Drugs During Pregnancy and Lactation (eBook)

Front cover 1
Drugs During Pregnancy and Lactation, Second edition 4
Copyright page 5
Contents 6
List of contributors 23
Preface 25
Notice 28
Chapter 1 General commentary on drug therapy and drug risks in pregnancy 30
1.1 Introduction 31
1.2 Development and health 32
1.3 Reproductive stages 32
1.4 Reproductive and developmental toxicology 35
1.5 Basic principles of drug-induced reproductive and developmental toxicology 38
1.6 Effects and manifestations 39
1.7 Pharmacokinetics in pregnancy 41
1.8 Passage of drugs to the unborn and fetal kinetics 42
1.9 Causes of developmental disorders 43
1.10 Embryo/fetotoxic risk assessment 44
1.11 Classification of drugs used in pregnancy 48
1.12 Paternal use of medicinal products 49
1.13 Communicating the risk of drug use in pregnancy 50
1.14 Risk communication prior to pharmacotherapeutic choice 51
1.15 Risk communication regarding the safety (or otherwise) of drugs already used in pregnancy 52
1.16 Teratology information centers 53
Chapter 2 Specific drug therapies during pregnancy 56
2.1 Analgesics and anti-inflammatory drugs 57
2.1.1 Paracetamol (acetaminophen) 57
2.1.2 Aspirin (acetylsalicylic acid) 58
2.1.3 Pyrazolone derivatives 61
2.1.4 Combination analgesic preparations 61
2.1.5 Opioid analgesics in general 62
2.1.6 Morphine 62
2.1.7 Codeine 63
2.1.8 Pethidine (meperidine) 63
2.1.9 Fentanyl, alfentanil, remifentanil, and sufentanil 65
2.1.10 Other narco-analgesics and centrally acting analgesics 66
2.1.11 Naloxone 67
2.1.12 Nonsteroidal anti-inflammatory drugs (NSAIDs) 67
2.1.13 Selective cyclooxygenase-2 (COX-2) inhibitors 70
2.1.14 Migraine medications 71
2.1.15 Additional analgesics 73
2.1.16 Additional antiphlogistics and antirheumatics 73
2.1.17 Myotonolytics 76
2.1.18 Gout interval therapy 77
2.1.19 Gout attack therapy 78
2.2 Antiallergic drugs and desensitization 86
2.2.1 Antihistamines (H[sub(1)]-blocker) 86
2.2.2 Glucocorticosteroids 89
2.2.3 Mast cell stabilizers 90
2.2.4 Immunotherapy 90
2.3 Antiasthmatic and cough medication 92
2.3.1 Asthma and pregnancy 92
2.3.2 Selective & #946
2.3.3 Corticosteroids 94
2.3.4 Anticholinergic drugs 96
2.3.5 Theophylline 97
2.3.6 Cromoglycate, nedocromil, and lodoxamide 98
2.3.7 Other mast cell inhibitors 99
2.3.8 Antileukotrienes 99
2.3.9 Monoclonal antibodies and other asthma medications 100
2.3.10 Expectorants and mucolytic agents 100
2.3.11 Antitussives 101
2.3.12 Non-selective & #946
2.4 Antiemetics 107
2.4.1 Nausea and vomiting in pregnancy 107
2.4.2 Diet manipulations and treatment 108
2.4.3 Complementary treatment options 109
2.4.4 Acupuncture and acupressure 110
2.4.5 Hypnosis 111
2.4.6 Ginger 111
2.4.7 Antihistamines (H[sub(1)]-blockers) 112
2.4.8 Dopamine antagonists 114
2.4.9 Pyridoxine (vitamin B[sub(6)]) 115
2.4.10 Thiamine (vitamin B[sub(1)]) 116
2.4.11 Serotonin antagonists 116
