Drug index

RAAS inhibitors (teratogenic)

Fetotoxic — stop pre-conception; switch to labetalol/nifedipine.

Nucleoside analogue (HSV/VZV)

Genital herpes & VZV exposure in pregnancy — safe.

Purinergic A1 receptor agonist / AV nodal blocker

First-line for stable maternal SVT — safe every trimester.

Aminopenicillin (β-lactam)

Workhorse oral penicillin — GBS prophylaxis backup, UTI, listeria cover.

Polyene antifungal

Reserved for invasive/systemic fungal infection refractory to azoles.

Aminopenicillin (β-lactam)

IV penicillin for GBS prophylaxis and Listeria-suspected chorioamnionitis.

Alginate raft-forming antacid

First-line pregnancy GORD — safe throughout gestation.

Human Rh(D) immunoglobulin

Prevents Rh alloimmunisation in RhD-negative women.

Aromatase inhibitors (postmenopausal ER+ breast cancer)

First-line adjuvant in postmenopausal ER+ breast cancer.

Antiplatelet (COX-1 inhibitor)

75–150 mg nocte from 12/40 — prevents pre-eclampsia in high-risk women.

Oxytocin receptor antagonist

Alternative tocolytic when nifedipine contraindicated.

Purine antimetabolite

IBD / SLE / transplant — compatible in pregnancy.

Macrolide

Single-dose cure for chlamydia in pregnancy; PPROM latency arm of ORACLE.

Beta-lactam antibiotic

First-line intrapartum GBS prophylaxis.

Long-acting corticosteroid

Antenatal corticosteroid for fetal lung maturation 24–34⁺⁶ weeks.

Anti-VEGF monoclonal antibody

Ovarian cancer maintenance — watch BP, proteinuria, perforation.

Long-acting amide local anaesthetic

Backbone of obstetric epidural and spinal anaesthesia.

Dopamine D2 agonist

Suppress lactation; treat prolactinoma.

Calcium salt

Antidote to magnesium toxicity; hyperkalaemia cardio-protection.

Thionamide antithyroid (prodrug → methimazole)

Second-trimester onwards thionamide — switch FROM PTU after T1.

Platinum alkylating agent

Ovarian cancer backbone — dose by AUC.

Synthetic prostaglandin F2α analogue

Third-line uterotonic for refractory atonic PPH.

1st-generation cephalosporin

Pre-incision prophylaxis at LSCS — reduces endometritis & wound infection >60%.

3rd-generation cephalosporin

Single-dose IM cure for gonorrhoea in pregnancy.

2nd-generation cephalosporin

Surgical prophylaxis for caesarean section (single dose pre-incision).

1st-generation cephalosporin (oral)

Oral step-down for UTI, cellulitis & wound infection in pregnancy.

4-aminoquinoline antimalarial

Safe in pregnancy for prophylaxis & treatment in chloroquine-sensitive zones.

Calcineurin inhibitors

Compatible — useful steroid-sparing option; monitor BP and renal function.

Platinum alkylating agent

Curative-intent radiosensitiser for cervical cancer (Ch-RT).

Lincosamide antibiotic

GBS prophylaxis when severe penicillin allergy; BV alternative.

Selective oestrogen receptor modulator (ovulation induction)

First-line ovulation induction in anovulatory PCOS (with letrozole).

Selective oestrogen receptor modulator (SERM)

Oral ovulation induction — first-line for anovulatory PCOS (alongside letrozole).

Imidazole antifungal (topical)

First-line for vulvovaginal candidiasis in pregnancy.

Aminopenicillin + β-lactamase inhibitor

Workhorse for chorioamnionitis, endometritis, mastitis with abscess.

Sulfonamide + DHFR inhibitor

Folate antagonist + sulfa — avoid T1 (NTDs) and at term (kernicterus).

Opioid prodrug (CYP2D6 → morphine)

Contraindicated in breastfeeding — MHRA and FDA warning.

Anti-inflammatory (microtubule inhibitor)

Safe and essential to continue in FMF — stopping risks amyloidosis, not the baby.

Oestrogen + progestogen contraceptive

UKMEC 4 in breastfeeding <6 weeks; useful for cycle control non-pregnancy.

Combined hormonal contraceptive (patch)

Weekly patch — same UKMEC as COC, useful if PO adherence poor.

Combined hormonal contraceptive (ring)

Monthly ring — steady hormone delivery, user-controlled.

