12 Medications That Can Be Dangerous to Take If You’re Pregnant
Key takeaways:
Some medications are dangerous to take while you’re pregnant. The risk is highest with FDA Pregnancy Category D or X medications. But that doesn’t mean other medications don’t have risks as well.
Retinoids, warfarin, and certain blood pressure medications are best to avoid during pregnancy. And nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, and benzodiazepines can also harm a developing fetus.
If you’re pregnant, or thinking about starting a family, talk to your healthcare provider about the risks and benefits of your medications.
Table of contents
Taking medication during pregnancy can be complicated. It’s hard to know which are safe and which aren’t. Below, we’ll review 12 medications that may be dangerous to take during pregnancy. Just keep in mind, this isn’t an all-inclusive list. So it’s best to discuss any medications you take during pregnancy with your healthcare provider first.
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1. Claravis, and other oral retinoid medications
Isotretinoin (Absorica, Claravis) belongs to a class of medications known as retinoids. These lab-made forms of vitamin A treat acne.
Taking isotretinoin while pregnant can cause a fetus’ brain, nerves or heart to develop abnormally. It also raises the risk of miscarriage and premature birth. The FDA classifies isotretinoin as a Pregnancy Category X medication. This means that clinical studies have shown it can cause harm to fetuses, and there’s no possible benefit that outweighs the risk of taking it.
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Anyone who prescribes, dispenses, or takes isotretinoin must enroll in an FDA program called iPLEDGE. This program ensures that people taking isotretinoin who may become pregnant are using proper birth control during treatment.
It’s also best to avoid using topical retinoids, such as tretinoin (Retin-A) or adapalene (Differin), while you’re pregnant.
High amounts of vitamin A in supplements or food can also be dangerous. Your healthcare provider will let you know what vitamins to take during your pregnancy. Be sure to follow their recommendations.
2. Lisinopril and certain other blood pressure medications
Keeping your blood pressure within a healthy range is important when you’re pregnant. But some blood pressure medications are unsafe to take during pregnancy. These include angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Common examples of these medications include lisinopril (Zestril) and losartan (Cozaar).
ACE inhibitors and ARBs are considered Pregnancy Category D medications during the second and third trimesters. This means there’s evidence that they pose a risk to fetuses, but in rare cases their benefits may outweigh the risks. Studies have also suggested there are some risks of taking these medications during the first trimester.
When taken during pregnancy, ACE inhibitors and ARBs can harm a fetus’ kidneys. They can also affect the fluid around the fetus (amniotic fluid). Low amniotic fluid can cause problems with the development of a fetus’ lungs and skeleton.
3. Warfarin
Warfarin (Coumadin, Jantoven) is also considered dangerous to take during pregnancy. Warfarin is a blood thinner used to prevent and treat blood clots. It’s classified as a Pregnancy Category D medication. So in most cases, you shouldn’t take it while you’re pregnant.
Warfarin can raise the risk of miscarriage, stillbirth, and problems with a fetus’ nose, eyes, and nervous system. Blindness and intellectual disability have also been associated with taking warfarin during the second and third trimesters.
4. Carbamazepine and other anti-seizure medications
Seizures during pregnancy are associated with birth defects and other problems. Experts recommend continuing seizure treatment while you’re pregnant. But some anti-seizure medications can be dangerous, including:
Carbamazepine (Tegretol, Carbatrol)
Valproic acid and other related products
Topiramate (Topamax, Trokendi Xr)
These anti-seizure medications have a high risk of birth defects and are considered Pregnancy Category D. They can cause cleft palate, spina bifida, and male genital issues. There have also been reports of developmental problems after birth if they’re taken during pregnancy.
In some cases, your healthcare provider may decide that the benefits of these medications outweigh the risk. If you’re taking anti-seizure medications while pregnant, you’re encouraged to enroll in the North American Anti-Epileptic Drug Pregnancy Registry. This registry helps researchers monitor the safety of these medications during pregnancy.
5. Lithium
Lithium (Lithobid) is a prescription medication that treats bipolar disorder. It’s classified as a Pregnancy Category D medication, because it can cause birth defects in the heart. Lithium may be especially dangerous to take during the first trimester, when the fetal heart develops.
If you’re trying to become pregnant, your healthcare provider can help you stop taking lithium safely and find an alternative. But if your bipolar symptoms are severe, they might recommend restarting your lithium treatment once the fetus’ organs have developed.
6. Lipitor and other statins
Statins are medications that lower high cholesterol levels. Some common examples include atorvastatin (Lipitor) and simvastatin (Zocor).