2.4.12 Glucocorticoids 117
2.4.13 Other agents with antiemetic properties 118
2.5 Gastrointestinal and antilipidemic agents and spasmolytics 123
2.5.1 Gastritis and peptic ulcer during pregnancy 123
2.5.2 Antacids and sucralfate 124
2.5.3 H[sub(2)]-receptor antagonists 126
2.5.4 Proton-pump inhibitors 127
2.5.5 Bismuth salts 128
2.5.6 Additional ulcer therapeutics 128
2.5.7 Helicobacter pylori therapy 130
2.5.8 Acids 131
2.5.9 Atropine and other anticholinergic spasmolytics 131
2.5.10 Cholinergics 132
2.5.11 Other prokinetic agents 133
2.5.12 Constipation during pregnancy 134
2.5.13 Stool-bulking agents 134
2.5.14 Hyperosmotic and saline laxatives 134
2.5.15 Diphenylmethanes 135
2.5.16 Anthraquinone derivatives 136
2.5.17 Castor oil 136
2.5.18 Lubricants and emollient laxatives 137
2.5.19 Antidiarrheals 137
2.5.20 Drugs for chronic inflammatory bowel disease 138
2.5.21 Dimeticon and plant-based carminatives 141
2.5.22 Chenodeoxycholic acid and ursodeoxycholic acid 141
2.5.23 Clofibrine acid derivatives and analogs 142
2.5.24 Cholesterol synthesis-enzyme inhibitors 143
2.5.25 Cholestyramine and other lipid reducers 144
2.5.26 Appetite suppressants, obesity and weight loss 145
2.6 Anti-infective agents 152
2.6.1 Penicillins 153
2.6.2 Cephalosporins 154
2.6.3 Other & #946
2.6.4 Macrolide antibiotics 155
2.6.5 Lincomycin and clindamycin 157
2.6.6 Tetracyclines 157
2.6.7 Sulfonamides, trimethoprim, atovaquone, and pentamidine 158
2.6.8 Quinolones 160
2.6.9 Nitrofurantoin and other drugs for urinary tract infections 161
2.6.10 Aminoglycosides 162
2.6.11 Chloramphenicol 163
2.6.12 Metronidazole and other nitroimidazole antibiotics 164
2.6.13 Polypeptide antibiotics 165
2.6.14 Antimycotics in general 165
2.6.15 Nystatin 166
2.6.16 Clotrimazole and miconazole for topical use 166
2.6.17 Other local "conazole" antimycotics 167
2.6.18 Other local antimycotics 167
2.6.19 "Conazole" antimycotics for systemic use 168
2.6.20 Amphotericin B 169
2.6.21 Flucytosine 170
2.6.22 Griseofulvin 171
2.6.23 Terbinafine 171
2.6.24 Malaria prophylaxis and therapy in pregnancy 172
2.6.25 Chloroquine 173
2.6.26 Proguanil 173
2.6.27 Mefloquine 174
2.6.28 Pyrimethamine, sulfadoxine and dapsone 175
2.6.29 Quinine 176
2.6.30 Halofantrine 177
2.6.31 Primaquine 177
2.6.32 Artemisinin derivatives 178
2.6.33 Other malarial agents 179
2.6.34 Tuberculosis and pregnancy 180
2.6.35 Isoniazid (INH) 181
2.6.36 Rifampicin 182
2.6.37 Ethambutol 182
2.6.38 Pyrazinamide (PZA) 183
2.6.39 Aminoglycosides in tuberculosis 183
2.6.40 Para-aminosalicylic acid (PAS) 183
2.6.41 Quinolones in tuberculosis 184
2.6.42 Other second-line antituberculous drugs 184
2.6.43 Dapsone 185
2.6.44 Aciclovir and other herpes antivirals 185
2.6.45 Antiviral drugs for influenza 187
2.6.46 Ribavirin 187
2.6.47 Other antiviral drugs 188
2.6.48 HIV prophylaxis and therapy 188
2.6.49 Mebendazole and flubendazole 191