Non-hormonal LARC / emergency contraception

Most effective EC (< 0.1% failure) — up to 5 days.

Non-hormonal IUD

Most effective EC; long-term contraception.

H1-antihistamine antiemetic

Workhorse antiemetic for hyperemesis.

Alkylating agent

Contraindicated — reserved for organ- or life-threatening flare only.

Progestogen-only injectable contraceptive

12-weekly injection — highest amenorrhoea rates, reversible BMD loss.

Opioid — prodrug of morphine

IM labour analgesia — long UK obstetric heritage.

Cardiac glycoside

Rate control in AF/flutter and fetal SVT via maternal transplacental route.

Prostaglandin E2

Cervical ripening / IOL — Propess pessary.

Integrase strand-transfer inhibitor (INSTI)

Preferred 3rd agent in HIV ART in pregnancy (WHO/BHIVA 2023).

Selective α1-adrenergic antagonist

Add-on for multi-drug resistant hypertension in pregnancy.

Tetracycline

Effective for chlamydia/PID — but absolutely AVOID in pregnancy (teeth/bone).

H1-antihistamine + Vitamin B6

Licensed first-line for nausea & vomiting of pregnancy.

SNRI

Only licensed pharmacotherapy for stress urinary incontinence.

NNRTI antiviral

Effective HIV NNRTI — avoid T1 if alternatives exist; dolutegravir now preferred.

Low molecular weight heparin

Anticoagulant of choice in pregnancy — VTE prophylaxis and treatment.

Inhaled 50:50 N₂O / O₂ analgesic

Ubiquitous UK labour analgesia — patient-controlled, rapid on/off.

Ergot alkaloid uterotonic

Second-line uterotonic for PPH — powerful but pressor.

Macrolide antibiotic

PPROM prophylaxis — ORACLE I.

Oestrogen replacement

Transdermal preferred — no first-pass, no VTE excess.

Progestogen-only subdermal implant (LARC)

3-year LARC — Pearl Index < 0.05, top-tier efficacy.

H2-receptor antagonist

Preferred H2RA in pregnancy after ranitidine withdrawal (NDMA).

IV iron replacement

Single-dose IV iron for pregnancy anaemia intolerant to oral iron.

Oral iron replacement

First-line iron for pregnancy anaemia — cheap, effective, GI-heavy.

Triazole antifungal

Avoid oral in pregnancy — use topical imidazoles.

B9 vitamin

Pre-conception & 1st trimester — prevents neural tube defects.

Loop diuretic

Pulmonary oedema in pre-eclampsia and peripartum cardiomyopathy.

Nucleoside analogue (anti-CMV)

Treats severe maternal/neonatal CMV — teratogenic, use only for life-threatening disease.

Aminoglycoside

Critical adjunct in severe pelvic sepsis; ototoxic on the fetus.

GnRH receptor agonist (with initial flare → downregulation)

Endometriosis, fibroids, IVF downregulation, hormone-sensitive cancers.

GnRH receptor antagonist

Immediate LH suppression — IVF short protocol; relugolix for fibroids/endometriosis.

GnRH agonist

Pre-op endometriosis/fibroid shrinkage; downregulation in IVF.

Ovulation trigger / luteal support

LH-mimetic trigger — precipitates ovulation ~36 h post injection.

Gonadotropin — urinary FSH + LH activity

Combined FSH/LH stimulation — hypogonadotropic hypogonadism.

Direct arterial vasodilator

IV rescue for severe hypertension when labetalol fails or is contraindicated.

B12 replacement

Standard IM B12 replacement — vegan and post-bariatric mothers.

Antimalarial / DMARD

Safe in pregnancy SLE/APS — continue throughout.

Non-selective NSAID (COX-1/2)

Tocolysis <32/40 when nifedipine unsuitable.

Inhaled glucocorticoid preventer

Anti-inflammatory backbone of pregnancy asthma control.

Short- and intermediate-acting insulins

Mainstay for T1DM, severe GDM, and DKA in pregnancy.

Oral retinoid

Extreme teratogen — Pregnancy Prevention Programme mandatory.

Targeted synthetic DMARD (Janus kinase inhibitor)

Avoid in pregnancy — small molecules cross the placenta freely; insufficient safety data.

Combined α/β-adrenergic blocker

The NHS workhorse — first-line for hypertension in pregnancy.

