Thursday, October 30, 2008

Pregnancy and the safety of allergy or asthma medications

The Food and Drug Administration has a classification for safety of drugs during pregnancy, as in the table. Some comments: there is no medication in the A category and there never will be. To be placed in this category the drug maker would have to do double-blind, placebo-controlled studies of the drug in pregnant women. Of course, there is the theoretical risk of an adverse reaction in a pregnant woman, which could affect the baby - NOT GOOD! So no drug maker will ever do this study. Most drugs are category B, C, or D. It depends on the drug, the length of time it has available, the amount the drug is used, and the underlying disease being treated. B means there is more data indicating safety, although there is not a well-defined explanation of how B is better than C or D. Category X is bad news: there is evidence that the drug adversely affects the baby. These drugs should be avoided, unless there is a life-threatening condition. It is a difficult decision. Fortunately, in allergy and asthma, there are no medications that are category X. NR means not rated. In the case of pregnancy, with no data, these medications should be avoided. These ratings are the same for breast-feeding or pregnancy.

What are specific allergy and asthma meds rated? See the list I made below.

Accolate, Albuterol inhaler, Alocril, Atrovent NS, Brethine, chlorpheniramine (Chlor-Trimeton), Claritin (loratadine), Crolom, diphenhydramine (Benedryl), Guaifed PD, Intal inhaler, Lastacraft, Pulmicort resp., Pulmicort Turbuhaler, Rhinocort Aq, Semprex D, Singulair, Sudafed (pseudoephredrine, abbreviated as 'D'), Tavist (clemastine), Xolair, Xyzal, Zyrtec (cetirizine).

Acular, Acuneb, Advair, Aerobid, Alacol DM, Alamast, Allegra (fexofenedine), Allegra-D 12 hour, Allegra-D 24 hour, Allerex, Alrex, Alvesco, Asmanex, Astelin, Beconase AQ, Bepreve, Clarinex (desloratadine), Clarinex-D 12 hour, Clarinex-D 24 hour, Claritin-D 12 hour, Dallergy, Deconamine, dextromethorphan (abbreviated as DM), Duratuss, Dulera, Elestat, Elidel, Elocon, Entex PSE, Flonase (fluticasone propionate), Flovent HFA, Foradil, guaifenesin, Histavent, Livostin, Maxair AH, Medrol, Mucinex, Mucinex-D, Mucinex-DM, Nasacort Aq (triamcinolone acetonide), Nasalide, Nasarel, Nasonex, Omnaris, Optivar, Pataday, Patanase, Perforomist, Prednisone, Proair HFA, Promethazine, Protopic, Proventil HFA, Qvar, Rondec DM, Serevent, Symbicort, Tanafed, Tussend, Tussionex, Ventolin HFA, Veramyst, Xopenex HFA, Xopenex nebs, Zaditor, Zyflo, Zyrtec-D.

Naphcon-A, Visine-AC.

[Antibiotics: amoxicillin B, Augmentin B, Avelox C, Bactrim (trimethoprim/sulphamethoxazole) C, Bactroban ointment B, Biaxin (clarithromycin) C, Ceftin B, Cefzil B, Cipro C, Cleocin (clindamycin) C, Levaquin (levofloxacin) C, Lorabid (loracarbef) B, Omnicef (cefdinir) B, Vibra-tabs (doxycycline) D, Zithromax (Z-pack, zithromycin) B]

[Antifungals: Diflucan C, Nystatin C]

[Pain medications: acetaminphen B, ibuprofen/ketoprofen/naproxen B/D, aspirin D]

[Histamine-2 antagonists: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid): all B]

[Proton pump inhibitors: Omeprazole (brand names: Prilosec) C, Lansoprazole (Prevacid) B,
Esomeprazole (Nexium) B, Pantoprazole (brand names: Protonix) B, Rabeprazole (Aciphex) B]

If you have questions about the F.D.A.'s pregnancy rating for your allergy or asthma medication, ask you doctor...

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