2.6.50 Pyrviniumembonate 192
2.6.51 Albendazole and thiabendazole 193
2.6.52 Niclosamide 193
2.6.53 Praziquantel 194
2.6.54 Pyrantel 194
2.6.55 Ivermectin and diethylcarbamazine 195
2.6.56 Hyperthermia 195
2.6.57 Traveling 197
2.7 Vaccines and immunoglobulins 207
2.7.1 Vaccination and pregnancy 208
2.7.2 Cholera vaccine 209
2.7.3 Hemophilus influenza b (HIB) vaccine 209
2.7.4 Hepatitis A vaccine 209
2.7.5 Hepatitis B vaccine 210
2.7.6 Human Papilloma Virus (HPV) vaccine 211
2.7.7 Influenza vaccine 211
2.7.8 Measles and mumps vaccines 212
2.7.9 Meningococcal meningitis vaccine 213
2.7.10 Pneumococcal vaccination 213
2.7.11 Poliomyelitis vaccine 213
2.7.12 Rabies vaccine 214
2.7.13 Rubella vaccine 215
2.7.14 Tetanus and diphtheria vaccines 216
2.7.15 Typhoid vaccine 216
2.7.16 Varicella vaccine 217
2.7.17 Yellow fever vaccine 218
2.7.18 Immunoglobulins 218
2.8 Heart and circulatory system drugs and diuretics 222
2.8.1 Arterial hypertension and pregnancy 223
2.8.2 & #945
2.8.3 & #946
2.8.4 Hydralazine and dihydralazine 227
2.8.5 Nifedipine and other calcium antagonists 229
2.8.6 ACE inhibitors 232
2.8.7 Angiotensin-II receptor antagonists 234
2.8.8 Clonidine 236
2.8.9 Diazoxide 237
2.8.10 Magnesium sulfate 237
2.8.11 Nitroprusside 238
2.8.12 Reserpine 238
2.8.13 Other antihypertensives 239
2.8.14 Pulmonary hypertension and its medication 240
2.8.15 Hypotension and antihypotensives 243
2.8.16 Dihydroergotamine 244
2.8.17 Adrenergic substances 245
2.8.18 Cardiac glycosides 245
2.8.19 Antiarrhythmic therapy of the pregnant woman and of the fetus 246
2.8.20 Nitrates and other so-called vasodilators 251
2.8.21 Cardiovascular drugs 252
2.8.22 Diuretics 253
2.8.23 Thiazide diuretics 253
2.8.24 Furosemide and other high-ceiling diuretics 254
2.8.25 Aldosterone antagonists 255
2.8.26 Amiloride and triamterene 256
2.8.27 Mannitol 256
2.9 Anticoagulant and fibrinolytic drugs 266
2.9.1 Pregnancy and coagulation 266
2.9.2 Heparins 268
2.9.3 Protamines 269
2.9.4 Low-dose aspirin (LDA) 270
2.9.5 Other non-coumarin antithrombotic drugs 270
2.9.6 Vitamin K antagonists 271
2.9.7 Vitamin K 275
2.9.8 Fibrinolysis 276
2.9.9 Streptokinase 276
2.9.10 Other fibrinolytics 277
2.9.11 Inhibitors of fibrinolysis 278
2.9.12 Volume expanders 278
2.10 Antiepileptics 283
2.10.1 Epilepsy and antiepileptic drugs in pregnancy 284
2.10.2 Benzodiazepines 286
2.10.3 Carbamazepine 289
2.10.4 Ethosuximide and other succimides 290
2.10.5 Oxazolidine anticonvulsants 291
2.10.6 Phenobarbital and primidone 292
2.10.7 Phenytoin 295
2.10.8 Sultiam 297
2.10.9 Valproic acid 298
2.10.10 Felbamate 302
2.10.11 Gabapentin 302
2.10.12 Lamotrigine 303
2.10.13 Levetiracetam 305
2.10.14 Oxcarbazepine 306
2.10.15 Pregabalin 307
2.10.16 Tiagabine 307
2.10.17 Topiramate 308
2.10.18 Vigabatrin 308
2.10.19 Zonisamid 309
2.11 Psychotropic drugs 317
2.11.1 Tricyclic and tetracyclic antidepressants 318
