Cardiovascular Medications in Pregnancy

Aka: Cardiovascular Medications in Pregnancy, Anti-Arrhythmic Medications in Pregnancy

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II. Background

  1. Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
    2. Although FDA Pregnancy Categories are no longer designated, they are included here
      1. As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking

III. Class B: No risk in controlled animal studies

  1. Anticoagulants
    1. Enoxaparin (Lovenox)
    2. Dalteparin (Fragmin)
    3. Danaparoid (Orgaran)
    4. Heparin
  2. Antihypertensives
    1. Methyldopa (Aldomet)
    2. Acebutolol (first trimester only)
    3. Pindolol (first trimester only)
  3. Antiarrhythmic
    1. Encainide
    2. Sotalol (Betapace) - first trimester only
  4. Diuretics
    1. Torsemide (Demadex) - not in Briggs (1998)
    2. Amiloride
  5. AntiHyperlipidemic
    1. Cholestyramine
    2. Colestipol

IV. Class C: Small risk in controlled animal studies

  1. Antiplatelet Medications
    1. Clopidogrel (Plavix) - not in Briggs (1998)
    2. Dipyridamole (Persantine)
    3. Ticlopidine (Ticlid) - not in Briggs (1998)
  2. Antiarrhythmic
    1. Atropine
    2. Digoxin
    3. Disopyramide (Norpace)
    4. Lidocaine
    5. Procainamide
    6. Quinidine
    7. Amiodarone
      1. Neonatal Hypothyroidism
      2. Intrauterine Growth Retardation
      3. Cardiac disturbance
  3. Antihypertensive
    1. Hydralazine
    2. Diazoxide
    3. Clonidine
    4. Nitroprusside (Nipride)
    5. Prazosin
    6. Reserpine
    7. All Calcium Channel Blockers
      1. Nifedipine XL (is a drug of choice for severe Hypertension in Pregnancy)
      2. Avoid other Calcium Channel Blockers in pregnancy
    8. Most Beta Blockers (first trimester only)
      1. Labetolol (drug of choice for severe Hypertension in Pregnancy)
      2. Metoprolol
      3. Nadolol
      4. Propranolol
      5. Timolol
      6. Esmolol (Class C in all trimesters)
  4. Diuretics
    1. Acetazolamide (Diamox)
    2. Furosemide (Lasix)
    3. Mannitol
  5. Lipid lowering medications
    1. Niacin
    2. Gemfibrozil (Lopid)

V. Class D: Strong evidence of risk to the human fetus

  1. Anticoagulants
    1. Coumadin (Warfarin)
    2. Dicumarol
  2. Antihypertensive
    1. ACE Inhibitors
    2. Angiotensin II Antagonists
    3. Most Beta Blockers (second and third trimester)
      1. Associated with Intrauterine Growth Retardation
      2. Metoprolol
      3. Nadolol
      4. Propranolol
      5. Timolol
      6. Acebutolol (second and third trimester)
      7. Pindolol (second and third trimester)
      8. Atenolol
  3. Diuretics
    1. Ethacrynic Acid
    2. Triamterene (Class B per manufacturer)
    3. Bumetanide (Bumex)
    4. Hydrochlorothiazide
    5. Spironolactone

VI. Class X: Very high risk to the human fetus

  1. HMG CoA Reductase Inhibitors (Statins)
    1. Fluvastatin
    2. Lovastatin
    3. Pravastatin
    4. Simvastatin

VII. References

  1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
  2. Larimore (2000) Prim Care 27(1):35-53 [PubMed]

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