Effects of Isoniazid + Rifampicin+ Pyridoxine on fetus during first trimester in pregnancy
A 28 years old female patient was diagnosed with Extrapulmonary Tuberculosis (Lymph node at neck) and was on following medications, i.e., Tablet Isoniazid, Rifampicin and Pyridoxine. During the course of treatment (3rd month) she was confirmed with pregnancy (7th week).The gynecologist asked the patient to contact our DIC for the effects of above tablets on fetus during first trimester.
Comments: Isoniazid and Rifampin, is considered to be relatively safe for both the mother and the fetus for treating active tuberculosis infection in pregnancy. Although a clear causal relationship has not been established, pulmonary tuberculosis infection itself has been associated with a significantly higher frequency of miscarriage. There are also case reports of infants with congenital tuberculosis and drug-resistant disease may present an increased risk to the fetus. Careful clinical and laboratory monitoring for hepatitis is recommended.
- Pyridoxine supplementation (25 milligrams/day) is recommended for all women taking isoniazid who are either pregnant or breastfeeding.
- When rifampin is given during the last several weeks of pregnancy, chances of postnatal hemorrhages may occur in the mother and infant.
- The American Thoracic Society recommends use of the anti-TB drugs for tuberculosis occurring during pregnancy because, “Untreated tuberculosis represents a far greater hazard to a pregnant woman and her fetus than does treatment of the disease”.
Effect of Tablet Flutamide 250mg and Spironolactone 25 mg on fetus during first trimester
Patient History: Age: 26 years, Weight: 60kg, Disease: Polycystic Ovary Disease (PCOD) became pregnant and has taken the said drugs for 3months in her first trimester.
Polycystic Ovary Disease (PCOD) is a hormonal disorder problem in women.The symptoms include changes in the menstrual cycle, acne, obesity, ovarian cysts, development of male characters like increased hair growth on face and other parts of the body (Hirsutism) due to increased male hormones, infertility and other problems.
Flutamide- It is an oral nonsteroidal antiandrogen (male hormone) drug primarily used to treat prostate cancer. It may also be used to treat excess androgen levels in women.
Antineoplastic agents are drugs that can cross placental barrier and thus can affect the life or quality of life of the fetus. However adequate data specifically on Flutamide is not available. But decreased survival time in offspring, feminization of male fetuses, skeletal malformations have been reported from animal studies.
Spironolactone: It is a potassium sparing diuretic. It is also used as an antiandrogen. Potassium-sparing diuretics are not recommended for use during pregnancy. Adequate study reports on humans are not available.
In animals, spironolactone has known endocrine effects, including pregestational and antiandrogenic effects. Studies in animals have shown an increased occurrence of fetal damage.
Conclusion: Both the drug causes abnormal effects on the fetuses. Possibility of skeletal malformations and sexual characters should be watched out