Prescription Drugs of Choice During Pregnancy
The table below summarizes commonly recommended or preferred options for selected conditions in pregnancy. It is intended as a quick prescribing orientation, not as a substitute for the full guideline, drug monograph, or consultation when a condition is severe, refractory, uncommon, or complicated.
| Condition | Medication / treatment option | Key pregnancy note | Reference(s) |
|---|---|---|---|
| Asthma | Albuterol for rescue therapy. Inhaled corticosteroid controller therapy when indicated; budesonide has the largest pregnancy safety experience. Add long-acting beta2-agonist when clinically indicated for persistent asthma. | Do not undertreat maternal asthma. Step therapy should be individualized by symptom control and exacerbation risk. | 1 |
| Bacterial vaginosis, symptomatic | Metronidazole or clindamycin. | Treat symptomatic pregnant patients. Routine treatment of asymptomatic BV solely to prevent preterm birth is not recommended in most settings. | 2 |
| Chlamydia | Azithromycin 1 g orally once. | Test-of-cure is recommended in pregnancy approximately 4 weeks after treatment. | 2 |
| Cholestasis of pregnancy | Ursodeoxycholic acid (UDCA) for maternal symptoms. | Delivery timing is guided primarily by bile acid level, gestational age, and comorbidities. | 3 |
| Chronic hypertension | Labetalol, extended-release nifedipine, or methyldopa. First-line options | Avoid ACE inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists in pregnancy unless expert-directed exceptional circumstances apply. | 4 |
| Chronic urticaria | Cetirizine or loratadine. | Second-generation antihistamines are generally preferred when ongoing therapy is needed. | 5 |
| Depression / anxiety disorders | Psychotherapy for mild disease when available and acceptable. For moderate to severe, recurrent, or impairing illness, pharmacotherapy may be indicated; SSRIs are commonly used, with sertraline or escitalopram often reasonable first-line choices when starting therapy. | Avoid abrupt discontinuation in stable patients without weighing relapse risk. Psychiatric comorbidity, prior response, suicidality, bipolar disorder, and lactation plans matter. | 6,7 |
| Diabetes, pregestational or medication-requiring gestational | Insulin remains standard when medication is required and glycemic targets are not achieved with nutrition/exercise alone. Metformin may be used in selected patients after counseling. | Use individualized targets, hypoglycemia education, and trimester-specific insulin adjustment. | 8,9 |
| Epilepsy | Monotherapy at the lowest effective dose when feasible. Lamotrigine and levetiracetam are commonly preferred options due to comparatively favorable reproductive safety profiles. | Monitor antiseizure medication levels when appropriate. Avoid valproate when possible, especially for migraine prophylaxis or non-epilepsy indications. | 10,11 |
| Gonorrhea, uncomplicated genital/rectal/pharyngeal | Ceftriaxone 500 mg IM once for patients weighing <150 kg; ceftriaxone 1 g IM once if ≥150 kg. Treat chlamydia if infection has not been excluded. | For cephalosporin allergy or complex resistance concerns, consult infectious disease or an STI expert. Azithromycin is no longer routine dual therapy. | 2 |
| Hepatitis B, high viral load | Tenofovir disoproxil fumarate is commonly used for antiviral prophylaxis in late pregnancy when HBV DNA is high, in addition to neonatal HBIG and vaccination. | Coordinate with hepatology/infectious disease. Timing and threshold depend on guideline framework and viral load. | 12,13 |
| Herpes simplex virus | Acyclovir or valacyclovir for treatment. Suppressive therapy is commonly started at 36 weeks for recurrent genital HSV. | Mode of delivery depends on lesions/prodromal symptoms at labor. | 14 |
| Human immunodeficiency virus (HIV) | Use a complete, suppressive antiretroviral regimen. Current U.S. perinatal guidance lists preferred and alternative regimens; bictegravir/tenofovir alafenamide/emtricitabine is now listed as a preferred option in pregnancy and when trying to conceive. | Do not discontinue ART in pregnancy. Use the NIH perinatal guideline for the latest regimen table, resistance considerations, viral load monitoring, and intrapartum/neonatal management. | 15 |
| Hypothyroidism | Levothyroxine. | Dose requirements often increase in pregnancy. Monitor TSH/FT4 using trimester- and assay-appropriate interpretation. | 16,17 |
| Hyperthyroidism | Propylthiouracil (PTU) is generally preferred in the first trimester; methimazole is generally preferred after the first trimester when antithyroid drug therapy is needed. Short-term beta-blocker therapy may be used for significant adrenergic symptoms. | Use the lowest effective antithyroid drug dose; monitor maternal thyroid function and fetal findings when Graves disease/TRAb is relevant. | 16,17 |
| Immune thrombocytopenia (ITP) | Corticosteroids or IVIg when treatment is indicated; IVIg may be used when a more rapid platelet rise is needed or steroids are contraindicated. | Treatment threshold depends on bleeding, platelet count, gestational age, and anticipated delivery/anesthesia needs. | 18 |
