Drugs
On this page 3 sections
DRUGS IN PREGNANCY AND LACTATION
Analgesics During Pregnancy
| Drug | High-yield consideration |
|---|---|
| Paracetamol | Generally the preferred first-line analgesic when clinically indicated |
| NSAIDs | Avoid from 20 weeks unless specifically advised; avoid at 30 weeks and later because of fetal risks |
| Aspirin | Low-dose aspirin may be prescribed for specific obstetric indications; analgesic-dose aspirin is generally avoided |
| Codeine | Use only when clinically indicated after individualized assessment |
| Tramadol | Requires individualized risk assessment; not a routine first choice |
Important: Do not stop prescribed low-dose aspirin used for an obstetric indication without advice from the treating clinician.
Antibiotics During Lactation
Use antibiotics with caution or avoidance during breastfeeding. The decision should account for the specific medication, infant age, prematurity, infant health and available alternatives.
| Antibiotic/class | High-yield consideration |
|---|---|
| Tetracyclines | Short courses of some agents may be acceptable in selected circumstances; prolonged or repeated courses warrant more caution |
| Chloramphenicol | Generally avoided when safer alternatives are available |
| Fluoroquinolones | Often not first choice when suitable alternatives exist; assess individual drug and infant factors |
| Sulfonamides | Use caution, particularly with premature, jaundiced or ill infants and those at risk of G6PD-related hemolysis |
| Metronidazole | Breastfeeding recommendations depend on dose and regimen; a single high dose may prompt different advice from routine divided doses |
| Clindamycin | May be used when indicated, with monitoring for infant diarrhea or candidiasis |
Exam tip: Drug safety in pregnancy and lactation is drug-specific. Avoid memorizing a blanket statement that every drug in a class is absolutely contraindicated.