Summary: When you are pregnant in ten months, it is difficult to guarantee that you will not get sick during the entire pregnancy, but as a pregnant woman, you are always confused about taking medicine: can you take medicine? What medicine can I use? In response to the confusion of pregnant mothers, Chen Chuxiong, deputy chief pharmacist of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, recently introduced the \”Graded Medication for Pregnant Women\” guide in an interview. When you are ten months pregnant, it is difficult to guarantee that you will not get sick at all during pregnancy, but as a pregnant woman, you are always confused about taking medicine: can you take medicine? What medicine can I use? In response to the confusion of pregnant mothers, Chen Chuxiong, deputy chief pharmacist of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, recently introduced the drug classification guide for pregnant women in an interview.
Level 5 drug safety for pregnant women
According to Chen Chuxiong, the safety classification standards for drug use during pregnancy formulated by the U.S. Food and Drug Administration (FDA) are clear in meaning, scientific and objective. This standard divides the pregnancy safety of drugs into five levels: A, B, C, D, and X.
Level A means that it is safe for pregnant women to use, and this type of drug has little effect on the fetus. There are very few Class A drugs, such as vitamin A, vitamin D, folic acid, levothyroxine sodium, potassium chloride, etc., all within the normal range. It is worth noting that large doses of vitamin A (for example, a daily dose of 20,000 international units has teratogenic effects) can become a Class X (banned) drug. Doses of vitamin D, vitamin E, and vitamin B1 that exceed the U.S. recommended daily intake are classified as C.
Grade B indicates that it should be used with caution when there are clear indications. Most lactam and macrolide antibiotics belong to this class. It is worth noting that diphenhydramine, as a commonly used anti-allergic drug, belongs to Class B drugs, but it still needs to be used with caution because it may cause adverse reactions such as cleft palate.
Category C means fully weighing the pros and cons and deciding whether to use it when there are indeed indications for its application. Such drugs should only be used after weighing the benefits to the pregnant woman outweighing the risks. Take anti-tuberculosis drugs as an example. Ethambutol is only a Class B drug among commonly used anti-tuberculosis drugs, and anti-tuberculosis treatment is often a combination of several drugs. Therefore, doctors are considering using C-type drugs such as promazinamide and isoniazid. When using similar drugs, the situation should be explained to the patient.
Class D means avoidance of use, but when there are indications for use and the patient benefits outweigh the possible risks, use with caution under close observation. There is clear evidence that these drugs are harmful to the human fetus, but pregnant women can definitely benefit from them (for example, when these drugs are used to save a pregnant woman\’s life, or to treat a serious illness that has not responded to other, safer drugs). Class D drugs should be avoided during pregnancy, especially in the first trimester. Drugs that fall into this category include aminoglycosides, tetracyclines, and voriconazole.
X rating represents disabled people. Most androgens, progestins, estrogens, and gonadotropins fall into this category.
Different effects of the same drug at different gestational ages
Chen Chuxiong pointed out that some drugs are grade D in the first trimester and may be grade C or B in the third trimester.For example, dexamethasone and prednisone are grade D during the first three months of pregnancy and grade C after three months. Therefore, using the same drug at different gestational weeks will have different effects.
There are also drugs that are Category C or B in the first trimester, but may become Category D in the third trimester. For example, diclofenac sodium and indomethacin belong to category B in the first and second trimesters, and category D in the third trimester or near delivery; captopril, irbesartan, bisoprolol, metoprolol, etc. It belongs to Category C when used in the first trimester, and Category D when used in the second and third trimesters of pregnancy. Therefore, not all drugs are safer when given during the third trimester.
It is also worth noting that the same drug, but different routes of administration, can also cause changes in pregnancy classification. For example, tetracycline is Category B when applied externally to the skin and Category D when used by the ocular or oral route. The pregnancy classification of some drugs also changes over time with use. For example, if indomethacin is used in early pregnancy, the pregnancy classification will be grade B, but if it is used continuously for more than 48 hours, the pregnancy grade will be changed to grade D.
Medication Grading Guidelines for Pregnant Women
Class A
Safe to use by pregnant women
These drugs belong to category A: normal doses of vitamin A, vitamin D, folic acid, levothyroxine sodium, potassium chloride, etc.
Category B
Use caution when explicitly directed
These drugs belong to class B: most lactam and macrolide antibiotics. Metronidazole, ethambutol, acetaminophen, insulin, metformin, acarbose, diphenhydramine, desloratadine, chlorpheniramine, montelukast sodium, clopidogrel, acetyl hemi- Cystine, ranitidine, esomeprazole, lansoprazole, sucralfate, metoclopramide, etc.
Class C
When there are indeed indications for use, fully weigh the pros and cons and decide whether to use it.
These drugs belong to category C: quinolones, clarithromycin, vancomycin, pyrazinamide, vitamin B12, allopurinol, perphenazine, glipizide, glimepiride, nateglinide, rosiglide ketone, amlodipine, diltiazem, verapamil, etc.
Category D
Avoid use, but when there is an indication for use and the patient benefit outweighs the possible risks, it should be used with caution and under close observation.
These drugs belong to category D: aminoglycosides, tetracyclines, voriconazole, tigecycline, colchicine, lithium carbonate, phenobarbital, phenytoin, sodium valproate, propylthiouracil, methimazole, Azathioprine, mycophenolate mofetil, etc.
Class X
Disable
These drugs belong to category X: most androgens, progestins, estrogens, and gonadotropins. Ribavirin, thalidomide, methotrexate, mitomycin, goserelin, triptorelin, bicalutamide, atorvastatin calcium, alprostadil, warfarin sodium, mifepristone, misoprostol, tretinoin, isotretinoin, leflunomide, estazolam, bi Hydroergot alkaloids, etc.