Teratogenic drugs
Drugs during pregnancy
Safe:
ABX: penicillins, piperacillin, mezlocillin, cephalosporins, azteronam, monobactam, imipenem, erythromycin (except estolate form), azithromycin, clindamycin, nitrofurantoin, vancomycin, INH, rifampin, ethambutol,
Quinolones are not recommended during pregnancy, except in resistant infections.
Antifungal: clotrimazole, miconazole, nystatin, fluconazole, itraconazole, butaconazole, amphotericin-B.
Antiviral: zidovudine, zalcitabine (ddC), didanosine (ddI), stavudine (d4T), lamivudine (3TC), acyclovir, ganciclovir, amantidine (has embryotoxic potential), oseltamivir, interferon.
Drugs or substances suspected or proven to be human teratogens: ACEI, alcohol, aminopterin, androgens, busulfan, carbamazepine, chorbiphenyls, coumarin, cyclophosphamide, danazol, DES, etiretinate, isotretinoin, lithium, methimazole, methotrexate, penicillamine, phenytoin, radioactive iodine, tetracycline, trimethadione, valproic acid:
Tetracyclines: parenteral tetracyclines including doxycycline and minocycline can cause fulminant maternal hepatitis and pancreatitis when administered during the 3rd trimester of pregnancy. Oral tetracycline causes staining and deformity of deciduous teeth as well as deposition in fetal long bones. They should be avoided in pregnancy. The only exception for their use in pregnacy is in treatment of maternal syphilis in penicillin-allergic women for whom sensitization is impractical.
Aminoglycosides: Streptomycin causes fetal CN VIII damage, if given for protracted period of time.
Sulfonamides: maternal toxicity does not increase with sulfonamides, but fetal toxicity does in the perinatal period and during 1st trimester. This is because the neonatal liver is unable to conjugate sulfonamides, resulting in hyperbilirubinemia and kernicterus (blockage of binding sites necessary to conjugate bilirubin).
TMP is a folate antagonist. Although no congenital anomalies have been reported with its use, it must not be used.
Griseofulvin: congenital anomalies of CNS and musculoskeletal
Ribavirin: antiviral given by aerosol inhalation for treatment of RSV. Pregnant women working in intensive care nuseries must avoid inhaling the drug (given to neonates). Causes hydrocephalus, and limb anomalies.
Tobacco: fetal growth retardation.
Cocaine: placental abruption
Thalidomide: phocomelia.