TERATOGENICITY AND DRUGS THAT AFFECT THE FETUS (Part Five)
8-ANTIVIRALS
A - Acyclovir
- Included in category B of medications.
- At therapeutic doses, it has no teratogenic effect on pregnant women.
- In pregnancy, it is used for the treatment of genital infection by Herpes Simplex Virus type 2 and the disseminated infection by this virus.
- Acyclovir is used during breastfeeding.
B - Amantadine
- Included in category C of medications.
- Used for the treatment and prophylaxis of influenza A and as an antiparkinsonian preparation.
- Data in pregnant women are incomplete although amantadine easily crosses the placental barrier and causes fetal anomalies, especially in the first trimester of pregnancy.
- The most common congenital anomalies are: cardiovascular system (single ventricle with pulmonary atresia), limb reduction anomalies.
- Not used during breastfeeding because it may cause urinary retention, vomiting, and skin rash.
C - Famciclovir
- Included in category B of medications.
- Used for the treatment of infections by Herpes Simplex Virus type 1 and 2, infections by Varicella Zoster.
- There is incomplete study data in animals and pregnant women regarding teratogenicity.
- In the cases studied, there have been ectopic pregnancies, spontaneous abortions, and normal pregnancies.
D - Ganciclovir
- Included in category C of medications.
- Used for the treatment of CMV retinitis and other infections.
- It easily crosses the placental barrier although there are no complete studies in humans, while in animals it causes hypoplastic tests, anophthalmia or microphthalmia, cleft lip and palate, absence of eyes, aplastic kidneys and pancreas, hydrocephaly.
- Due to serious side effects, it is not used during lactation.
E - Ribavirin
- Included in category X of medications.
- Used for the treatment of respiratory syncytial virus.
- Contraindicated in pregnancy due to teratogenic effect.
- Causes anomalies in the skull, palate, eyes, jaw, skeleton, limbs, and gastrointestinal system.
- Not used during lactation due to unknown effects.
F - Rimantadine
- Included in category C of medications.
- Used for the treatment of influenza A.
- It easily crosses the placental barrier and in doses over 11 times the therapeutic doses causes anomalies.
- Due to serious side effects, it should not be used during lactation.
9 - ANTIFUNGALS
A - Fluconazole
- Included in category C of medications.
- Used for the treatment of vaginal, oropharyngeal, and cutaneous candidiasis.
- Studies are limited for the use of fluconazole in pregnancy.
- Studies show a link between the use of fluconazole and fetal craniofacial anomalies.
- A single dose of 150 mg is not associated with congenital anomalies whereas doses above 400 mg used in the first trimester of pregnancy are associated with a high risk for congenital anomalies.
- The most frequently observed anomalies are: brachycephaly, facial anomalies, calvarial development anomalies, cleft lip and palate, thin ribs and long bones, congenital cardiac anomalies.
B - Itraconazole
- Included in category C of medications.
- Used for the treatment of fungal infections in patients with normal or compromised immune systems.
- The use of Itraconazole is associated with congenital anomalies dependent on dose and timing of exposure during pregnancy
- The most common anomalies are: hand dysplasia, hip joint dysplasia, finger anomalies, pyloric stenosis, small eyes, cardiovascular and genitourinary anomalies.
- Should not be used in the first trimester of pregnancy.
- Excreted in breast milk and as such should not be used during breastfeeding.