TERATOGENECITY

Teratogenic drugs

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Definition
Teratogenecity;-
it refers to the capacity of a drug to cause foetal
abnormalities when administered to the pregnant
mother.
Drug effects on embryo are often irreversible
Thalidomide disaster (1958-61)- resulting in
thousands of babies born with phocomelia (seal
like limbs) & other defects.

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Phocomelia

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Drugs affect foetus at three stages:
1. Fertilization and implantation (conception
to 17 days ):- failure of pregnancy may occur.

2. Organogenesis (first trimester):- most

sensitive period, deformities are produced.

3. Growth and development:- development and

functional abnormalities can occur.

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 Examples:-
Drugs: Effects:
 Thalidomide phocomelia, multiple defects
 Methotrexate Multiple defects, foetal death
 Corticosteroids Cleft palate, cardiac effects
 Warfarin Growth retardation
 Phenytoin Hypoplastic phalanges, cleft lip
 lithium Foetal goiter etc

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 Prescribing in pregnancy

Most of the drugs taken by pregnant mother reach

the foetus in uterus, some in large amount and
some in small.
 Drugs taken by pregnant mother may have
harmful effects on the foetus.
Drugs can be dangerous during any stage of
pregnancy.

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Guidelines for the safe prescribing in
pregnancy
 Before prescribing drugs to women of reproductive
age group, they should be asked if they are
pregnant.
 As far as possible no drug should be used during
1st trimester of pregnancy.
 If possible avoid all drugs during 2nd and 3rd
trimester as well (except iron calcium)
 Use the lowest effective dose of drug & limit
duration to minimum.
 Always try to use drugs that have been used
previously & found safe in pregnancy.

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Some medications are commonly used in
pregnancy.

A daily dose of 400 microgram folic acid

should ideally be started preconceptually
and continued through the first 12 weeks
of pregnancy to reduce the risk of neural
tube defects

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Women with gastro-oesophageal reflux
should be advised to eat smaller amounts
of food more frequently and avoid
aggravating, rich foods.

However, antacids are often required and

can be used at any stage of pregnancy.

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Ferrous sulphate is commonly prescribed
for iron deficiency anaemia in pregnancy
but alternative salt formulations can be
tried if there is poor gastrointestinal
tolerance.

If the response to oral treatment is poor

then women may need to be referred for
parenteral iron.
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 Reduced gastrointestinal motility in
pregnancy can lead to constipation. Lifestyle
changes are again first-line management, with
emphasis on increasing fluids and dietary
fiber.

A bulk laxative such as ispaghula and/or an

osmotic laxative such as lactulose can be
safely prescribed, but stimulant laxatives
should be avoided.
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Penicillin's
and cephalosporin's are
considered safe to use in pregnancy.

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Vaginal candidiasis is more common in
pregnancy and can be treated with topical
antifungal such as clotrimazole,

but oral antifungal agents including

fluconazole, itraconazole and terbinafine
should be avoided.

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 Paracetamolis considered a safe analgesic
throughout pregnancy.

 Formore powerful analgesia opiates such

as codeine can be prescribed, but it should
be remembered that if they are used
towards term then they run the risk of
inducing neonatal respiratory depression
and withdrawal syndrome.

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Prescribing in elderly

Drug therapy in elderly should be considered

different than adults

In aged person pharmacodynamic changes may

cause altered drug responsiveness, multiple
problems and ADRs are common & compliance
is often poor.

Bcoz of these reasons it is very important to be

critical while prescribing for elderly.

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Guidelines for prescribing elderly
 Take proper drug history from patient before
prescribing.
 Don’t prescribe medicines for every disease, don’t try
to prescribe a pill for every ill.
 Normal aging process shouldn’t be regarded as disease,
no drug can cure old age.
 Start with lowest effective dose of each drug & only
increase it cautiously according to patient’s need.
 Give drugs for the minimum period necessary. Review
prescription periodically & delete drugs that are no
longer required.
 Avoid doubtful drugs in elderly like anti obesity etc.

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 Keep in mind that ADR are common in elderly so
as far as possible don’t treat the ADR of one drug
by giving another.
 Old people may have swallowing difficulty so try
not to give big sized tab/cap. Liquids can be used
as an alternatives if swallowing is very difficult.
 Try to simplify the drug regimen. Give instruction
using simple languages.
 write down important instructions in clear & large
handwriting in local language

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THANK YOU

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