2.11.2 Selective serotonin reuptake inhibitors (SSRIs) 320
2.11.3 Monoaminoxidase inhibitors (MAOIs) 325
2.11.4 Other antidepressants 326
2.11.5 Antipsychotic drugs and pregnancy – "classical" or atypical antipsychotics? 328
2.11.6 Phenothiazines and thioxanthenes 329
2.11.7 Butyrophenones 330
2.11.8 Atypical antipsychotic drugs 331
2.11.9 Other neuroleptic drugs 333
2.11.10 Lithium and other mood-stabilizers/antimanic agents 334
2.11.11 Barbiturates as sedative-hypnotic agents 335
2.11.12 Benzodiazepines 336
2.11.13 Zaleplon, zolpidem, and zopiclone 338
2.11.14 Other anxiolytic drugs 338
2.11.15 Chloral hydrate 339
2.11.16 Other sedative-hypnotic drugs 339
2.11.17 Psychoanaleptic drugs 340
2.11.18 Parkinson drugs 341
2.12 Immunomodulators 350
2.12.1 Immunomodulators in general 350
2.12.2 Azathioprine 351
2.12.3 Cyclosporine A 352
2.12.4 Selective immunosuppressants 353
2.12.5 Monoclonal antibodies as part of an immunomodulatory therapy 355
2.12.6 Interferons 356
2.12.7 Thalidomide 358
2.12.8 Other immunomodulators 359
2.13 Antineoplastic drugs 364
2.13.1 Cancer and pregnancy 364
2.13.2 Classification of the drugs used for chemotherapy 367
2.13.3 Vinca alkaloids and structural analogs 368
2.13.4 Podophyllotoxin derivatives 369
2.13.5 Nitrogen mustard agents 369
2.13.6 Nitrogen mustard analogs 370
2.13.7 Other alkylating agents 371
2.13.8 Cytotoxic anthracycline antibiotics 372
2.13.9 Other cytotoxic antibiotics 374
2.13.10 Folate antagonistic antimetabolites 375
2.13.11 Purine-derived antimetabolites (purine antagonists) 378
2.13.12 Pyrimidine-derived antimetabolites (pyrimidine antagonists) 379
2.13.13 Taxanes 381
2.13.14 Platin compounds 381
2.13.15 Other antineoplastic drugs 383
2.13.16 Enzymes and antibodies exerting antineoplastic effects 384
2.13.17 Antineoplastic drugs with endocrine effects 386
2.13.18 Cytostatic drugs of plant origin 387
2.13.19 Occupational handling of cytostatic drugs 387
2.14 Uterine contraction agents, tocolytics, vaginal therapeutics, and local contraceptives 397
2.14.1 Prostaglandins 397
2.14.2 Oxytocin 400
2.14.3 Ergot alkaloids (see also Chapter 2.1) 401
2.14.4 Tocolytics in general 401
2.14.5 & #946
2.14.6 Calcium antagonists 402
2.14.7 Magnesium sulfate 403
2.14.8 Oxytocin receptor antagonists 404
2.14.9 Prostaglandin antagonists 404
2.14.10 Other tocolytics 404
2.14.11 Vaginal therapeutics 405
2.14.12 Spermicide contraceptives 406
2.14.13 Intrauterine devices 406
2.15 Hormones 410
2.15.1 Hypothalamic releasing hormones 411
2.15.2 Anterior pituitary hormones 413
2.15.3 Prolactin antagonists 415
2.15.4 Posterior pituitary hormones 416
2.15.5 Thyroid function and iodine supply during pregnancy 417
2.15.6 Hypothyroidism, triiodothyronine (T3), and thyroxine (T4) 418
2.15.7 Hyperthyroidism and thyrostatics 419
2.15.8 Glucocorticoids 421
2.15.9 Diabetes mellitus and pregnancy 426
2.15.10 Insulin 428
2.15.11 Oral antidiabetics 430
