Drugs for pregnancy and breastfeeding
Safe drugs to use in dentistry for pregnant patients and breastfeeding patients
Below is a table of the commonly used drugs in dentistry and the safety level for pregnant women and those breastfeeding.
Key medication considerations
during pregnancy and breast-feeding. |
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AGENT
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FDA PR*
CATEGORY
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SAFE DURING PREGNANCY?
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SAFE DURING BREAST-FEEDING?
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Analgesics and Anti-inflammatories†
Acetaminophen
Aspirin
Codeine
Glucocorticoids (dexamethasone, prednisone)
Hydrocodone Ibuprofen§
Oxycodone
|
B C/D C
C C C/D B
|
Yes
Avoid
Use with caution
Avoid‡
Use with caution
Avoid use in third trimester Use with caution |
Yes
Avoid Yes Yes Use with caution
Yes
Use with caution
|
Antibiotics¶# Amoxicillin
Azithromycin Cephalexin Chlorhexidine (topical) Clarithromycin Clindamycin Clotrimazole (topical) Doxycycline Erythromycin Fluconazole
Metronidazole
Nystatin
Penicillin
Terconazole
(topical) Tetracycline |
B B B B C B B D B
C/D B
C B B D
|
Yes Yes Yes Yes
Use with caution
Yes
Yes Avoid Yes Yes (single-dose regimens)
Yes Yes
Yes Yes Avoid |
Yes Yes Yes Yes
Use with caution
Yes
Yes Avoid Use with caution
Yes
Avoid; may give breast
milk an unpleasant taste Yes Yes
Yes Avoid |
Local Anesthetics
Articaine Bupivacaine Lidocaine (with or without epinephrine)
Mepivacaine (with or without
levonordefrin) Prilocaine Benzocaine (topical)
Dyclonine (topical) Lidocaine (topical) Tetracaine (topical) |
C C B C B C C B C
|
Use with caution Use with caution Yes
Use with caution
Yes
Use with caution
Yes
Yes
Use with caution
|
Use with caution
Yes Yes Yes Yes
Use with caution
Yes
Yes
Use with caution
|
Sedatives Benzodiazepines
Zaleplon Zolpidem |
D/X C
C
|
Avoid
Use with caution
Use with caution
|
Avoid
Use with caution
Yes
|
Emergency Medications
Albuterol
Diphenhydramine
Epinephrine Flumazenil Naloxone Nitroglycerin |
C B
C C C C
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Steroid and β2-agonist inhalers are safe
Yes
Use with caution Use
with caution Use with caution Use with caution |
Yes
Avoid
Yes
Use with caution Use
with caution Use with caution |
*
FDA PR: U.S. Food and Drug Administration Pregnancy Risk. See Table 1 for FDA PR category definitions. † In the case of combination products (such as oxycodone with
acetaminophen), the safety with respect to either pregnancy or breast-feeding is dependent on the highest-risk moiety. In the example of oxycodone with acetaminophen, the combination of these two drugs should be used with caution, because the oxycodone moiety carries a higher risk than the acetaminophen moiety. ‡ Oral steroids should not be withheld from patients with acute severe asthma.
§ Ibuprofen is representative
of all nonsteroidal anti-inflammatory drugs. In breast-feeding patients, avoid cyclooxygenase selective inhibitors such as celecoxib, as few data regarding their safe use in this population are available, and avoid doses of aspirin higher than 100 milligrams because of risk
of platelet dysfunction and Reye syndrome. ¶ Antibiotic
use during pregnancy: The patient should receive the full adult dose and for the usual length of treatment. Serious infections should be treated aggressively. Penicillins and cephalosporins are considered safe. Use higher-dose regimens (such as cephalexin 500 mg three times per day rather than 250 mg three times per day), as they are cleared from the system more quickly because of the increase in glomerular filtration rate in pregnancy.
# Antibiotic
use during breast-feeding: These agents may cause altered bowel flora and, thus, diarrhea in the baby. If the infant develops a fever, the clinician should take into account maternal antibiotic treatment. |
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From 2012 Consensus Statement (ACOG) if link not work search “oral health” on ACOG |
210 pregnancies that had dental work showed no differences when using local anesthetics while having dental work Hagai JADA Aug 2015
Bryan Bauer, DDS, FAGD
630-665-5550
630-665-5550
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