Analgesics during pregnancy and lactation
Analgesics during pregnancy
Acetaminophen (Panadol, Novaldol) is analgesic drug of choice for pain during pregnancy (Pregnancy category B). See, figure-1-FDA pregnancy categories prior to 2014.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Aspirin (salicylate analgesics/antipyretic) should be avoided during pregnancy, unless needed for specific indications (such as preeclampsia prophylaxis).
- Aspirin is pregnancy category C in the first and second trimesters, pregnancy category D in the third trimester.
Use other NSAIDs cautiously during first and second trimesters (Pregnancy category B), avoid use in third trimester (Pregnancy category D).
- Ibuprofen is the analgesic of choice second to paracetamol, and the anti-inflammatory agent of first choice until gestational week 28.
- Use of diclofenac is also possible.
- After 28 weeks of gestation, repeated use of NSAIDs should be avoided. If used repeatedly during the third trimester, ductal flow and amniotic fluid volume should be regularly evaluated by sonography. Conflicting evidence for risk of persistent pulmonary hypertension of the newborn (PPHN) with maternal exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy.
Opiate analgesics
American Academy of Nursing recommends against prescribing opioid pain medication in pregnancy without discussing and fully weighing risks to woman and fetus. Opioid use during pregnancy may be associated with increased risk of adverse maternal and fetal outcomes, including...
- Maternal depression and anxiety
- Chronic medical conditions
- Preterm labor
- Poor fetal growth
- Stillbirth
Analgesics during lactation
Ibuprofen is considered the best choice analgesic during lactation. COX-2 inhibitors (Celebrex) should be avoided.
References
- Drugs during pregnancy and lactation, 3rd edition, Elsevier 2015.
- Coluzzi F, Valensise H, Sacco M, Allegri M. Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014;80(2):211-224.