2.15.12 Estrogens 433
2.15.13 Progestins (gestagens) 434
2.15.14 Diethylstilbestrol 437
2.15.15 Androgens and anabolics 437
2.15.16 Antiestrogens, antiandrogens, and danazol 438
2.15.17 Mifepristone (RU486) 439
2.15.18 Clomiphene 440
2.16 General and local anesthetics and muscle relaxants 452
2.16.1 Halogenated inhalation agents for general anesthesia 453
2.16.2 Ether (diethyl ether) 455
2.16.3 Nitrous oxide 456
2.16.4 Injectable anesthetics 456
2.16.5 Local anesthetics 460
2.16.6 Epidural and spinal analgesia/anesthesia in pregnancy 461
2.16.7 Muscle relaxants 462
2.16.8 Occupational exposure to inhalation anesthetics 463
2.17 Dermatological medications and local therapeutics 470
2.17.1 Typical skin changes during pregnancy 470
2.17.2 Anti-infective agents 471
2.17.3 Antiseptics and disinfectants 473
2.17.4 Astringents 476
2.17.5 Polidocanol 477
2.17.6 Camphor and menthol 477
2.17.7 Coal tar and slate oil preparations 477
2.17.8 Local immunomodulators and neurodermatitis therapy 478
2.17.9 Keratolytics 478
2.17.10 Retinoids for acne and psoriasis therapy 481
2.17.11 Photochemotherapy and fumaric acid 485
2.17.12 Sex hormones and cyproterone acetate 485
2.17.13 5-Fluorouracil 486
2.17.14 Lithium 486
2.17.15 Scabies and lice medications 487
2.17.16 Diethyltoluamide and icaridin 487
2.17.17 Eye, nose, and ear drops 488
2.17.18 Hemorrhoid medications 490
2.17.19 Vein therapeutics 491
2.17.20 Antihidrotica 491
2.17.21 Minoxidil 491
2.17.22 Cosmetics 492
2.18 Vitamins, minerals, and trace elements 496
2.18.1 Vitamin A (retinol) 497
2.18.2 Vitamin B[sub(1)] (thiamine) 499
2.18.3 Vitamin B[sub(2)] (riboflavin) 499
2.18.4 Vitamin B[sub(3)] (nicotinamide) 500
2.18.5 Vitamin B[sub(6)] (pyridoxine) 500
2.18.6 Vitamin B[sub(12)] (cyanocobalamin) 500
2.18.7 Folic acid 501
2.18.8 Vitamin C (ascorbic acid) 503
2.18.9 Vitamin D group 504
2.18.10 Vitamin E (tocopherol) 505
2.18.11 Vitamin K 505
2.18.12 Multivitamin preparations 506
2.18.13 Iron 506
2.18.14 Calcium 507
2.18.15 Fluoride 508
2.18.16 Strontium 508
2.18.17 Biphosphonates and other osteoporosis drugs 509
2.18.18 Iodide 510
2.18.19 Trace elements 510
2.19 Herbs during pregnancy 514
2.19.1 The safety of herbs during pregnancy 514
2.19.2 Counseling a pregnant woman about herbs 515
2.19.3 General concepts regarding the use of herbs during pregnancy 517
2.19.4 Herbs used as foods 518
2.19.5 Essential oils that are safe during pregnancy 518
2.19.6 Herbs frequently used during pregnancy 519
2.19.7 Herbs controversially used during pregnancy 520
2.19.8 Herbs contraindicated during pregnancy 520
2.20 Diagnostic agents 531
2.20.1 X-ray examinations 531
2.20.2 Ultrasound 534
2.20.3 Magnetic resonance imaging 535
2.20.4 Barium sulfate 536
2.20.5 Iodine-containing contrast media 536
2.20.6 Ultrasonographic and magnetic resonance contrast media 537
2.20.7 Radioactive isotopes 537
2.20.8 Stable isotopes 538
