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Antistaminici e antiallergici: La maggior parte degli esperti ritiene gli antistaminici di uso sicuro in gravidanza. Tuttavia in alcuni studi su animali è stato evidenziato un effetto teratogeno e in letteratura vengono riportati casi di malformazioni o di danni funzionali che possono essere collegati ad alcuni antistaminici.
Gli antistaminici vengono spesso usati per i vomiti, le “chinetosi” e il prurito gravidorum. La meclizina è teratogena nei roditori, ma questo effetto non è stato dimostrato nell’uomo. La meclizina, antistaminico del gruppo delle piperazine, prescritto spesso contro le cinetosi (“mal d’auto”), la nausea e il vomito, è teratogeno nei roditori, ma questo effetto non è stato documentato nell’uomo. Agisce principalmente sul labirinto.
Antitosse: tra i sedativi della tosse la codeina e i suoi derivati (deidrocodeina, idrocodone) sono controindicati in gravidanza. La codeina in particolare è ritenuta responsabile di cardiopatie, malformazioni scheletriche, malformazioni del tubo digerente. Tutti possono provocare una sindrome da astinenza nel neonato. Tra i sedativi centrali offre sicurezza d’impiego il destrometorfano. Di uso più sicuro appaiono i farmaci antitosse ad azione periferica. Occorre tuttavia ricordare che la tosse è il sintomo di una rritabilità dell’albero respiratorio di cui si deve individuare la causa. In gravidanza in particolare curare il sintomo tosse senza averne diagnosticata la causa può essere difficilissimo, può esporre la madre e il feto all’azione tossica dei farmaci e può sopprimere un meccanismo fisiologico di clearance bronchiale.
Gli espettoranti a base di acetilcisteina e ambroxolo sono molto ben tollerati.
Per quanto riguarda i decongestionanti nasali a base di efedrina, nafazolina, imidazolina, ecc., vanno usati con moderazione e per brevi periodi.
|tab. 13 – Antistaminici||Malformazioni/management|
nel IIIº trimestre: può provocare bradicardia fetale
collasso cardiocircolatoriomeclizinaAntivert cps, cpr, cpr masticabiliembriotossicaChetotifeneZaditen embriotossica
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