Gastrointestinal Medications in Pregnancy

Aka: Gastrointestinal Medications in Pregnancy

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II. Class A: No risk in controlled human studies

  1. Pyridoxine (Vitamin B6)

III. Class B: No risk in controlled animal studies

  1. Milk of Magnesia
  2. Doxylamine
  3. Metoclopramide
  4. Calcium Carbonate (Tums)
    1. Pregnancy risk class is unknown, but appears safe in pregnancy
    2. First choice agent of the Antacids in pregnancy
    3. Crosses the placenta
    4. Risk of Milk-Alkali Syndrome at high dose
    5. May interfere with iron absorption
  5. Aluminum hydroxide (Maalox, Mylanta)
    1. Pregnancy risk class is unknown, but appears safe in pregnancy
    2. May interfere with iron absorption
    3. Neurotoxicity and fetal malformation risk at high dose
  6. Magnesium Hydroxide or Magnesium carbonate (Maalox, Mylanta)
    1. Pregnancy risk class is unknown, but appears safe in pregnancy
    2. May interfere with iron absorption
  7. Kaolin-pectin (Kaopectate)
    1. Previously considered antidiarrheal of choice in pregnancy but now contains bismuth and Aspirin
    2. Not absorbed but risk of Iron Deficiency Anemia
  8. Sucralfate
  9. Meclizine (Antivert)
  10. Mesalamine
  11. Ranitidine (Zantac)
    1. Crosses placenta but considered safe
    2. Used as second line after Maalox, Mylanta or tums
  12. Cimetidine (Tagamet)
    1. Crosses placenta but considered safe
    2. Used as second line after Maalox, Mylanta or tums
    3. Ranitidine may be preferred over Cimetidine for longer term use
  13. Famotidine (Pepcid)
    1. Limited human data
    2. Crosses the placenta
  14. Lactulose
  15. Simethicone
    1. Not absorbed and does not cross the placenta, so considered safe in pregnancy
  16. Proton Pump Inhibitors
    1. Cross the placenta
    2. FDA Category B as a class including Esomeprazole (Nexium), Rabeprazole (Aciphex) and Lansoprazole (Prevacide)
    3. FDA Category C for Omeprazole (Prilosec) based on animal studies, but appears safe in pregnancy and is best studied of the PPI agents (see below)

IV. Class C: Small risk in controlled animal studies

  1. Hydroxyzine (Vistaril)
  2. Prochlorperazine (Compazine)
  3. Droperidol (Inapsine)
  4. Metamucil
  5. Bismuth Subsalicylate (Pepto Bismol)
    1. Risk of Salicylate absorption
    2. Not recommended in pregnancy (especially in second and third trimester due to Aspirin component)
  6. Loperamide (Imodium)
    1. Possible associations with fetal cardiovascular defects
    2. Avoid in first trimester
  7. Atropine-Diphenoxylate (Lomotil)
    1. Class D in third trimester
    2. Not recommended in pregnancy
  8. Nizatidine (Axid)
    1. Avoid in pregnancy
    2. IUGR, fetal death and abortion seen in rabbit studies
  9. Docusate Sodium (Colace)
  10. Promethazine (Phenergan)
  11. Senna
  12. Polyethylene Glycol 3350 (Miralax)
    1. Preferred Laxative for Constipation in Pregnancy
  13. Omeprazole
    1. FDA Category C for Omeprazole (Prilosec) based on animal studies
    2. However appears safe in pregnancy and is best studied of the PPI agents
  14. Mineral Oil
    1. Not absorbed (and does not cross the placenta)
    2. Avoid in pregnancy
    3. Risk of fat soluble Vitamin Decreased absorption (risk of neonatal Coagulopathy and bleeding complications)

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

  1. Misoprostol
  2. Bismuth Subsalicylate (Pepto Bismol) in trimester 3
  3. Castor Oil

VI. References

  1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed, Lippincott Williams and Wilkins, Philadelphia, PA
  2. Briggs (2008) Drugs in Pregnancy and Lactation, Lippincott Williams and Wilkins, Philadelphia, PA
  3. Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
  4. Larimore (2000) Prim Care 27(1):35-53 [PubMed]
  5. Servey (2014) Am Fam Physician 90(8): 548-55 [PubMed]

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