| Inflammatory bowel disease (IBD) | Continue most maintenance therapy, including 5-ASA, thiopurines, and anti-TNF therapy, when needed for disease control. Treat flares rather than stopping effective therapy. | Active disease is usually a greater pregnancy risk than many maintenance medications. Coordinate with gastroenterology. | 19 |
| Malaria | Regimen depends on species, geography/resistance, severity, and gestational age. Chloroquine is used where susceptible. Severe malaria in pregnancy requires urgent parenteral therapy. | Use CDC malaria guidance or expert consultation because resistance patterns and drug availability change. | 20 |
| Migraine headaches | Acute: acetaminophen; metoclopramide, often with diphenhydramine, for persistent migraine/nausea. Sumatriptan may be considered when needed after shared decision-making. Prevention: optimize nonpharmacologic measures; selected beta-blockers, calcium-channel blockers, or other agents may be considered with caution when benefits justify risk. | Evaluate red flags and secondary headache causes, especially new-onset, severe, neurologic, hypertensive, or postpartum headache. Avoid ergot alkaloids; avoid valproate for migraine prevention in pregnancy. | 21 |
| Nausea and vomiting of pregnancy | Pyridoxine, with or without doxylamine, first-line. Add antihistamines, dopamine antagonists, phenothiazines, or metoclopramide based on severity and response. | Assess dehydration, ketonuria, electrolyte abnormalities, weight loss, and alternate diagnoses in severe/refractory cases. | 22 |
| Pediculosis pubis | Permethrin 1% cream rinse or pyrethrins with piperonyl butoxide. | Treat partners and decontaminate bedding/clothing as recommended. | 2 |
| Preeclampsia prevention | Low-dose aspirin 81 mg/day for high-risk patients; consider for patients with more than one moderate-risk factor. Start after 12 weeks, optimally before 16 weeks, and continue until delivery unless contraindicated. | Risk-factor based selection follows ACOG/SMFM and USPSTF frameworks. | 23,24 |
| Pyelonephritis | Initial inpatient management with broad-spectrum beta-lactam therapy; examples include ceftriaxone, cefepime, ampicillin plus gentamicin, or aztreonam for selected beta-lactam allergy scenarios. Tailor to culture and response. | Treat for a total 14-day course. Persistent fever or clinical instability requires evaluation for complications/resistance. | 25 |
| Rheumatoid arthritis (RA) | Pregnancy-compatible options include hydroxychloroquine, sulfasalazine with folic acid, azathioprine, corticosteroids when needed, cyclosporine/tacrolimus in selected cases, and certain biologics including certolizumab. | Preconception medication review is important; stop teratogens such as methotrexate before conception. | 26 |
| Seizure, eclamptic | Magnesium sulfate for seizure treatment and prevention. | Levetiracetam is not standard first-line eclampsia therapy but may be relevant when magnesium is contraindicated or in selected neurologic contexts with specialist input. | 27 |
| Septic shock, vasoactive therapy | Norepinephrine is the preferred first-line vasopressor for septic shock. | Do not delay source control, cultures, antibiotics, fluids, and ICU-level support when indicated. | 28 |
| Scabies | Permethrin 5% cream. | Treat close contacts and repeat treatment when clinically indicated. | 2 |
| Supraventricular tachycardia (SVT), acute maternal treatment | Vagal maneuvers first when stable. Adenosine is first-line drug therapy for acute regular narrow-complex SVT. Beta-blockers, verapamil, procainamide, or synchronized cardioversion may be used depending on rhythm, stability, and contraindications. | Unstable tachyarrhythmia requires synchronized cardioversion. Consider cardiology/electrophysiology for recurrent SVT. | 29 |
| Syphilis | Benzathine penicillin G. | Penicillin is the only recommended therapy with proven fetal efficacy; desensitize if allergic. | 2 |
| Systemic lupus erythematosus (SLE) | Continue hydroxychloroquine unless contraindicated. Pregnancy-compatible options include nonfluorinated corticosteroids, azathioprine, cyclosporine/tacrolimus, and selected biologics when indicated. | Coordinate with rheumatology/MFM; avoid mycophenolate, methotrexate, and cyclophosphamide for routine pregnancy use. | 30 |
| Trichomoniasis | Metronidazole 500 mg orally twice daily for 7 days. | Treat symptomatic pregnant patients and partners; counsel regarding reinfection. | 2 |
| Urinary tract infection, acute cystitis or asymptomatic bacteriuria | Nitrofurantoin, beta-lactams such as cephalexin or amoxicillin-clavulanate, or fosfomycin when appropriate; tailor to culture and susceptibility. | Nitrofurantoin is reasonable in the first trimester when no suitable alternative is available and should be avoided in G6PD deficiency. Avoid empiric amoxicillin/ampicillin because of resistance unless susceptibility supports use. | 25 |
| Venous thromboembolism (VTE) | Low molecular weight heparin, commonly enoxaparin, dalteparin, or tinzaparin. | Warfarin and direct oral anticoagulants are generally avoided during pregnancy. Coordinate peripartum anticoagulation and neuraxial timing. | 31 |
| Vulvovaginal candidiasis | Topical azole therapy for 7 days. | Avoid oral fluconazole in pregnancy unless expert-directed for severe systemic fungal disease. | 2 |
Medical information changes over time. Verify dosing, contraindications, warnings, and guideline updates before prescribing.
