Acarbose—(Precose) International Brand Names Glibose (Taiwan); Glicobase (Italy); Glucobay (Argentina, Austria, Bangladesh, Belgium, Brazil, Bulgaria, Chile, Colombia, Costa Rica, Czech Republic, Denmark, Dominican Republic, Ecuador, El Salvador, England, Germany, Greece, Guatemala, Honduras, Hungary, India, Israel, Italy, Japan, Korea, Malaysia, Mexico, Netherlands, Nicaragua, Norway, Pakistan, Panama, Peru, Poland, Portugal, Spain, Sweden, Switzerland); Gluconase (Philippines); Glumida (Spain); Prandase (Canada, Israel); Rebose (India) # Drug Class .......................... a Glucosidase inhibitor; Antidiabetic agents; Oral hypoglycemics # Indications ......................... Diabetes mellitus, type II # Mechanism ......................... An oral pancreatic a amylase and intestinal a glucoside hydrolase inhibitor that delays bowel carbohydrate metabolism, slowing the postprandial rise in glucose # Dosage with Qualifiers ....... Diabetes mellitus, type II begin 25mg (50mg if >60kg); thereafter, 50 100mg PO ac tid based on glucose levels PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL Contraindications hypersensitivity to drug or class, DKA, cirrhosis, intestinal obstruction or malabsorption syndromes Caution renal dysfunction # Maternal Considerations ..... Acarbose is the subject of a large ongoing trial to determine whether its use can reduce or delay the onset of type II diabetes in patients with impaired glucose intolerance. The preliminary results indicate benefit. There are no adequate reports or well controlled studies of acarbose in pregnant women. There is a single report of 6 pregnant women with impaired glucose tolerance treated with acarbose. Glucose levels returned to normal, and the pregnancies were reportedly uncomplicated. Side effects include intestinal discomfort consisting of pain, diarrhea, flatulence, elevated LFTs, and jaundice. # Fetal Considerations ........... There are no adequate reports or well controlled studies in human fetuses. Only 2% of the oral dose is absorbed. Rodent studies are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses almost 10 higher than those used clinically. # Breastfeeding Safety .......... There is no published experience in nursing women. It is unknown whether acarbose enters human breast milk. A single rat study suggests acarbose might alter the composition of breast milk by inhibiting lipogenesis. Less than 2% of acarbose is bioavailable. It is unlikely any would be excreted into the milk and or absorbed by the neonate. # Drug Interactions ................ Some drugs tend to produce hyperglycemia. They include thiazides and similar class diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. Women taking both acarbose and one of these drugs should be monitored closely for loss of glucose control. Discontinuation of such drugs may lead to hypoglycemia. Intestinal adsorbents (e.g., charcoal) and digestive enzyme such as amylase and pancreatin may reduce the effect of acarbose and should not be taken together. Acarbose may alter digoxin bioavailability when they are co administered. 1 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 # References ......................... Hanefeld M, Schaper F, Koehler C. Cardiovasc Drugs Ther 2008; 22:225 31. Mercer SW, Williamson DH. Biochem J 1987; 242:235 43. Product information. Precose, Bayer Corp., 1997. Zarate A, Ochoa R, Hernandez M, Basurto L. Ginecol Obstet Mex 2000; 68:42 5. # Summary ........................... Pregnancy Category: B Lactation Category: S (likely) Insulin and diet regulation remain the standard treatments for glucose intolerance during pregnancy. There is a growing interest in the use of oral hypoglycemic agents during pregnancy, and acarbose is a candidate for future study in this area. Acebutolol—(ACB; Alol; Beloc; Diasectral; Espesil; Lupar; PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL Neptal; Rhotral; Sectral; Sectral LP; Wesfalin) International Brand Name ACB (New Zealand, Singapore); Acecor (Italy); Diasectral (Denmark, Finland); Espesil (Finland); Flebutol (Venezuela); Grifobutol (Chile); Monitan (Canada); Prent (Germany, Italy, Portugal); Rhotral (Canada); Sectral (Belgium, Bulgaria, Canada, Czech Republic, England, France, Hong Kong, Ireland, Italy, Malaysia, Netherlands, Poland, South Africa, Spain, Switzerland, Taiwan); Sectral LP (France) # Drug Class .......................... Antiarrhythmics, class II; Antiarrhythmics, ventricular; Antihypertensives; b Blocker # Indications ......................... Chronic hypertension, ventricular arrhythmias # Mechanism ......................... Cardioselective partial b adrenoceptor antagonist # Dosage with Qualifiers ....... Hypertension begin 400 800mg PO qd; max 1200mg/d Ventricular arrhythmia begin 200 400mg/d; typical dose, 600 1200mg/d Contraindications hypersensitivity, CHF, heart block, hypotension, pulmonary disease Caution diabetes mellitus, hepatic or renal dysfunction # Maternal Considerations ..... There are no adequate reports or well controlled studies of acebutolol in pregnant women. Acebutolol was significantly less successful than either labetalol or a methyldopa in controlling chronic arterial hypertension >90mmHg in one small randomized trial. The rates of pregnancy complications among the 3 groups of women were similar. Side effects include CHF, bronchospasm, fatigue, dizziness, headache, constipation, and diarrhea. # Fetal Considerations ........... There are no adequate reports or well controlled studies in human fetuses. Acebutolol and its main metabolite, N acetylacebutolol, cross the placenta with a 0.6:0.8 M:F ratio. A prospective study of acebutolol’s hemodynamic and renal impact on neonates after chronic in utero exposure found hemodynamic failure in 5/11 children delivered of treated mothers. Exposed neonates had significantly less early neonatal diuresis, absence of a significant rise in the GFRs, and reduced sodium and calcium balances. The direct effect of the drug on the glomerular and tubular functions and/or the renal arteriolar vasomotoricity could explain these effects. 2 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 Acebutolol and N acetylacebutolol are concentrated in breast milk (M:P ratios 2:9 for acebutolol and 2:25 for N acetylacebutolol), though symptoms of neonatal b blockade are rarely reported. A neonate might receive pharmacologically active amounts of acebutolol if the daily maternal dosage exceeds 400mg and/or renal function in the mother is impaired. However, the American Academy of Pediatrics considers acebutolol permissible with breastfeeding. # Drug Interactions ................ Catecholamine depleting drugs, such as reserpine, may have an additive effect when given with b blockers. Women treated with both acebutolol and catecholamine depletors should be observed closely for bradycardia or hypotension that may present as vertigo, syncope/presyncope, or orthostatic hypotension without compensatory tachycardia. Women receiving b blockers should be warned that hypertensive responses may follow the combined use of b blockers and a adrenergic agonists, including those in OTC cold remedies and vasoconstrictive nasal drops. NSAIDs may blunt the antihypertensive effect of b blockers. PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL # Breastfeeding Safety .......... # References ......................... Boutroy MJ, Bianchetti G, Dubruc C, et al. Eur J Clin Pharmacol 1986; 30:737 9. Committee on Drugs, American Academy of Pediatrics. Pediatrics 1994; 93:137 50. Lardoux H, Blazquez G, Leperlier E, Gerard J. Arch Mal Coeur Vaiss 1988; 81(Spec No):137 40. Yassen H, Boutroy MJ, Monin P, Vert P. Arch Fr Pediatr 1992; 49:351 5. # Summary ........................... Pregnancy Category: B (1st trimester), D (2nd and 3rd trimesters) Lactation Category: S There are alternative agents for which there is more experience during pregnancy and lactation. Consider withholding oral acebutolol therapy for 12h prior to the anticipated delivery to minimize the risk to the neonate. 3 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 Acetaminophen—(APAP; Acephen; Aceta; Acetaminophen Uniserts; Anapark; Apacet; Asidon; Calip; Dapacin; Ed-Apap; Feverall; Genapap; Genebs; Mapap; Maranox; Neopap; Oraphen-PD; Panadol; Redutemp; Ridenol; Silapap; Tapanol; Tempra; Tylenol; Uni-Ace) PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL International Brand Name Abenol (Canada); Acamol (Chile, Israel); Acamoli Forte suppositories for Kids (Israel); Acet (Malaysia, Philippines); Acetalgin (Switzerland); Acetam (Peru); Acetamol (Italy); ACET suppositories (Singapore); Adorem (Colombia); Afebrin (Hong Kong, Indonesia, Philippines); Algiafin (Chile); Alphagesic (Indonesia); Alvedon (Sweden); Amol (Israel); A Mol (Thailand); Anaflon (Germany); Analgiser (Israel); Apirex (France); Arfen (Malaysia, South Africa); Atamel (Peru); Benuron (Japan); Ben U Ron (Belgium, Germany, Portugal, Switzerland); Biogesic (Indonesia, Philippines, Thailand); Biogesic Suspension (Hong Kong); Bodrex (Indonesia); Brenal (Philippines); Calapol (Indonesia); Calodol (Philippines); Calpol (India, Ireland, Israel, Japan, Puerto Rico, South Africa, Thailand); Causalon (Argentina); Cemol (Thailand); Christamol (Hong Kong); Claradol (Morocco); Clocephen (Philippines); Crocin (India); Daga (Thailand); Datril (Mexico, Venezuela); Depyretin (Taiwan); Dirox (Argentina); Dismifen (Mexico); Dolex (Uruguay); Dolex 500 (Colombia, Uruguay); Doliprane (France, Morocco); Dolitabs (France); Dolofen (Colombia); Dolomol (Israel); Dolorol (South Africa); Dolotemp (Mexico); Doltem (Peru); Drilan (Philippines); Dymadon (Australia); Efferalgan 500 (Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Israel, Nicaragua, Panama); Efferalganodis (France); Eraldor (Ecuador); Expandol (France); Fervex (Brazil); Flurinol (Philippines); Fortolin (China); Gelocatil (Spain); Geluprane 500 (France); Gunaceta (Indonesia); Kamolas (Indonesia); Kyofen (Colombia); Lemgrip (Belgium); Lotemp (Thailand); Malidens (India); Mebinol (Peru); Meforagesic (Philippines); Metagesic (Philippines); Mexalen (Austria, Czech Republic, Hungary); Milidon 500 (Singapore); Minopan (Korea); Mypara (Thailand); Nalgesik (Indonesia); Napa (Singapore); Napamol (South Africa); Naprex (Indonesia); NEBS (Japan); Nektol 500 (Philippines); Nilapur (Indonesia); Pacemol (Brazil, Singapore); Pacimol (India); Pamol (Denmark, New Zealand); Panadol (Belgium, Brazil, Bulgaria, Chile, England, Finland, France, Greece, Hong Kong, Indonesia, Ireland, Italy, Korea, Netherlands, South Africa, Switzerland, Taiwan, Thailand, Uruguay); Panadol Actifast (Malaysia, Singapore); Panamax (Australia); Panodil (Denmark, Norway, Sweden); Paracet (Norway); Parageniol (Paraguay); Paragin (Thailand); Paralgin (Australia); Paralief (Ireland); Paramidol (Peru); Paramol (Israel, Taiwan); Parapaed (Germany); Parapaed Junior (New Zealand); Parapaed Six Plus (New Zealand); Paratabs (New Zealand); Parvid (Philippines); Paximol (Singapore); Pedipan (Korea); Penral Night (Korea); Pinex (Norway); Poro (Malaysia); Predimol (India); Puernol (Italy); Raperon (Korea); Rapidol (Chile); Reliv (Sweden); Remedol (Puerto Rico); Revanin (South Africa); Rhinapen elixir (Korea); Roxamol Gelcaps (Israel); Salzone (South Africa); Saridon (Colombia); Serimol (Hong Kong); Setamol (Australia); Sinedol (Dominican Republic); Taganopain (Korea); Tamifen (Ecuador); Tempra (Belgium, Canada, Costa Rica, Ecuador, El Salvador, Greece, Guatemala, Honduras, Indonesia, Japan, Mexico, Nicaragua, Panama, Spain, Thailand); Tempte (Taiwan); Temzzard (Mexico); Termofren (Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama); Turpan (Indonesia); Tylenol (Australia, Austria, Brazil, Bulgaria, Canada, China, France, Germany, Hong Kong, Israel, Japan, Korea, Mexico, Philippines, Portugal, Spain, Switzerland, Thailand, Venezuela); Tylenol Extra Fuerte (Paraguay, Peru); Tylex (Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama); Winadol (Colombia, Venezuela); Winasorb (Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama); Xebramol (Thailand); Zetifen (Philippines); Zolben (Venezuela); Zydinol (Philippines) # Drug Class .......................... Analgesics, non narcotic; Antipyretics; NSAID # Indications ......................... Mild pain, fever, menstrual cramps, osteoarthritis, tension headache # Mechanism ......................... Nonspecific cyclooxygenase inhibitor # Dosage with Qualifiers ....... Pain and/or fever 650 1000mg PO/PR q4 6h; max 4g/d NOTE: included in many combinations. Contraindications hypersensitivity to drug or class Caution hepatic or renal dysfunction, chronic alcohol use, G6PD deficiency, PKU # Maternal Considerations ..... Acetaminophen is component of a long list of OTC medications. It is metabolized in the liver and excreted by the kidneys. During the 1st trimester, the mean t/2 is significantly lower and oral clearance is significantly higher compared to nonpregnant control subjects. Only during pregnancy is weight related to clearance, 4 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 suggesting the dose may need to be adjusted in obese women. Ibuprofen