Osmotic disaccharide laxative

First-line pregnancy constipation — non-absorbed, safe throughout.

Voltage-gated Na⁺ channel blocker antiepileptic

Preferred AED in pregnancy — lowest teratogenic profile of major AEDs.

DMARD (pyrimidine synthesis inhibitor)

Contraindicated in pregnancy — needs an active washout, not just stopping.

Aromatase inhibitor

Now preferred first-line over clomifene for ovulation induction in PCOS.

Aromatase inhibitor — off-label ovulation induction

First-line ovulation induction in PCOS — better live-birth vs clomifene.

SV2A synaptic vesicle modulator antiepileptic

Alternative first-line AED in pregnancy — clean interaction profile.

Progestogen emergency contraception

OTC EC up to 72 h — safe in breastfeeding, compatible with quick-start.

Progestogen

EC within 72 h — double dose if BMI >26.

Progestogen intrauterine system

Mirena — long-acting reversible contraception, also HMB treatment.

Intrauterine progestogen system (LARC)

First-line for HMB and endometrial protection on HRT.

Synthetic thyroid hormone (T4)

Hypothyroidism in pregnancy — increase dose early, monitor TSH q4–6 wks.

Mood stabiliser

Ebstein's anomaly risk in T1; narrow therapeutic window in pregnancy.

Osmotic polyethylene glycol laxative

Alternative osmotic laxative — better tolerated than lactulose.

Anticonvulsant / NMDA antagonist

Gold standard for eclampsia prevention and treatment, and fetal neuroprotection.

Biguanide oral hypoglycaemic

First-line oral agent for GDM and pre-existing T2DM in pregnancy.

Antimetabolite (folate antagonist)

Single-dose IM for stable ectopic pregnancy.

Central α2-adrenergic agonist

Oldest, most-studied antihypertensive — safe but sedating.

D2 antagonist / prokinetic

Antiemetic — limit to 5 days (EPSE risk).

Nitroimidazole antibiotic

BV, trichomonas, anaerobic chorio/endometritis.

Imidazole antifungal (topical)

Topical alternative to clotrimazole for VVC in pregnancy.

Selective progesterone receptor modulator (antiprogestin)

Primes the pregnancy for misoprostol — medical TOP and miscarriage.

Medical abortion combination

Standard medical termination & missed miscarriage regimen.

β3-adrenergic agonist

Non-anticholinergic OAB option — good for elderly or cognitive concerns.

Synthetic PGE1 analogue

Versatile prostaglandin — induction, miscarriage, PPH, cervical priming.

Immunosuppressant (IMPDH inhibitor)

Contraindicated — first-trimester loss and a recognisable malformation pattern.

Calcium channel blocker (off-label tocolytic)

Preferred tocolytic to buy 48 h for steroids and in-utero transfer.

Dihydropyridine calcium channel blocker

First-line alternative when Labetalol is contraindicated (e.g. asthma); second-line oral agent for mild-to-moderate hypertension/pre-eclampsia when Labetalol alone is insufficient.

Thiazolide antiprotozoal

Cryptosporidium and giardia in immunocompetent women.

Nitrofuran antibiotic

First-line UTI in T1/T2; avoid at term.

α1-adrenergic vasopressor

First-line vasopressor in obstetric septic shock and haemorrhagic vasoplegia.

Non-selective COX inhibitor

Avoid from 30/40 — premature ductus arteriosus closure.

COX inhibitors

Avoid after 20 weeks — oligohydramnios, ductal closure, renal impairment.

Polyene antifungal (topical)

Topical oral candidiasis in mother and neonate.

PARP inhibitor

Maintenance therapy in BRCA-mutated ovarian cancer.

Proton pump inhibitor

Third-line pregnancy GORD; first-line for severe symptoms or ulcer.

5-HT3 receptor antagonist

Second-line antiemetic for hyperemesis gravidarum.

Neuraminidase inhibitor

First-line for influenza in pregnancy — start within 48 h, but treat any pregnant case.

Non-selective antimuscarinic

Legacy OAB drug — high anticholinergic burden.

Posterior pituitary hormone / uterotonic

First-line uterotonic for induction, augmentation and active 3rd-stage management.

Taxane microtubule stabiliser

Partner for carboplatin in ovarian and endometrial cancer.

Central COX inhibitor / analgesic

First-line analgesic in all trimesters and lactation.

