Teratogenic drugs
What it means
Avoid in pregnancy: warfarin, ACEi/ARB, sodium valproate, isotretinoin/retinoids, methotrexate, lithium (Ebstein anomaly), tetracyclines, fluoroquinolones, aminoglycosides, trimethoprim (1st trimester, folate antagonist). Safer alternatives: LMWH (anticoagulation), labetalol/nifedipine/methyldopa (BP), levothyroxine, paracetamol, penicillins/cephalosporins.
Worked example
Sodium valproate is contraindicated in pregnancy/those who could become pregnant (neural-tube defects, neurodevelopmental harm) — Pregnancy Prevention Programme.
In the exam
A woman planning pregnancy on an enzyme-inducing antiepileptic associated with neural-tube and neurodevelopmental harm must be switched and counselled under a prevention programme.
What settles it
Valproate is the prototypical avoid-in-pregnancy AED (NTDs); lamotrigine/levetiracetam are generally preferred.
Classically confused with
Therapeutic drug monitoring
Source: BNF; MHRA