Pharmacology and toxicology
Codeine is the most widely used antitussive. It is a derivative of morphine, and has strong antitussive and analgesic properties. Because of its analgesic action, it is also used in compound antitussive preparations. An association between the prenatal use of codeine and congenital malformations has not been shown. When codeine is used in high doses for longer periods, or near term, respiratory depression and withdrawal symptoms can occur in the neonate (see also Chapter 2.1).
Dextromethorphan has no analgesic properties, but its antitussive effect is similar to that of codeine. Its use is considered safe during pregnancy. Einarson and associates reported pregnancy outcomes of women who had used dextromethorphan during pregnancy, most of them in the first trimester. No increased incidence of congenital malformations or other adverse pregnancy outcomes was found (Einarson 2001). In another recent study, an association between congenital malformations and prenatal exposure to dextromethor- ^^ phan could not be established (Martinez-Frias 2001).
There is no experience in the use of other antitussives, such as EJ benproperine, Clobutinol, dropropizine, eprazinone, noscapin, pen-toxyverin, and pipacetate, during pregnancy.
Recommendation. In the case of persistent dry cough, codeine and dextromethorphan can be given in alt trimesters of pregnancy. Higher doses given for longer periods, or use near delivery, can cause neonatal withdrawal symptoms and respiratory depression. Inadvertent use of other antitussives does not require any intervention.
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