Pregnancy NSAIDs

The NSAIDs are contraindicated in patients with known hypersensitivity. There is a cross-sensitivity to other NSAIDs. Therefore, if a patient is allergic to one NSAID, there is an increased risk of an allergic reaction with any other NSAID. Hypersensitivity to aspirin is a contraindication for all NSAIDs. In general, the NSAIDs are contraindicated during the third trimester of pregnancy and during lactation. 

Celecoxib is contraindicated in patients who are allergic to die drug itself, die sulfonamides, odier NSAIDs, or aspirin it also is contraindicated during pregnancy (Category C) and lactation. 

The use of OCs is beneficial in women with menorrhagia who do not desire pregnancy. A 43% to 53% reduction in menstrual blood loss has been observed in 68% of patients treated with OCs containing greater than or equal to 35 meg estradiol for the treatment of menorrhagia.29 As with the use of NSAIDs, the reduction in blood loss is proportional to pretreatment blood loss. 

NSAIDs may also cause kidney diseases, hepatitis, hypersensitivity reactions, rash, and CNS complaints of drowsiness, dizziness, headaches, depression, confusion, and tinnitus. All nonselective NSAIDs inhibit COX-l-dependent thromboxane production in platelets, thereby increasing bleeding risk. NSAIDs should be avoided in late pregnancy because of the risk of premature closure of the ductus arteriosus. 

NSAIDs are contraindicated after 37 weeks gestation. For refractory migraines, narcotics may be used. Salicylates and indomethacin should be avoided throughout pregnancy if possible. The use of sumatriptan is controversial. Nausea of migraines may be treated with metoclopramide. 

Eideriy Age appears to increase the possibility of adverse reactions to NSAIDs. The risk of serious ulcer disease is increased this risk appears to increase with dose. Ketorolac is cleared more slowly by the elderly use caution and reduce dosage. Pregnancy Category B (ketoprofen, naproxen, naproxen sodium, flurbiprofen, diclofenac, fenoprofen, ibuprofen, indomethacin, meclofenamate, sulindac). 

Category C (etodolac, ketorolac, mefenamic acid, meloxicam, nabumetone, oxaprozin, tolmetin, piroxicam, celecoxib). All NSAIDs are Category D if used in the third trimester or near delivery. Avoid during pregnancy, especially in the third trimester. 

Uterus and pregnancy The whole pregnancy period Avoid NSAIDs in the last trimester. Use NSAIDs in first and second trimester only after careful consideration of possible risks (early miscarriages and malformations, respectively). Misoprostol is contraindicated throughout pregnancy... 

Nutritional iron deficiency anaemia other causes in which iron deficiency can occur are pregnancy, lactation, infants, children. In patients with malabsorption syndrome, patients who are taking NSAIDs for long period, patients with chronic inflammatory disease and in patients of gastrectomy. 

Lithium Mechanism of action uncertain suppresses inositol signaling and inhibits glycogen synthase kinase-3 (GSK-3), a multifunctional protein kinase No significant antagonistic actions on autonomic nervous system receptors or specific CNS receptors no sedative effects Bipolar affective disorder-prophylactic use can prevent mood swings between mania and depression Oral absorption, renal elimination half-life 20 h. narrow therapeutic window (monitor blood levels) Toxicity Tremor, edema, hypothyroidism, renal dysfunction, dysrhythmias pregnancy category D Interactions Clearance decreased by thiazides and some NSAIDs... 

Meclofenamate and mefenamic acid (Table 36-1) inhibit both COX and phospholipase A2. Meclofenamate appears to have adverse effects similar to those of other NSAIDs, though diarrhea and abdominal pain may be more common it has no advantages over other NSAIDs. This drug enhances the effect of oral anticoagulants. Meclofenamate is contraindicated in pregnancy its efficacy and safety have not been established for young children. 

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

Theis JGW. Acetylsalicylic acid (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy are they safe Can Fam Physician 1996 42 2347-2349. 

PGE alprostadil (used to maintain the patency of the ductus arteriosus in neonates with congenital heart defects, and for erectile dysfunction by injection into the corpus cavemosum of the penis) misoprostol (used for prophylaxis of peptic ulcer associated with NSAIDs) gemeprost (used as pessaries to soften the uterine cervix and dilate the cervical canal prior to vacuum aspiration for termination of pregnancy). 

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