2.20.9 Dyes 539
2.20.10 Other diagnostic agents 539
2.21 Recreational drugs 543
2.21.1 Alcohol (ethanol) 543
2.21.2 Caffeine and other xanthine derivatives 549
2.21.3 Tobacco and smoking 550
2.21.4 Drugs of abuse in general (excluding alcohol) 554
2.21.5 Opiates 554
2.21.6 Stimulants 556
2.21.7 Hallucinogens 559
2.21.8 "Sniffed" substances 562
2.22 Poisonings and toxins 572
2.22.1 The general risk of poisoning in pregnancy 572
2.22.2 Treatment of poisoning in pregnancy 573
2.22.3 Chemicals 574
2.22.4 Medicines 578
2.22.5 Animal toxins 583
2.22.6 Mushrooms 584
2.22.7 Other plant toxins 585
2.22.8 Bacterial endotoxins 585
2.23 Occupational, industrial, and environmental agents 590
2.23.1 Solvent exposure in general 593
2.23.2 Formaldehyde and formalin 602
2.23.3 Chloroprene (chlorobutadiene) 603
2.23.4 Cyanide 604
2.23.5 Photographic/printing chemicals 604
2.23.6 Pesticides 605
2.23.7 Phenoxyacetic acid derivatives and chlorinated dibenzo-dioxins 610
2.23.8 Metals 612
2.23.9 Hazardous waste landfill sites 619
2.23.10 Radiation associated with the nuclear industry 621
2.23.11 Video display terminals (VDTs) 623
2.23.12 Mobile phones 625
2.23.13 Other sources of electromagnetic radiation 625
2.23.14 Electric shocks and lightning strikes 627
Chapter 3 General commentary on drug therapy and drug risk during lactation 638
3.1 The advantages of breastfeeding versus the risks of maternal medication 638
3.2 The passage of medications into the mother's milk 641
3.3 Infant characteristics 642
3.4 Milk plasma ratio 643
3.5 Amount of medication in the milk and relative dose 644
3.6 Toxicity of medications in the mother's milk 646
3.7 Medications that affect lactation 648
3.8 Breastfeeding support 649
Chapter 4 Specific drug therapies during lactation 650
4.1 Analgesics, antiphlogistics and anesthetics 652
4.1.1 Paracetamol 652
4.1.2 Acetylsalicylic acid 653
4.1.3 Opioid analgesics and other centrally acting analgesics 654
4.1.4 Classic nonsteroid anti-inflammatory drugs 656
4.1.5 Selective cyclooxygenase-2 (COX-2) inhibitors 658
4.1.6 Pyrazolone- and phenylbutazone derivatives 658
4.1.7 Other antirheumatics 659
4.1.8 Migraine medications 660
4.1.9 Local anesthetics 661
4.1.10 Other medications used in connection with anesthesia 662
4.1.11 Myotonolytics 663
4.1.12 Gout therapy 664
4.2 Antiallergics, antiasthmatics, and antitussives 668
4.2.1 Antihistamines (H[sub(1)]-blockers) 668
4.2.2 & #946
4.2.3 Other sympathomimetics 671
4.2.4 Anticholinergics for asthma treatment 671
4.2.5 Theophylline 671
4.2.6 Cromoglycic acid and nedocromil 672
4.2.7 Corticoids 672
4.2.8 Leukotrien-receptor antagonists 673
4.2.9 Acetylcysteine and other mucolytics 673
4.2.10 Antitussives 673
4.3 Gastrointestinal drugs 677
4.3.1 Antacids 677
4.3.2 H[sub(2)]-receptor blockers and other ulcer therapeutics 678
4.3.3 Peristaltic stimulators 679
4.3.4 Cholinergics 680