SSRI with anticholinergic action

Avoid in pregnancy where alternatives exist (T1 cardiac risk).

Anti-PD-1 immune checkpoint inhibitor

Adds to chemo/chemoradiation in PD-L1+ / dMMR gynae cancers.

Glucocorticoid

Maternal disease control — minimal placental transfer.

Phenothiazine D2 antagonist antiemetic

Second-line NVP/HG antiemetic — buccal and IM formulations.

Progestogen-only contraceptive

Safe in breastfeeding from day 21 — UKMEC 1.

GABA-A positive modulator IV induction agent

Induction agent of choice for elective LSCS under GA.

Thionamide antithyroid

Preferred antithyroid in 1st trimester (carbimazole switch in T2).

Antifolate + sulfonamide antiprotozoal

Treats confirmed fetal toxoplasmosis (≥18/40 with positive amnio).

Quinoline alkaloid antimalarial

Quinine + clindamycin = first-line for falciparum malaria in pregnancy where artesunate unavailable.

Gonadotropin — recombinant follicle-stimulating hormone

Controlled ovarian stimulation in IVF and clomifene-resistant PCOS.

Ultra-short-acting μ-opioid

Alternative labour analgesia when epidural contraindicated.

Nucleoside analogue antiviral

Teratogenic — contraindicated in pregnancy and in male partners of pregnant women.

Anti-CD20 monoclonal antibody

Can be used for severe disease; expect transient neonatal B-cell depletion if given after ~20 weeks.

Short-acting β2-agonist (SABA)

Rescue bronchodilator — safe in every trimester.

Stimulant laxatives

Short-term rescue when osmotic laxatives fail — third-trimester friendly.

SSRI

First-line antidepressant in pregnancy and breastfeeding.

GABA-enhancing broad-spectrum antiepileptic

Most teratogenic mainstream AED — MHRA Pregnancy Prevention Programme mandatory.

M3-selective antimuscarinic

First-line pharmacotherapy for overactive bladder in women.

Macrolide antiprotozoal

First-line for maternal Toxoplasma seroconversion (T1) — prevents vertical transmission.

Cyclodextrin — selective NMB reversal

Rapid reversal of rocuronium and vecuronium — game-changer in obstetric anaesthesia.

DMARD / aminosalicylate

Compatible in pregnancy — give with folic acid.

Depolarising neuromuscular blocker

Rapid sequence induction paralysing agent in obstetric GA.

Selective estrogen receptor modulator (SERM)

ER+ breast cancer adjuvant; ovulation induction (off-label).

Selective oestrogen receptor modulator (SERM)

5–10 y adjuvant in ER+ breast cancer — premenopausal cornerstone.

NRTI antiviral

Backbone of HIV ART and prevents perinatal hepatitis B transmission.

β2-adrenergic agonist

Acute tocolysis for intrauterine resuscitation.

Broad-spectrum bacteriostatic antibiotics

Contraindicated after 18 weeks — tooth staining and bone deposition.

Immunomodulatory / anti-angiogenic

Historical severe teratogen — restricted current use with mandatory PPP.

Nitroimidazole antiprotozoal

Alternative to metronidazole for trichomoniasis — avoid in T1.

Biologic DMARD (anti-TNF)

Compatible — certolizumab preferred through third trimester (minimal placental transfer).

Antifibrinolytic (lysine analogue)

Within 3 hours of PPH — reduces mortality (WOMAN trial).

Anti-HER2 monoclonal antibody

Backbone of HER2-positive breast cancer — cardiotoxic.

Dihydrofolate reductase inhibitor

Avoid T1 (folate antagonist) — UTI option T2/T3.

Selective progesterone receptor modulator (SPRM)

EC up to 120 h post-UPSI; outperforms LNG late.

Selective progesterone receptor modulator (EC)

EC up to 120 h — more effective than levonorgestrel near ovulation.

Indirect thrombin inhibitor

Reserved for renal failure, peri-delivery, or massive PE — reversible with protamine.

Prodrug of aciclovir

Better bioavailability for genital HSV suppression in late pregnancy.

Glycopeptide

MRSA cover in severe maternal sepsis or penicillin-anaphylactic women.

Vitamin K antagonist

Teratogen — avoid 6–12/40. Used only for mechanical heart valves after careful counselling.

Nucleoside reverse transcriptase inhibitor

Intrapartum IV in HIV with VL >1000 — PMTCT.