Leathem A M
Clin Pharm. 1986 Aug;5(8):660-8.
The safety and efficacy of antiemetic drugs used in the treatment of nausea and vomiting during pregnancy are reviewed. Confirmation of the teratogenicity of drugs in humans is difficult; the risk can be estimated from results of cohort studies and case-control studies. The possible teratogenicity of Bendectin (doxylamine succinate and pyridoxine hydrochloride) was studied thoroughly; although the risk was minimal, the drug was withdrawn from the U.S. market. Whether phenothiazines are teratogenic has still not been conclusively determined. A large number of epidemiological studies have not shown meclizine to be teratogenic in humans. More information about metoclopramide is necessary before it can be safely recommended for use during pregnancy. The risks of using dimenhydrinate and diphenhydramine appear to be low. Pyridoxine is considered safe for use during pregnancy, but its efficacy in treating nausea and vomiting has not been determined. The relative efficacy of these agents has not been determined. The available data suggest that meclizine and dimenhydrinate are the antiemetics that present the lowest risk of teratogenicity; meclizine is the drug of first choice. Phenothiazines should be reserved for treating persistent vomiting that threatens the maternal nutritional status.
本文综述了用于治疗孕期恶心和呕吐的止吐药物的安全性和有效性。确定药物对人类的致畸性很困难；可以根据队列研究和病例对照研究的结果来估计风险。对敏克静（琥珀酸多西拉敏和盐酸吡哆醇）可能的致畸性进行了深入研究；尽管风险极小，但该药物已从美国市场撤出。吩噻嗪类药物是否致畸仍未最终确定。大量流行病学研究未表明茶苯海明对人类有致畸性。在可以安全推荐在孕期使用甲氧氯普胺之前，需要更多关于它的信息。使用乘晕宁和苯海拉明的风险似乎较低。吡哆醇被认为在孕期使用是安全的，但其治疗恶心和呕吐的有效性尚未确定。这些药物的相对疗效尚未确定。现有数据表明，茶苯海明和乘晕宁是致畸风险最低的止吐药物；茶苯海明是首选药物。吩噻嗪类药物应保留用于治疗威胁母体营养状况的持续性呕吐。
