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

A REFERENCE GUIDE TO FETAL AND NEONATAL RISK

Drugs in
Pregnancy and
Lactation, Tenth Edition

A REFERENCE GUIDE TO FETAL AND NEONATAL RISK

Drugs in
Pregnancy and
Lactation, Tenth 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, Washington

Roger K. Freeman, MD

MemorialCare Center for Women

Miller Childrens Hospital

Long Beach Memorial Medical Center

Long Beach, California

Director Mednax Medical Group

Clinical Professor of Obstetrics and Gynecology

University of California, Irvine

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Library of Congress Cataloging-in-Publication Data

Briggs, Gerald G., author.

Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk / Gerald G. Briggs, Roger K. Freeman, Sumner J. Yaffe. Tenth edition.

p. ; cm.

Includes bibliographical references.

ISBN 978-1-4511-9082-3 ISBN 1-60831-708-0

I. Freeman, Roger K., 1935- author. II. Yaffe, Sumner J., 1923-2011, author. III. Title.

[DNLM: 1. Infant, Newborn, Diseaseschemically inducedHandbooks. 2. Drug-Related Side Effects and Adverse ReactionsHandbooks. 3. Lactationdrug effectsHandbooks. 4. Maternal-Fetal Exchangedrug effectsHandbooks. 5. Milk, Humandrug effectsHandbooks. 6. Pregnancydrug effectsHandbooks. WS 39]

RG627.6.D79

618.3'2dc23

2014012988

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

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10 9 8 7 6 5 4 3 2 1

In Memory

Sumner J. Yaffe, M.D.

May 9, 1923August 10, 2011

On August 10, 2011, Dr. Sumner J. Yaffe, often regarded as the father of pediatric clinical pharmacology, passed away. He had a long and distinguished career as a renowned researcher and expert in pediatric pharmacology.

Dr. Yaffe was our friend, colleague, and co-author for 31 years. In 1980, he enthusiastically accepted our offer to co-author this book. At that time, he was the Director of the Center for Research for Mothers and Children at the National Institute of Child Health and Human Development. Over the years, he authored and/or contributed to nearly 300 scientific articles and books, including ours. His comments on our reviews were always on target. Our readers and ourselves have reaped the benefits of his vast experience. We were indeed fortunate to have received his wise advice and counsel over three decades.

Foreword

This book is now in its 10th edition and continues to enjoy great success with physicians and other professionals involved in the care of pregnant and lactating patients. Many of the reviews are exhaustive but pertinent to the management of pregnant and lactating patients who have already ingested a drug or who are in need of drug therapy where a costbenefit analysis may be necessary for appropriate counseling. There are seldom absolute answers to questions a woman may have when she ingests a drug when pregnant or nursing because human experience is usually, of necessity, somewhat anecdotal. Even with all the information in this publication, there are risks that are yet unknown that may apply to a small number of people making the dictum of not using drugs in pregnancy without good cause still important. The effect of drugs in animals, the importance of timing and dose, and the effect of environmental factors are all involved in the risks and benefits of drugs in pregnant and/or lactating women and their fetuses/neonates. These factors are considered when data are available, but we must admit that in no individual case is the understanding of risks and benefits absolute.

Because many pregnant and lactating women take substances, both legal and illegal, without the knowledge of their caregivers, the challenge to understand the risks/benefits of any drug and its interactions with these substances is daunting. Today, we are just beginning to understand the specific genetic influences on the action, toxicity, and teratogenicity of drugs in an individual. I expect in the future there will be many identified genetic factors that will influence therapeutic decisions.

The contributions of Dr. Sumner J. Yaffe, who died after the last edition, will be greatly missed. His vast experience and expertise regarding the use of drugs in pregnancy and lactation were significant contributions to all editions of this book.