Table 14-9: Alternative/Complimentary Medication to Avoid in Pregnancy
| Drug Name |
Animal Data |
Human Experience in Pregnancy |
| Vitamin A |
A known teratogen at high doses in animal data. |
A double-blind randomized trial of low-dose supplementation with vitamin A or beta-carotene (7000 μg retinol equivalent) in malnourished pregnant women reported a 40% decrease in newborn mortality (West, 1999). In a prospective case-controlled study of 423 exposures to 10,000 IU vitamin A during the first 9 wk an increased risk of major malformations was not reported (Mastroiacovo, 1999). |
Until more data are available it is prudent to consume only the recommended dietary allowance of 8000 IU (which can be obtained by a balanced diet). |
| Vitamin B6 (in doses above 100 mg/day) |
None |
None |
Avoid use of high doses in pregnancy. Possible health hazard: ataxia and peripheral neuropathy. * |
| Niacin (in doses above 500 mg immediate-release or 750 mg sustained-release) |
None |
None |
Avoid use of high doses in pregnancy. Possible health hazard: GI symptoms (nausea, vomiting, diarrhea, abdominal cramps); liver disease.* |
| Selenium (in doses of greater than 800–1000 μg per day) |
None |
None |
Avoid use of high doses in pregnancy. Possible health hazard: tissue damage.* |
| Ma-huang (Ephedra sinica) |
None |
None |
Avoid use in pregnancy. The FDA warns against using Ma-huang (Ephedra sinica) due to possible health hazards including: high blood pressure, irregular heartbeat, nerve damage, injury, insomnia, tremor, headache, seizure, heart attack, stroke, and death.* Over 500 reports of adverse events including 8 fatalities have been reported to the FDA (CDC, 1996). |
| St. John’s wort (Hypericum perforatum) |
None |
None |
Metaanalysis of St. John’s wort suggests that it was more effective than placebo and as effective as low-dose tricyclic antidepressants for short-term management of mild to moderately severe depression (Kim, 1999). Due to the lack of data in pregnancy the routine use of St. John’s wort cannot be recommended. Major drug interaction: Indinavir trough concentration (Cmin) decreases by 81% when co-administered with St. John’s wort. |
| Chaparral herb (traditional American Indian medicine) |
None |
None |
Avoid use in pregnancy. Possible health hazard: liver disease, possibly irreversible.* |
| Comfrey herb |
None |
None |
Avoid in pregnancy. Possible health hazard: obstruction of blood flow to liver, possibly leading to death.* |
| Slimming/dieter’s tea |
None |
None |
Avoid in pregnancy. Possible health hazard: nausea, diarrhea, vomiting, stomach cramps, chronic constipation, fainting, possibly death.* |
| Germander herb |
None |
None |
Avoid in pregnancy. Possible health hazard: liver disease, possibly leading to death.* |
| Lobelia herb (Indian tobacco) |
None |
None |
Avoid in pregnancy. Possible health hazard: respiratory distress, tachycardia, hypotension, and possibly coma and death at higher doses.* |
| Magnolia-Stephania herb |
None |
None |
Avoid in pregnancy. Possible health hazard: renal failure which may be irreversible.* |
| Willow bark herb |
None |
None |
Avoid in pregnancy. Possible health hazard: allergic reaction (marketed as aspirin-free product, although it actually contains a precursor of aspirin with subsequent conversion to aspirin).* |
| Wormwood herb |
None |
None |
Avoid in pregnancy. Possible health hazard: neurological symptoms, paresthesia, delirium and paralysis.* |
| Germanium mineral |
None |
None |
Avoid in pregnancy. Possible health hazard: kidney damage, possibly death.* |
| L-tryptophan amino acid |
None |
None |
Avoid in pregnancy. Possible heath hazard: eosinophilic myalgia syndrome, a potentially fatal blood dyscrasia. (FDA has limited its import into the US).* |