Allergy & Asthma-Kent H. DeYarman, MD

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Allergy Medications During Pregnancy

Allergy Medications During Pregnancy

There is not an easy answer to using medications in pregnancy. Obviously it would be nice to avoid all medications during pregnancy as all medications likely have at least some risk. It is not easy to study medications for risks during pregnancy. We cannot purposefully give pregnant women medications to see if there are side effects. We can study them in animals and we can look at human experience where medications have been used in women who are pregnant. The FDA has a classification for medications in pregnancy that is as follows:

 

Category A medications - medications that have been purposefully given to women who are pregnant to do scientific studies regarding safety and other factors. There are no Category A medications because this type of study would be unethical to do and therefore they have not been done.

 

Category B medications - medications that have been studied in animals without significant problems found in the animal studies and that have been used fairly extensively by pregnant women without problems being found in those women.

 

Category C medications - medications that have been used fairly extensively by pregnant women without problems being found in those women but when studied in animals were found to have caused at least some problems in pregnant animals. These include studies where the doses given to animals were extremely high, far exceeding doses ever used in humans.

 

Category D medications - medications known to cause problems in animal studies and know to cause problems in humans from experience in humans (thalidomide would be an example of a Category D medication).

 

Medications used during pregnancy are therefor virtually always Category B or C.

 

Category B medications are generally preferable to Category C medications but this at times defies common sense. For instance budesonide is a Category B medication when given in an inhaler for the chest but a Category C medication when use in a nose spray that delivers a much lower dose.

 

In addition it is useful to know how long a medication has been in use. It makes sense to pick a medication that is Category B or C that has been in use for decades over one that has been in use only for a year or two. It is also reasonable to use medications that have no or very low absorption rather than those that are readily absorbed.

 

Medication Class Pregnancy Category     Year Introduced
     
Antihistamines    
Chlorpheniramine Category B 1949
Zyrtec Category B 1995
Xyzal Category B  
Claritin Category B  
Clarinex Category C  
Allegra Category C  
     
Decongestants    
None    
     
Bronchodilators-Inhaled    
Brethair (no longer in US) Category B 1974
Albuterol Category C 1981
Alupent Category C 1973
Maxair Category C 1988
Xopenex Category C  
Serevent (long acting) Category C 1994
     
Bronchodilators-Oral    
Theophylline Category C 1930's
Albuterol Category C  
     
Mast Cell Stabilizers    
Cromolyn Category B 1973
Tilade Category B 1993
     
Anticholinergics    
Atrovent (ipatropium) Category B 1930's
Spiriva (tiotropium) Category C  
     
Leukotriene Inhibitors    
Accolate Category B 1996
Singulair Category B 1998
     
Cortisone (Steroids)    
Pulmicort (budesonide) Category B 1998
Rhinocort (budesonide) Category C 1998
Beclomethasone Category C 1976
Nasalide (flunisolide) Category C 1981
Aerobid (flunisolide) Category C 1981
Azmacort (triamcinolone) Category C 1984
Nasacort (triamcinolone) Category C 1984
Flovent (fluticasone) Category C 1996
Flonase (fluticasone) Category C 1996
Veramyst (fluticasone) Category C 2008
Nasonex (mometasone) Category C  
Asmanex (mometasone) Category C  
Prednisone Category C  
     
Eye Drops    
Crolom (cromolyn) Category B  
Alomide (lodoxamide) Category B  
Alocril (Nedoramil) Category B  
Patanol Category C  
Pataday Category C  
Alamast (pemirolast) Category C  
Zaditor (ketotifen) Category C  
Optivar (azelastine) Category C  
Elestat (epinastine) Category C  
Acular (ketorolac) Category C