Browse the corpus

©2013 UpToDate ® Print Email Antiarrhythmic drugs in pregnancy Drug Pregnancy Breastfeeding Amiodarone Has been associated with serious adverse effects. Congenital goiter/hypothyroidism and hyperthyroidism can occur after in utero exposure. Other potential risks include prolonged QT interval in neonates. Not recommended because of potential risk of hypothyroidism in neonate. Beta blockers No evidence of increased risk of teratogenesis, but some (particularly atenolol) may impair fetal growth when used for a prolonged duration in the second and third trimesters. Use only in the third trimester is associated with reduced placental weight. Newborns of women taking these drugs near delivery are at risk of bradycardia, hypoglycemia, and other symptoms of beta-blockade. Among this class of drugs, atenolol appears to have the most unfavorable effect on birthweight. AAP considers these agents compatible with breastfeeding, but newborns should be observed for signs of beta-blockade. Atenolol is a weak base that will accumulate in milk. Accumulation is enhanced by its water-soluble, low protein binding, little or no hepatic metabolism, and renal excretion properties. Because it has been associated with beta-blocking effects and cyanosis in nursing infants, it is best avoided during breast feeding. Sotalol Sotalol, which has both beta blocker and type III antiarrhthmic properties, is not teratogenic, and its use has not been associated with fetal growth restriction. Its use near birth has been associated with newborn bradycardia. Sotalol is concentrated in breast milk, with milk levels several-fold higher than those in maternal plasma, so close monitoring for bradycardia, hypotension, respiratory distress, and hypoglycemia is advised. Adenosine No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. No information. Because of very short half-life, it is unlikely to have any adverse effects on the neonate. Digoxin No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. AAP considers digoxin compatible with breastfeeding. Verapamil No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. AAP considers verapamil compatible with breastfeeding. Procainamide No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects.

No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. AAP considers digoxin compatible with breastfeeding. Verapamil No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. AAP considers verapamil compatible with breastfeeding. Procainamide No evidence of increased risk of teratogenesis or increased risk of adverse fetal/neonatal effects. AAP classifies procainamide as compatible with breastfeeding. However, the long-term effects of exposure in the nursing infant are unknown, particularly with respect to potential drug toxicity (eg, development of antinuclear antibodies and lupus-like syndrome). Quinidine No evidence of increased risk of teratogenesis. In therapeutic doses, the oxytocic properties of quinidine have been rarely observed, but high doses can produce this effect and may result in preterm labor or abortion. AAP considers quinidine compatible with breastfeeding. Flecainide Developmental toxicity has been noted in animals, but limited information on human risk from early pregnancy exposure. This risk appears to be low when used for refractory fetal arrhythmia. It may be the treatment of choice for tachycardia in hydropic fetuses. AAP considers flecainide compatible with breastfeeding. Adapted from: Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, 8th edition. Philadelphia: Lippincott Williams & Wilkins.