12 Medications to Avoid During Pregnancy

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Of the non-genetic causes of birth defects, medications are a well-known offender. Early in the first trimester, many women don’t yet know that they are pregnant. This is a high-risk time to be taking certain medications as this is the major period of organogenesis or development of the organs.

While the science is very limited (pregnant women are generally not included in medication safety studies) there are a handful of medications that are considered category X drugs, or drugs that should not be taken in women who are or may become pregnant. If you are of reproductive age, and not using a reliable form of birth control, know this list of category X medications and avoid them.

  1. Absorica (isotretinoin) is a pill taken for acne, and must not be used by women who are pregnant or who may become pregnant. there is an extremely high risk that severe birth defects can result if pregnancy occurs while taking isotretinoin in any amount. If you are taking Absorica, you will be enrolled in the iPLEDGE program where you must meet certain requirements, and show proof or a reliable birth control method, to obtain the medication.
  2. Lipitor (atorvastatin), lovastatin, Pravachol (pravastatin), Zocor (simvastatin) and Lescol (fluvastatin are “statin” drugs used to lower cholesterol. They have been shown to cause fetal abnormalities in pregnant women and should not be used in women who are or may become pregnant. Why are statins so bad in early pregnancy? Cholesterol biosynthesis is important in fetal development and statins can affect that.
  3. Arthrotec (diclofenac sodium/misoprostolis used for joint pain due to osteoarthritis or rheumatoid arthritis. Arthrotec contains diclofenac and misoprostol which can cause abortion, premature birth, or birth defects.
  4. Migranal (dihydroergotamine mesylateis used for the treatment of migraine headaches. Dihydroergotamine is oxytocic meaning it is a medication that causes uterine contractions and increased tone of the uterus, which could be dangerous if you’re pregnant. 
  5. Coumadin (warfarin) is a blood thinner used to treat or prevent clots in the veins, arteries, lungs or heart. Warfarin crosses the placenta and serious fetal abnormalities have been reported following early first-trimester exposure. For women on warfarin who plan on conceiving, a switch to Lovenox (low molecular weight heparin) or at least frequent pregnancy tests are recommended so you can substitute Lovenox as soon as pregnancy is confirmed.
  6. Soriatane (acitretinis prescribed for the treatment of severe psoriasis. Acitretin must not be used by women who are pregnant, or who intend to become pregnant during therapy, or for three years following the discontinuation of therapy. Women of reproductive age who use Soriatane must prove they are using a form of contraception during treatment.
  7. Restoril (temazepam) is a benzodiazepine used for the treatment of insomnia in adults. All benzodiazepines are assumed to cross the placenta, increasing the incidence of premature birth and low birth weights.
  8. Danocrine (danazol) is used for the treatment of endometriosis, and for breast pain or tenderness due to fibrocystic breast disease. Danazol may result in androgenic (male hormone) effects on the female fetus.
  9. Arava (leflunomideis an immune modulator used in the treatment of Rheumatoid arthritis. Women of reproductive potential must use effective contraception during treatment due to the potential for fetal harm.
  10. Lupron (leuprolideis an injection used in women for the treatment of endometriosis and uterine fibroids and can be dangerous for pregnant women. Although leuprolide usually inhibits ovulation and stops menstruation, a non-hormonal contraceptive should be used in conjunction. 
  11. Rheumatrex (methotrexate) is used for the treatment of psoriasis and rheumatoid arthritis. It has been reported to cause fetal death and/or congenital anomalies and is not recommended for women of childbearing potential.
  12. Tazorac (tazaroteneis a creme used for the treatment of acne, wrinkles, and psoriasis. Tazorac may cause fetal abnormalities and a negative pregnancy test should be obtained within 2 weeks prior to treatment.

Hope this helps!

Dr O.

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