Drugs to Avoid in Pregnancy
NSAIDS (Ibuprofen, Advil, Motrin) May increase risk for miscarriage, jaundice and
fetal kernicterus in the newborn. If taken too close to delivery, both mother and baby have higher
risk of hemorrhage at birth. Instead, recommend Acetaminophen/Tylenol.
ACE Inhibitors and ARBs Increased risk of fetal renal damage, increased risk of
oligohydramnios (decreased amniotic fluid), and fetal growth restriction. Instead, use beta blockers
like Labetalol or CCB like Nifedipine.
Fluoroquinolones (Cipro, Levofloxacin) Can cause problems with fetal muscle and
skeletal growth. Increases the risk of miscarriage. May increase the risk of aortic tears or ruptures in
the mother. Instead, use PCNs, cephalosporins (Keflex) or Clindamycin.
Sulfonamides (Bactrim) Increased risk of miscarriage and fetal jaundice at birth.
Chloramphenicol (Treats a variety of infections, like viral meningitis) - Can cause gray
baby syndrome, a life threatening condition that causes a circulatory collapse in the newborn. These
babies are born with an ashen-gray appearance, cyanosis and abdominal distention which may lead
to death. Always avoid.
Codeine All narcotics should be used rarely in pregnancy, but this specifically increases the
risk of fetal cardiac defects and spina bifida. Use Acetaminophen instead. If stronger analgesics are
needed, Oxycodone or Norco would be considered safer alternatives to Codeine.
Warfarin May increase risk of birth defects, but primary concern is increased risk of bleeding
behind the placenta. This often leads to growth restriction and can also result in placental abruption.
Instead, use Heparin or LMWH (Lovenox).
Benzodiazepines If taken too close to delivery, can cause life-threatening withdrawal
symptoms in the newborn infant. Instead, use counseling, lifestyle modification. The antihistamine
Hydroxyzine (Vistaril) is both effective and safe for anxiety during pregnancy/breastfeeding.
Isotretinoin (Accutane) NEVER To be used in pregnancy, as it can lead to severe birth
defects including cleft lip/palate, ear/eye defects, cardiac/thymus deformities, and severe mental
retardation. Women of childbearing age on Accutane are typically required to get monthly
pregnancy tests and need to be on TWO separate forms of birth control.
Bismuth Subsalicylate (Pepto-Bismol) Increases risk of bleeding problems if taken
too close to delivery. Instead, use calcium carbonate PRN for heartburn and reflux symptoms.
Castor Oil No direct harm to the fetus, but can increase maternal diarrhea which can cause
dehydration and other stomach-related issues that increase risk for preterm contractions/labor.
Mineral Oil Some women use this to treat constipation in pregnancy, but it should be avoided as
it prevents absorption of essential nutrition. Colace/Docusate Sodium would be a better OTC treatment.
