Gerald G. Briggs - Briggs Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 12th Edition

Gerald G. Briggs , BPharm, FCCP

Pharmacist Clinical Specialist (Obstetrics) (Retired)
MemorialCare Center for Women
Miller Childrens Hospital
Long Beach Memorial Medical Center
Long Beach, California
Clinical Professor of Pharmacy
University of California, San Francisco
Adjunct Professor of Pharmacy Practice
University of Southern California, Los Angeles
Adjunct Professor
Department of Pharmacotherapy
Washington State University, Spokane

Craig V. Towers , MD, FACOG

MaternalFetal Medicine
Obstetrical Director
East Tennessee Regional Perinatal Program, Knoxville

Alicia B. Forinash , PharmD, FCCP, BCPS, BCACP

Professor of Pharmacy Practice
Saint Louis College of Pharmacy
Clinical Pharmacy Specialist (Obstetrics)
MaternalFetal Care Clinic, Saint Marys Health Center
Saint Louis, Missouri

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Twelfth Edition

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ISBN: 978-1975-1-6237-5

This work is provided as is, and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturers package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

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Roger Freeman has been a coauthor of this book since the first edition in 1983. As a world-renown obstetrician, his presence on the book was a significant reason for its success. I first met Roger when he was the Medical Director at Womens Hospital, Long Beach Memorial Medical Center. He encouraged me to write the book, and his comments were always important. Roger has now retired.

Roger, please accept my sincere thank you for your input into this book over 40 years. We will miss your vital comments that have been a key reason for its popularity. It has helped many pregnant women and their infants, as well as their physicians and caregivers. Your involvement will be missed.

Gerald Briggs

I am excited to have contributed to the 12th edition of this textbook. We have extensively updated the 12th edition and added subheadings with each review to aid the health care professional. Additionally, we have added many new medication reviews. This reference continues to aid the health care professional caring for patient during pregnancy. The summary and in-depth reviews provide valuable information to assist with decisions about medication safety in pregnancy and lactation. However, the health care professional still needs to utilize patient-specific information to make the ultimate decision in the management of the patient. Several of the reviews have contact information to enroll patients taking these medications during pregnancy in studies and registries. Please enroll or encourage your patients to enroll in these studies/registries as these will continue aiding our understanding of the safety and/or efficacy of the medications during pregnancy. I would like to thank my husband, Brian, and my children, Riley and Cole, for all of their support while I have been working on this edition. Also, I would like to thank all of the exceptional health care professionals and staff that I have the opportunity to collaborate with every day at the Maternal Fetal Care Center and Women and Infant Substance Help (WISH) Center at SSM Health St. Marys and the St. Louis College of Pharmacy.

Alicia B. Forinash, PharmD, FCCP, BCPS, BCACP
St. Louis, Missouri

The subject of drugs in pregnancy is very complex and multifaceted. The topic involves numerous questions that may never be fully answered. It is not as simple as what does this single drug do in pregnancy? It also involves many other questions including: What does this drug do in combination with other drugs (of which there are thousands if not millions of different combinations)? What part does genetics or epigenetics play in drug metabolism and other aspects of drug action and interactions within the human body and fetus? What are the different effects of a drug based on gestational age of use, daily or intermittent use of a drug, and total dosage ingested? Do the effects in animals correlate with human usage? And the list of questions goes on and on.

Despite all these unanswered questions, this book is truly a magnificent source for all clinicians worldwide who care for pregnant women. Very few studies regarding drugs are ever performed during pregnancy for fear of potential adverse outcomes. This leaves health care providers in an uncomfortable position of trying to determine if the potential benefits of using a drug in pregnancy outweigh the potential risks. It is our hope and goal that this 12th edition will continue to provide needed information that can be used as part of these decision-making processes.