4.3.5 Anticholinergic spasmolytics 681
4.3.6 Laxatives 681
4.3.7 Agents used for chronic inflammatory bowel diseases 682
4.3.8 Antidiarrheals for acute diarrhea 683
4.3.9 Carminatives 683
4.3.10 Lipid reducers 684
4.3.11 Chenodeoxycholic acid and ursodeoxycholic acid 684
4.3.12 Appetite suppressants 685
4.3.13 Antiemetics 685
4.4 Anti-infectives 688
4.4.1 Antibiotics in general 689
4.4.2 Penicillins, cephalosporins, and other & #946
4.4.3 Erythromycin and other macrolides 690
4.4.4 Tetracyclines 691
4.4.5 Dapsone, nitrofurantoin, and other drugs for urinary tract infections 691
4.4.6 Quinolones 692
4.4.7 Other antibiotics and urinary tract antiseptics 693
4.4.8 Nitroimidazole antibiotics 694
4.4.9 Aminoglycoside antibiotics 694
4.4.10 Tuberculostatics 695
4.4.11 Malarial drugs 696
4.4.12 Local antimycotics 697
4.4.13 Systemic antimycotics 697
4.4.14 Antihelminthics 698
4.4.15 Acyclovir, antiretroviral drugs, and other virustatics 699
4.5 Vaccines and immunoglobulins 703
4.5.1 Maternal immunization 703
4.5.2 Efficacy of immunization in breastfed infants 704
4.5.3 Hepatitis A vaccine 704
4.5.4 Hepatitis B vaccine 704
4.5.5 Influenza vaccine 705
4.5.6 Polio vaccine 705
4.5.7 Rabies vaccine 706
4.5.8 Rubella vaccine 706
4.5.9 Smallpox vaccine 706
4.5.10 Typhoid vaccine 707
4.5.11 Immunoglobulins 707
4.6 Cardiovascular drugs and diuretics 709
& #946
4.6.2 Hydralazine 711
4.6.3 & #945
4.6.4 Calcium antagonists 712
4.6.5 ACE inhibitors 713
4.6.6 Angiotensin-II receptor-antagonists 713
4.6.7 Other antihypertensives 714
4.6.8 Dihydroergotamine and other antihypotensives 715
4.6.9 Digitalis 715
4.6.10 Antiarrhythmics 716
4.6.11 Diuretics 719
4.6.12 Circulatory drugs and vasodilators 720
4.7 Anticoagulants and fibrinolytics 724
4.7.1 Heparin 724
4.7.2 Vitamin K antagonists (coumarin derivatives and indanediones) 725
4.7.3 Other anticoagulants 725
4.7.4 Fibrinolytics 726
4.8 Antiepileptics 728
4.8.1 Carbamazepine 729
4.8.2 Clobazam and clonazepam 729
4.8.3 Ethosuximide and mesuximide 730
4.8.4 Phenobarbitone (phenobarbital), primidone, and barbexaclone 730
4.8.5 Phenytoin 731
4.8.6 Valproic acid 731
4.8.7 Recommendations: classical anticonvulsants 732
4.8.8 Gabapentin 732
4.8.9 Lamotrigine 733
4.8.10 Levetiracetam 733
4.8.11 Oxcarbazepine 733
4.8.12 Topiramate 734
4.8.13 Vigabatrin 734
4.8.14 Zonisamide 734
4.8.15 Recommendations: newer antiepileptics 734
4.9 Psychotropic drugs 737
4.9.1 Antidepressants in general 737
4.9.2 Tri- and tetracyclic antidepressants 738
4.9.3 Selective serotonin reuptake inhibitors 743
4.9.4 Other antidepressants 747
4.9.5 Phenothiazine and thioxanthene neuroleptics 749
4.9.6 Butyrophenones 753
4.9.7 Atypical neuroleptics 753
4.9.8 Antimanic drugs 756
4.9.9 Benzodiazepines 756
4.9.10 Other anxiolytics 759
4.9.11 Other hypnotics 760
4.9.12 Psychoanaleptics 761
4.9.13 Parkinson drugs 761
4.10 Immunomodulating and antineoplastic agents 767
