But Ranitidine is commonly given in labour or just before a caesarean section in many obstetric units.
This is true. This kind of use is considered perfectly safe and has been used for many years on hundreds of thousands of women about to give birth. No ill-effect on the baby has ever been reported.
Are there any ulcer-healing drugs apart from those mentioned above?
Yes. In some countries, Sucralfate (Antepsin®) is considered ideal for use in pregnancy, since it is not absorbed from the stomach.
Omeprazole (Losec®) is another useful drug. It belongs to a group of drugs called Proton pump inhibitors. Their safety in pregnancy cannot be guaranteed and therefore the advice is to avoid unless necessary. Other Proton pump inhibitors include Esomeprazole (Nexium®), Lansoprazole (Zoton®), Pantoprazole (Protium®) etc.
Carbenoxolone was used for gastric ulcers in the past but is no longer licensed for this (in the UK). It is still used in the form of a mouthwash for mild oral lesions. It is not used in pregnancy.
If one is living in or visiting tropical countries where there is risk of malaria, what are the antimalarials to be used in pregnancy?
Malaria itself can precipitate a miscarriage. For those who are not immune (i.e. those who normally live in malaria-free countries), this disease can be quite serious, even life-threatening.
Taking preventative medication will therefore be mandatory if visiting malarious areas.
Chloroquine: this is considered to be safe and has been used extensively and over many years by pregnant women without any apparent ill-effect. However, it is not a very effective preventative agent.
Proguanil (Paludrime®): This is considered to be safe but the advice is to take it together with folic acid.
Malarone (combination of Proguanil and Atovaquone): There is insufficient data to state for sure whether Malarone is safe to use in pregnancy. The standard advice is there fore to avoid unless absolutely necessary.
Mefloquine (Larium®): This is contraindicated in pregnancy. The advice is that when used, one should avoid pregnancy for three months thereafter. It is probably safe in late pregnancy but the advice is to use alternatives, even then.
Halofantrine (Halfan®): this is contraindicated in pregnancy.
Primaquine: while there is no conclusive evidence of illeffects, the contrary cannot be-guaranteed either. For this reason and by virtue of the fact that there are more effective alternatives, the advice is to avoid it.
Fansidar®: this is a pyrimethamine containing antimalarial. It should be used in pregnancy only when necessary. It is actually not recommended for prevention. When used, folic acid supplements should be taken. The same applies for other pyrimethamine-containing antimalarials, such as Metakelfin® and Maloprim®.
Quinine: the oldest antimalarial still remains one of the most effective. However, in pregnancy, quinine can provoke miscarriage or premature labour. For this reason, it should be opted for with great care. It is not used for prevention. There is no evidence of ill-effect on the fetus otherwise.
Artesunate-based drugs: These anti-malarials are very effective but have been around for only a few years. So far there has been no evidence of any adverse effects when used either for prevention or treatment in pregnancy. However, the current advice is that we do not have sufficient information to declare them absolutely safe.
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