The use of Hantihistamines during pregnancy has been very controversial due to possible teratogenic effects of these drugs. None of the antihistamines available today have been categorized as safe during pregnancy.
Control studies are available for certain first generation drugs regarding their safety in pregnancy, but the newer agents require further studies to be declared safer in pregnancy. A few drugs are comparatively safer to use in pregnancy than others. Pruritus is one of the most common dermatological symptoms in pregnancy.
Pruritus occurs due to various causes, and it can occur any time during pregnancy. Causes for pruritus in pregnancy are numerous ranging from specific dermatoses of pregnancy to various dermatological conditions such as atopic dermatitis, urticarial, infections, and infestations or drug induced. In addition to these, various systemic diseases can also manifest with pruritus.
Other than itching antihistamines are also used for various allergic diseases and also used for emesis during pregnancy. Any drug taken during the pregnancy has a potential teratogenic effect on the fetus. If a drug is consumed during the first trimester, it can result in severe structural fetal malformations and in the later part of pregnancy it can result in various functional defects or growth disorders and can also lead to minor malformations.
Drugs taken during the pregnancy can also lead to after effects in the neonatal and infancy period. All pharmacological interventions are generally avoided during pregnancy due to the alarming information present in the patient information leaflet and also on the drug envelopes.
The physician has to weigh the benefits of the treatment against the potential teratogenic effects before using any drug during pregnancy. Among the drugs prescribed during pregnancy, antihistamines are one of the commonest, either as an antipruritic agent or an antiemetic agent. Various studies on the use of antihistamines H 1 blockers during pregnancy, including a meta-analysis of more than , women shows no increase in the teratogenic risk of these drugs in the humans.
Drugs such as dexchlorpheniramine and alimemazine trimeprazine were not found to have any teratogenic effect even in animal studies. None of the antihistamines has been so far declared safe during the pregnancy by FDA on the basis of controlled animal or human studies. The first generation antihistamines include drugs such as diphenhydramine, cyproheptadine, promethazine, chlorpheniramine, and hydroxyzine.
They have a very potent effect with high lipophilicity but are short acting. They are metabolized in the liver by the microsomal cytochrome P system. The common side effects of this category of antihistamines include sedation and anticholinergic effects—dryness of the mouth, blurring of vision, constipation and urinary retention. FDA has categorized the first generation antihistamines according to the pregnancy complications [ Table 1 ].
Michigan Medicaid Birth Defects study has linked hydroxyzine to cleft palate in new borns. Pregnancy category B means the drug has failed to demonstrate a risk to the fetus in animal reproduction studies and there is a lack of well-controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy category C means that animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.
The second generation antihistamines include drugs such as loratadine, fexofenadine, cetirizine, and azelastine. They have a high therapeutic index, with highly selective actions and are nonsedating. They are long acting, but are poorly lipophilic and hence have no entry to the central nervous system. Side effects of the second generation antihistamines include photosensitivity, tachycardia, and prolongation of the Q—T interval. They can also give you unwanted side effects. Take Benadryl sparingly and only when you really need to.
You may want to try natural remedies after confirming their safety with your doctor to help soothe your allergy symptoms instead. Some medicines are considered unsafe to take during pregnancy. They may be damaging to you or your developing baby.
Discover some medicines to avoid…. High blood pressure is common during pregnancy, but can also be a serious concern to monitor. High blood pressure during pregnancy can occur due to….
Food poisoning occurs when you consume foods contaminated with bacteria, viruses, or parasites. Symptoms are usually uncomfortable but not severe. What you eat during pregnancy is important for your health, as well as the health of your baby. Here are 13 foods you should eat when you're pregnant. Certain foods can be very harmful for pregnant women and their babies. This is a list of 11 foods and drinks that pregnant women should avoid.
A new study finds that epidurals do not affect child development in their later years. A fetal arrhythmia is an irregular heart rate — too fast, too slow, or otherwise outside the norm.
It's often benign. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Diary from a Week in Practice. Jun 15, Issue. Over-the-Counter Medications in Pregnancy. Category B Either animal reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.
Category C Either studies in animals have revealed adverse effects on the fetus teratogenic or embryocidal or other and there are no controlled studies in women, or studies in women and animals are not available. Category D There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk e. Category X Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit.
Decongestants, Expectorants, and Antihistamines Women commonly use cold medications during pregnancy. Antacid Preparations Several antacids are available in OTC forms, including preparations that contain alginic acid, aluminum, magnesium, and calcium.
Antifungals The most common antifungal medications available as OTC drugs include the imidazole agents clotrimazole Mycelex , butoconazole Femstat , miconazole Monistat , and tioconazole Vagistat Smoking Deterrents Nicotine replacement therapy presents an interesting clinical dilemma. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription.
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Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Acetaminophen Tylenol. Pain reliever of choice. Ibuprofen Advil, Motrin. Chlorpheniramine Chlor-Trimeton. Antihistamine of choice.
Pseudoephedrine hydrochloride Novafed. Sympathomimetic decongestant. Guaifenesin Humibid L. Dextromethorphan hydrobromide Benylin DM. Non-narcotic antitussive. Appears to be safe in pregnancy.
Diphenhydramine Benadryl. Possible oxytocin-like effects at high dosages. Clemastine fumarate Tavist. Unknown safety profile. Kaolin and pectin Kaopectate. Antidiarrheal of choice not absorbed. Bismuth subsalicylate Pepto Bismol. Not recommended salicylate absorption. Not recommended adverse animal studies. Generally regarded as safe.
Calcium carbonate Tums. Simethicone Mylanta Gas. Preferred after antacids; generally regarded as safe. Probably safe, data needed. Butoconazole Femstat. Clotrimazole Lotrimin. Miconazole Monistat. Tioconazole Vagistat Updated July 13, Food and Drug Administration. Updated October 1, American Family Physician. Over the Counter Medications in Pregnancy. October 15, Effects of fexofenadine, diphenhydramine, and alcohol on driving performance. A randomized, placebo-controlled trial in the Iowa driving simulator.
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