Category X

Lots of drugs are a no-no in pregnancy. Here’s my way of remembering the teratogenic ones.

Pam is a very worried pregnant lady. She is sat at a cafe with her depressed parrot that suddenly has 3 seizures. She’s having miso soup because she’s on a low carb diet and he’s eating carrots.

  • pam – diazepam (anxiolytics)
  • paroxetine – antidepressants
  • seizures – carbamazepine, valproate, phenytoin
  • misoprostol
  • carbimazole
  • carrots – retinoids

A man called Danny, who is a well-known meth addict with a lisp approaches on a bicycle, holding a pack of cards. He says;

Lithen clothely, I am going to perform a magic trick”

Pam, remembering Danny’s last trick, puts tha’ lid on her soup and says, “It better not be a lame pencil trick again, that was just a fluke”

  • Androgen – danazol
  • methotrexate
  • cyclophosphamide
  • ace of spades – ace inhibitors
  • lithium
  • thalidomide
  • lame pencil – pencil-lame – penicillamine
  • fluconazole

He suddenly starts bleeding from one of his injection sites, starts glowing, and then screams “DIE ETHYL!”┬ábefore collapsing on the ground and lying completely static.

  • warfarin
  • radioactive contrast
  • diethylstilbestrol
  • statins

Disclaimer: not all of them are listed here, and the evidence may change in the future! This paper:

describes how not all of them are absolutely contraindicated, but most of them are avoided if possible. Sometimes discontinuing the drug, such as psychotropics, is likely to lead to a worse outcome than continuing.

Category X drugs in pregnancy:

Known Teratogenic drugs:

  • ACE inhibitors
    • captopril
    • enalapril
    • lisinopril
  • Antidepressants
    • paroxetine
  • Antiepileptics
    • carbamazepine
    • phenytoin
    • valproate
  • Anxiolytics
    • diazepam
  • Alkylating agents
    • cyclophosphamide
  • Androgens
    • danazol
  • Antimetabolites
    • methotrexate
  • Carbimazole
  • Coumarins
    • warfarin
  • Oestrogens
    • diethylstilbestrol
  • Fluconazole
  • Lithium
  • Misoprostol
  • Oral contraceptives
  • Penicillamine
  • Retinoids
    • isotretinoin
  • Radioactive iodine
  • Thalidomide

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