Table 5:
Cardiovascular Drugs In Pregnancy
Drug
Use
Potential
Side Effects
Safe
Use During
Breastfeeding
Adenosine Arrhythmia None reported Yes No data
Amiodarone Arrhythmia IUGR, prematurity, hypothyroidism No No data
ACE inhibitors Hypertension Oligohydramnios, IUGR, PDA, prematurity, neonatal hypotension, renal failure, anemia, death, musculoskeletal abnormalities No Ok
Beta-blockers Hypertension, arrhythmias, MI, ischemia, HCM, hyperthyroidism, mitral stenosis, Marfan syndrome, cardiomyopathy Fetal bradycardia, low birth weight, hypoglycemia, respiratory depression; prolonged labor Yes Ok
Digoxin Arrhythmia, CHF Low birth weight, Prematurity Yes Ok
Diuretics Hypertension, CHF Reduced utero- placental perfusion Unclear Ok
Flecainide Arrhythmia ? fetal death; limited data Limited data Limited data
Lidocaine Arrhythmia, anesthesia Neonatal CNS depression Yes Ok
Low Molecular Weight Heparin Mechanical valve, hypercoaguable state, DVT, AF, Eisenmenger syndrome Hemorrhage, unclear effects on maternal bone mineral density Limited data Limited data
Nitrates Hypertension Fetal distress with maternal hypotension Yes No data
Procainamide Arrhythmia None reported Yes Ok
Sodium nitroprusside Hypertension, aortic dissection Fetal thiocyanate toxicity Potentially unsafe No data
Sotalol Arrhythmia Fetal bradycardia, IUGR Limited data Ok
Unfractionated Heparin Mechanical valve, hypercoagulable state, DVT, AF, Eisenmenger syndrome Maternal osteoporosis, hemorrhage, thrombocytopenia, thrombosis Yes Ok
Warfarin Mechanical valve, hypercoagulable state, DVT, AF, Eisenmenger syndrome Warfarin embryopathy, fetal CNS abnormalities, hemorrhage Yes—after the 12th week of gestation Ok
IUGR = intrauterine growth retardation, ACE = angiotensin converting enzyme, PDA = patent ductus arteriosus, MI = myocardial infarction, HCM = hypertrophic cardiomyopathy, CHF = congestive heart failure, CNS = central nervous system, DVT = deep venous thrombosis, AF = atrial fibrillation

Adapted from reference 7.
Copyright 2003 The Cleveland Clinic Foundation

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