Drugs in Pregnancy, Labor, and

Lactation

Group of pregnancy, labor, and lactation is a

special group in pharmacotherapy

Pharmacokinetics of drugs during

pregnancy
1.Absorpsi
Decreased secretion of gastric acid
Decreased motility of the gastrointestinal tract
2.Distribusi
Increased the volume of plasma and
extracellular fluid
Decreased of serum albumin

Pharmacokinetics of drugs during

pregnancy
3.Metabolisme
Increased of the activity of drug metabolism

4.Eliminasi
Increased renal blood flow (RBF)

Drugs in Pregnancy
The FDA classifies drugs into 5 categories of
safety for use during pregnancy :
1. Category A: safe
Ex : antacids, Bisacodyl, methyl dopa,
paracetamol
2. Category B: unlimited usage
Ex : salmeterol, Gol.Sefalosporin, prazosin

3. Category C: negative effects on the fetus

Ex : fluoxetine, amitriptyline, clonazepam,
Cotrimoxazol

4. Category D: malformations on the fetus

Ex : valproic acid, ACE inhibitors, angiotensin II
antagonists
5. Category X: high risk of malformations,
absolute contraindications
Ex : misoprostol, isotretinoin, thalidomide

Principles of Drug Therapy in

Pregnancy
1. Consider overcome the disease without drugs
2. The drug is only used when the benefit > risk
3. Choose a well known drug
4. Avoid polypharmacy
5. Find out the drug categories A, B, C, D or X

Drugs in Labor
1. Oxytocic
Drugs that increase the strength of uterine
contractions
a. Oxytocin
b. Ergot alkaloids
c. Prostaglandins E and F

2. Tocolytic
Drugs that reduce / inhibit uterine contractions
Purpose: Prevent premature labor, so that the
fetus can be prepared aterm born
Adrenergic 2: Pitodrin, terbutaline
Pitrodine will stimulate 2 receptors on uterine
smooth muscle

Lactation Risk Categories

1.
2.
3.
4.
5.

L1 (safest)
L2 (safer)
L3 (moderately safe)
L4 (possibly hazardous)
L5 (contraindicated)