Until 2021, all statins were classified as Pregnancy Category X medications. But a recent, large clinical review found that taking statins during pregnancy isn’t associated with a higher risk of birth defects. But it didn’t rule out other statin risks, such as miscarriage.
The FDA now recommends that healthcare providers consider continuing statin treatment for high-risk people during pregnancy. Your provider can help decide which option is best for you.
7. Ibuprofen and other NSAIDs
In 2020, the FDA warned against taking nonsteroidal anti-inflammatory drugs (NSAIDs) starting around 20 weeks of pregnancy. NSAIDs are associated with an increased risk of life-threatening kidney problems in developing fetuses. They can also cause an issue with the fetus’ heart if taken in late pregnancy.
Keep in mind that this risk includes both prescription and over-the-counter (OTC) NSAIDs, such as:
Ibuprofen (Advil, Motrin)
Naproxen (Aleve, Naprosyn)
Diclofenac (Cambia, Cataflam)
The FDA warning only mentions the risk of taking NSAIDs after the 20-week mark. But that doesn’t mean they’re safe to take earlier in the pregnancy. It’s best to discuss the risks and benefits of taking NSAIDs while pregnant with your provider.
8. Tetracycline antibiotics
Tetracycline is an antibiotic that treats a variety of bacterial infections. It’s considered a Pregnancy Category D medication. It’s recommended that pregnant people avoid all tetracycline antibiotics, including doxycycline (Doryx) and minocycline (Minocin).
Taking tetracycline antibiotics can cause pregnant people to have liver damage. These medications can also affect bone growth and cause permanently yellowed or browned teeth in the infant.
9. Cipro and other fluoroquinolones
Fluoroquinolones are antibiotics that treat many bacterial infections. Examples include ciprofloxacin (Cipro) and levofloxacin.
These antibiotics are considered Pregnancy Category C medications based on birth defects seen in animal studies. There haven’t been enough large studies involving humans to determine if they’re safe to take during pregnancy. A review of the available data suggested that fluoroquinolones may not be associated with birth defects in humans. But larger studies are needed to confirm this.
10. Sudafed and other nasal decongestants
It’s not clear if decongestants like pseudoephedrine (Sudafed) are safe to take during pregnancy. Because of this lack of information, they’re classified as Pregnancy Category C medications.Some studies have linked pseudoephedrine to a higher risk of birth defects. And the American College of Obstetricians and Gynecologists advises not to take it during the first trimester.
There’s even less data when it comes to decongestant nasal sprays, such as oxymetazoline (Afrin). One study found a higher risk for several problems in unborn fetuses during the first or second trimesters. But your provider may OK it if other options haven’t worked for your congestion.
11. Xanax and other benzodiazepines
Benzodiazepines treat anxiety and alcohol use disorder, among other conditions. Some examples include alprazolam (Xanax) and clonazepam (Klonopin).
Most benzodiazepines are considered Pregnancy Category D or X medications. They’ve been linked to developmental issues that can affect a fetus’ brain, esophagus, and heart. They’ve also been linked to miscarriage, lower birth weights, and premature births. Taking benzodiazepines while pregnant can also lead to withdrawal symptoms in newborns.
12. Cannabis
Cannabis is often mentioned as a safe option for pregnancy-related nausea. But there’s no reliable evidence that shows it’s safe during pregnancy. Cannabis may be linked to lower birth weights and developmental delays of the child.
What’s the best way to know if a medication is safe to take while you’re pregnant?
The best way to decide if a medication is safe to take during pregnancy is to discuss it with your healthcare provider or pharmacist. The CDC and the FDA also offer resources to help you understand what medications are safe to take while pregnant. Whenever possible, choose non-medication treatment options. And only take OTC medication if you truly need it.
Good to know: FDA pregnancy categories help indicate the risk of taking a medication while pregnant. But starting in 2015, they’ve been replaced by the Pregnancy and Lactation Labeling Rule (PLLR). The PLLR is intended to provide more detailed information about the risk of taking medications during pregnancy.
The bottom line
Some medications are dangerous to take during pregnancy. They can cause birth defects or raise your risk of miscarriage. These include retinoids, warfarin, and certain blood pressure medications. NSAIDs, certain antibiotics, and benzodiazepines can also harm a growing baby. And cannabis isn’t considered safe, either.
Talk with your healthcare provider or pharmacist about the safety of your medications if you’re pregnant or thinking of starting a family. They discuss risks and benefits with you and offer safer alternatives when possible.
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References
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