4.10.1 Immunosuppressive and immune antineoplastic agents 767
4.10.2 Antineoplastics 769
4.11 Hormones and hormone antagonists 775
4.11.1 Pituitary and hypothalamic hormones 775
4.11.2 Methylergometrine (methylergonovine) 776
4.11.3 Bromocriptine and other prolactin inhibitors 777
4.11.4 Thyroid hormones and thyroid receptor antibodies 778
4.11.5 Thyrostatics 779
4.11.6 Iodine 780
4.11.7 Corticosteroids 781
4.11.8 Adrenaline 782
4.11.9 Insulin and oral antidiabetics 783
4.11.10 Estrogens, gestagens, and hormonal contraceptives 784
4.11.11 Androgens and anabolics 786
4.11.12 Cyproterone acetate and other sex-hormone inhibitors 786
4.11.13 Prostaglandins 787
4.12 Dermatological drugs and local therapeutics 791
4.12.1 General aspects of external applications: cosmetics, hair products, sunscreens 791
4.12.2 Medications for lice and scabies 792
4.12.3 Treatments for acne and psoriasis 794
4.12.4 Other dermatological medications 795
4.12.5 Eye, ear, and nose drops 795
4.12.6 Vaginal therapeutics 796
4.12.7 Vein therapeutics and other local therapeutics 797
4.13 Alternative remedies, vitamins, and minerals 800
4.13.1 Alternative remedies and phytotherapeutics 800
4.13.2 Herbal galactogogues and anti-galactogogues 802
4.13.3 Topical treatment for breast problems 804
4.13.4 Vitamins, minerals, and trace elements 804
4.13.5 Biphosphonates 805
4.13.6 Exercise 806
4.13.7 Glucose 6-phosphate-dehydrogenase deficiency 806
4.14 Diagnostics 808
4.14.1 X-ray studies, ultrasound, and magnetic resonance 808
4.14.2 Iodine-containing contrast media 809
4.14.3 Radionuclides 810
4.14.4 Magnetic resonance contrast agents 811
4.14.5 Fluorescein 812
4.14.6 Other diagnostics 813
4.15 Infections 815
4.15.1 Simple infections 815
4.15.2 Mastitis 816
4.15.3 Hepatitis A 816
4.15.4 Hepatitis B 817
4.15.5 Hepatitis C 817
4.15.6 Hepatitis E 819
4.15.7 Herpes simplex 819
4.15.8 Herpes zoster (shingles), chickenpox 820
4.15.9 HIV infection 820
4.15.10 Human cytomegalovirus 822
4.15.11 Tuberculosis 823
4.15.12 Other infectious diseases 823
4.16 Recreational drugs 826
4.16.1 Alcohol 826
4.16.2 Caffeine 827
4.16.3 Cannabis 829
4.16.4 Cocaine 829
4.16.5 Nicotine 830
4.16.6 Opiates, including methadone 832
4.16.7 Other drugs 833
4.17 Plant toxins 837
4.18 Industrial chemicals and environmental contaminants 839
4.18.1 Persistent organochlorine compounds (pesticides, polychlorinated biphenyls and dioxins) 840
4.18.2 Mercury 845
4.18.3 Lead 847
4.18.4 Cadmium 848
4.18.5 Other contaminants 849
4.18.6 Breastfeeding despite environmental contaminants? 850
4.18.7 Breastfeeding and the workplace 851
Appendix A: Teratology information services and centers 856
Appendix B: Addresses for breastfeeding support 868
Subject Index 882
A 882
B 884
C 885
D 887
E 889
F 890
G 890
H 891
I 892
J 893
K 893
L 893
M 894
N 896
O 897
P 897
Q 899
R 900
S 900
T 901
U 903
V 903
W 904
X 904
Y 904
Z 904