being completely prohibited during pregnancy. These are drugs such as methotrexate, alprazolam, chlordiazepoxide, diazepam, phenytoin, phenobarbital, valproic acid, lorazepam, simvastatin, isotretinoin, raloxifene, and finasteride.

 In general terms, we can say that the drugs that are prohibited during pregnancy are anticonvulsants, drugs to regulate immunity, sleeping drugs, antineoplastic drugs, and hormones.

In some chronic diseases, you must assess the risk to benefits.  For example, if you suffer from hyperthyroidism, propylthiouracil should not be used and methimazole should be continued to be measured along with levels of TSH, T3, and free T4 monthly to avoid congenital hypothyroidism.  

Patients with thromboembolic diseases and who wish to become pregnant should stop using Warfarin.

Some medications need to be changed before pregnancy: high blood pressure medications such as enalapril, captopril, irbesartan, losartan, lisinopril, and diabetes medications such as glibenclamide. 

Arthritis/lupus medications such as methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine (unless strictly necessary), steroids (unless strictly necessary) may also need to be changed, as well as antibiotics such as tetracyclines, trimethoprim sulfa, clavulanic acid, chloramphenicol, and ciprofloxacin.

If you take analgesics regularly for some kind of pain, avoid using ibuprofen, naproxen, and dexketoprofen. As for medications for the stomach, it is best to avoid metoclopramide, simethicone, and muscle relaxants for colic.

For coughS, anything that contains phenylephrine or chlorpheniramine should be avoided.

Any drugs taken should be under medical prescription, assessed for their risks and benefits.

Follow the recommendations of your doctor who will advise what medications you should change before and during pregnancy.

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