Medications that Should Be Used with Caution or Are Contraindicated in Pregnancy

• acyclovir (Zovirax): Category C— may cause chromosomal breaks at very high concentrations. No data available on risk in breast feeding.

• erythromycin estolate (Ilosone): Category B relative to fetus but contraindicated due to maternal risk of cholestatic hepatitis. No risk in breast feeding. All other erythromycin preparations are considered safe in pregnancy and breast feeding.

• lindane (Kwell): Category C— less toxic alternatives exist. Considered safe in breast feeding

• metronidazole (Flagyl): Category B— contraindicated in first trimester; use in later trimesters if benefits outweigh the risk. Discontinue breast feeding during use—recommend single dose therapy with resumption of breast feeding 12-24 hours after use.

• nitrofurantoin (Macrodantin, Macrobid): Category B— contraindicated in third trimester because of possibility of hemolytic anemia. Avoid during breast feeding if infant at risk for G6PD deficiency; otherwise considered safe.

• Quinolones: ciprofloxacin (Cipro), norfloxacin (Noroxin), ofloxacin (Floxin), levofloxacin (Levaquin): Category C— may cause arthropathy in fetuses, although recent review does not substantiate this risk.

• sulfonamides: Category B in first and second trimesters; Category D in third trimester due to possible kernicterus. Avoid during breast feeding in premature infants and infants with hyperbilirubinemia or G6PD deficiency. Considered safe in full term infants without medical problems.

• tetracyclines/doxycycline (Vibramycin): Category D— may stain teeth and bone.

• trimethoprim/sulfamethoxazole (Bactrim, Septra): Category C in first and second trimesters; Category D in third trimester. See s.y.!foD.§mld§s,, above. Trimethoprim interferes with folic acid metabolism and should be used in the first and second trimesters only if the potential benefits outweigh the risks.

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