Reviewed/updated by Mark Curran, M.D. 06/06/2026
References
1. American College of Obstetricians and Gynecologists. Asthma in Pregnancy. ACOG Practice Bulletin No. 90. Obstet Gynecol. 2008;111:457-464. PMID: 18238988.
2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. CDC guideline.
3. Lee RH, Greenberg M, Metz TD, Pettker CM. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy. Am J Obstet Gynecol. 2021;224:B2-B9. PMID: 33197417.
4. American College of Obstetricians and Gynecologists. Chronic Hypertension in Pregnancy. ACOG Practice Bulletin No. 203. Obstet Gynecol. 2019;133:e26-e50. PMID: 30575676.
5. Powell RJ, Leech SC, Till S, et al. BSACI guideline for the management of chronic urticaria and angioedema. Clin Exp Allergy. 2015;45:547-565. PMID: 25711134.
6. American College of Obstetricians and Gynecologists. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141:1232-1261. ACOG guidance.
7. American College of Obstetricians and Gynecologists. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. ACOG Clinical Practice Guideline No. 5. Obstet Gynecol. 2023;141:1262-1288. PMID: 37486661.
8. American Diabetes Association Professional Practice Committee. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S306-S320. ADA Standards of Care.
9. American College of Obstetricians and Gynecologists. Pregestational Diabetes Mellitus. ACOG Practice Bulletin No. 201. Obstet Gynecol. 2018;132:e228-e248. PMID: 30461693.
10. Tomson T, Battino D, Bromley R, et al. Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force. Epileptic Disord. 2019;21:497-517. PMID: 31782407.
11. Harden C, Tomson T, Gloss D, et al. Practice guideline update summary: Management issues for women with epilepsy—focus on pregnancy. Neurology. 2024;102:e209131. AAN guidance.
12. Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-1599. PMID: 29405329.
13. Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load. N Engl J Med. 2016;374:2324-2334. PMID: 27305192.
14. American College of Obstetricians and Gynecologists. Management of Genital Herpes in Pregnancy. ACOG Practice Bulletin No. 220. Obstet Gynecol. 2020;135:e193-e202. PMID: 32332414.
15. Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States. NIH ClinicalInfo; current online guideline. NIH Perinatal HIV Guidelines.
16. American College of Obstetricians and Gynecologists. Thyroid Disease in Pregnancy. ACOG Practice Bulletin No. 223. Obstet Gynecol. 2020;135:e261-e274. PMID: 32443080.
17. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017;27:315-389. PMID: 28056690.
18. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3:3829-3866. PMID: 31794604.
19. Nguyen GC, Seow CH, Maxwell C, et al. The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy. Gastroenterology. 2016;150:734-757.e1. PMID: 26688268.
20. Centers for Disease Control and Prevention. Treatment of Malaria: Guidelines for Clinicians (United States). CDC malaria treatment guidance.
21. American College of Obstetricians and Gynecologists. Headaches in Pregnancy and Postpartum. ACOG Clinical Practice Guideline No. 3. Obstet Gynecol. 2022;139:944-972. PMID: 35576364.
22. American College of Obstetricians and Gynecologists. Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin No. 189. Obstet Gynecol. 2018;131:e15-e30. PMID: 29266076.
23. American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine. Low-dose aspirin use for the prevention of preeclampsia and related morbidity and mortality. Practice Advisory, updated December 2021. ACOG Practice Advisory.
24. U.S. Preventive Services Task Force. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Preventive Medication. 2021. USPSTF recommendation.
25. American College of Obstetricians and Gynecologists. Urinary Tract Infections in Pregnant Individuals. Clinical Consensus No. 4. Obstet Gynecol. 2023;142:435-445. ACOG Clinical Consensus.
26. Russell MD, Dey M, Flint J, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2023;62:e48-e88. PMID: 36318966.
27. American College of Obstetricians and Gynecologists. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin No. 222. Obstet Gynecol. 2020;135:e237-e260. PMID: 32443079.
28. Society for Maternal-Fetal Medicine. SMFM Consult Series #67: Maternal sepsis. Am J Obstet Gynecol. 2023;229:B2-B19. PMID: 37562656.
29. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. J Am Coll Cardiol. 2016;67:e27-e115. PMID: 26409259.
30. Society for Maternal-Fetal Medicine. Consult Series #64: Systemic lupus erythematosus in pregnancy. Am J Obstet Gynecol. 2023;228:B41-B60. PMID: 36084704.
31. Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: VTE in the context of pregnancy. Blood Adv. 2018;2:3317-3359. PMID: 30482767.