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   Prescription Drugs of Choice During Pregnancy
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Condition Medication Reference(s)
Asthma Albuterol is rescue therapy of choice
Budesonide is the preferred inhaled corticosteroid
Long-acting b2-agonists salmeterol  is the preferred add-on controller therapy 		1
Bacterial Vaginosis Treatment is recommended for all pregnant women with symptoms.
Metronidazole OR
Clindamycin 		2
Chlamydia Azithromycin 2
Cholestasis of pregnancy  Ursodeoxycholic acid (UDCA) 14
Chronic hypertension Labetalol OR / AND
Methyldopa  >OR / AND>
Nifedipine slow-release preparation		 3.
Chronic urticaria Cetirizine or loratadine 31
Depression , mild Psychotherapy such as cognitive-behavioral therapy (CBT) OR interpersonal therapy 18
Depression , severe  Psychotherapy AND fluoxetine.
Alternative medications: sertraline or  tricyclic antidepressant		 18
Depression with psychosis Electroconvulsive therapy OR
Haloperidol AND antidepressant as above		 18
Depression mild, postpartum while breast-feeding Psychotherapy with or without antidepressant (sertraline or paroxetine) 18
Depression severe, postpartum while breast-feeding Supportive services AND sertraline
Alternative medication: Paroxetine 		18, 19
Diabetes  Insulin 4, 30
Epilepsy  Monotherapy with lamotrigine or leviteracetam . Monitoring of drug levels and dose adjustments are required. 36,37
Gonorrhea; uncomplicated genital

Ceftriaxone 250 mg as a single intramuscular dose, plus  azithromycin 1 g orally in a single dose
Patients with severe penicillin or cephalosporin allergy  gentamicin 250 mg IM  and 2-g oral azithromycin.

 5, 29
Hepatitis B  Tenofovir  27,28
Herpes  Acyclovir OR
Valacyclovir		 6.
Human immune deficiency virus
  • Abacavir and lamivudine is the preferred backbone combination for antiretroviral (ARV) -naive pregnant women
  • Atazanavir/ritonavir and darunavir/ritonavir are the preferred protease inhibitor (PI) drugs for use in ARV-naive pregnant women
  • SEE ALSO https://clinicalinfo.hiv.gov/en/guidelines/perinatal/whats-new for the most up to date guidelines
    		•   32
    Hypothyroidism  Levothyroxine 7,15
    Hyperthyroidism Propylthiouracil (PTU). in the first trimester of pregnancy.
    Methimazole  after first trimester
    Beta adrenergic blocking agents, such as propranolol  may be used for controlling hypermetabolic symptoms.    		 7
    Idiopathic thrombocytopenic purpura (ITP) Prednisone.
    IVIg may be used with corticosteroids when a more rapid increase in platelet count is required, or corticosteroids are contraindicated     		8.
    Inflammatory Bowel Disease (IBD) " In general, women on 5-ASA, thiopurine, or anti-tumor necrosis factor (TNF) monotherapy for maintenance should continue therapy throughout pregnancy...Women who have a mild to moderate disease flare while on optimized 5-ASA or thiopurine therapy should be managed with systemic corticosteroid or anti-TNF therapy, and those with a corticosteroid-resistant flare should start anti-TNF therapy. " 38
    Malaria Chloroquine , hydroxychloroquine
    For chloroquine-resistant P. falciparum infection, treat with either mefloquine or a combination of quinine sulfate and clindamycin     		 16,17
    Nausea and vomiting of pregnancy Doxylamine succinate and pyridoxine hydrochloride.
    Refractory cases add promethazine or dimenhydrate . If still no response add metoclopromide .    		 9, 36
    Pediculosis Pubis Permethrin 1% cream  OR
    Pyrethrins with piperonyl butoxide     		2
    Preeclampsia prevention Low-dose aspirin (81 mg/d) after 12 weeks of gestation in women who are at high risk for preeclampsia. 20-26
    Pyelonephritis
  • Cefriaxone  OR
  • Ampicillin AND  genatmicin OR
  • Cefazolin  OR
  • Cefotetan > OR
  • Aztreonam
    (Several other regimens are also acceptable )
    		•   10,11

     
     Rheumatoid arthritis (RA)  Prednisolone, hydroxychloroquine <=400 mg/day, sulfasalazine (with folic acid 5 mg/day in first trimester),azathioprine, ciclosporin (cyclosporine), certolizumab, intravenous immunoglobulin 40
    Seizure , eclamptic Magnesium, " Levetiracetam may be preferable in patients with myasthenia gravis, a condition that may be exacerbated by phenytoin." 21, 41
    Septic shock,  vasoactive therapy Norepinephrine 34
    Scabies Permethrin cream 5% 2
    Sustained* Supraventricular Tachycardia (SVT),  Fetal,  without hydrops or ventricular dysfunction . First or second line: Digoxin, Flecainide, Sotalol

     Sustained : occurring the majority of time or >≈50% of time monitored

    		 35
    Supraventricular Tachycardia (SVT), Maternal, Acute treatment Vagal maneuvers: >Valsalva for 10 to 30 seconds, carotid sinus massage (steady pressure for 5 to 10 seconds ) after absence of bruit has been confirmed by auscultation, ice-cold wet towel to the face .

    When vagal maneuvers fail to terminate SVT :
    First line drug: Adenosine .
    Second line:  Intravenous metoprolol , propranolol,
    Third line: Intravenous verapamil or procainamide

    When pharmacological therapy is ineffective or contraindicated:
    Synchronized cardioversion     		33
    Syphilis Benzathine penicillin 2
     Systemic lupus erythematosus (SLE) : Hydroxychloroquine , nonfluorinated corticosteroids, azathioprine not exceeding 2 mg/kg per day, cyclosporine A, certolizumab .
    		 39
    Trichomoniasis Metronidazole 2
    Ulcer Sucralfate
    Ranitidine    		 13
    Urinary tract infection Nitrofurantoin ( Avoid in first trimester)
    Cephalexin    		 11
    Venous thromboembolism (VTE) Low Molecular Weight Heparin
    Enoxaparin > OR
    Dalteparin>   OR
    Tinzaparin    		  12.
    Vulvovaginal Candidiasis  Only topical azole therapies, applied for 7 days, are recommended
    Terconazole 0.4% cream     		2
     

    Changes may occur, since the last update, which affect the accuracy and availability of the information presented. Visitors are advised to verify the information independently.

     Reviewed by Mark Curran, M.D.

     References

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