provides more rapid relief of perineal pain after vaginal delivery. Up to 2=3 of pregnant women ingest acetaminophen some time during gestation. In one recent RCT, acetaminophen plus oxycodone was superior to patient controlled morphine for the relief of post cesarean pain. There are no obvious differences in clearance at term. Chronic abuse and overdose are the most common problems. The damage appears secondary to free radical toxicity with consumption of glutathione. N acetylcysteine is the treatment of choice for acute overdose. In one prospective case control study, use of prenatal ibuprofen, naproxen, and aspirin, but not acetaminophen, increased the risk of spontaneous abortion by 80% (adjusted hazard ratio 1.8 [95% CI 1.0 3.2]). The association was stronger if the initial use occurred around conception or if the use lasted more than a week. Side effects include hepatotoxicity, nephrotoxicity, agranulocytosis, pancytopenia, hemolytic anemia, pancreatitis, rash, angioedema, and urticaria. There are no adequate reports or well controlled studies in human fetuses. Acetaminophen crosses the human placenta, reaching steady state in the isolated perfused model within 1h. The F:M ratio for acetaminophen approximated 0.12 in the pregnant ewe, and neither sulfate or glucuronide metabolites crossed. Acetaminophen use during labor to treat the fever of chorioamnionitis is associated with improved fetal umbilical blood gases, presumably by reducing fetal oxygen demand as the maternal core temperature declines. Although it was previously suggested that exposure to acetaminophen was associated with clubfoot and digital abnormalities, these reports are not sustained in large series. However, there appears to be a link between it and gastroschisis and small bowel atresia, but not cardiac ventriculoseptal defects. Unlike aspirin, acetaminophen has no antiplatelet activity and does not pose a hemorrhagic risk to the fetus. # Breastfeeding Safety .......... Acetaminophen is excreted in low concentrations into breast milk. The amount of the drug administered to the mother estimated to be available to the neonate ranges from 0.04% to 0.23%, and it is generally considered compatible with breastfeeding. # Drug Interactions ................ Tramadol may increase the risk of acetaminophen toxicity. Local anesthetics may increase the risk of methemoglobinemia. # References ......................... Beaulac Baillargeon L, Rocheleau S. Eur J Clin Pharmacol 1994; 46:451 4. Cleves MA, Savell VH Jr, Raj S, et al; National Birth Defects Prevention Study. Birth Defects Res Part A Clin Mol Teratol 2004; 70:107 13. Committee on Drugs, American Academy of Pediatrics. Pediatrics 1994; 93:137 50. Davis KM, Esposito MA, Meyer BA. Am J Obstet Gynecol 2006;194:967 71. Kamandetdecha R, Tanninandorn Y. J Med Assoc Thai 2008; 91:282 6. Kirshon B, Moise KJ Jr, Wasserstrum N. J Reprod Med 1989; 34:955 9. Li DK, Liu L, Odouli R. BMJ 2003; 327:368 73. Rayburn W, Shukla U, Stetson P, Piehl E. Am J Obstet Gynecol 1986; 155:1353 6. PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL # Fetal Considerations ........... 5 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 Wang LH, Rudolph AM, Benet LZ. J Pharmacol Exp Ther 1986; 238:198 205. Weigand UW, Chou RC, Maulik D, Levy G. Pediatr Pharmacol (New York) 1984; 4:145 53. Werler MM, Mitchell AA, Hernandez Diaz S, Honein MA. Am J Obstet Gynecol 2005;193:771 7. Werler MM, Sheehan JE, Mitchell AA. Am J Epidemiol 2002; 155:26 31. # Summary ........................... Pregnancy Category: B Lactation Category: S Acetaminophen is used throughout pregnancy for analgesia and to reduce fever. Like most drugs, it should be used during the 1st trimester only when clearly necessary. PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL Acetazolamide—(Acetadiazol; Acetamide; Azomid; Dehydratin; Diamox; Diamox Sequels; Diamox Sodium; Ederen; Glauconox; Inidrase; Nephramid; Oratrol) International Brand Name Acetadiazol (Mexico); Albox (Japan); Apo Acetazolamide (Malaysia); Carbinib (Portugal); Cetamid (Philippines); Defiltran (Germany); Diamox (Argentina, Bangladesh, Brazil, Bulgaria, Canada, Chile, Czech Republic, Ecuador, Germany, Greece, Hungary, Korea, Mexico, Pakistan, Peru, Poland, Portugal, Slovenia, South Africa, Turkey, Venezuela); Diamox Sustets (Colombia); Diluran (Czech Republic); Diural (Uruguay); Diuramid (Germany, Poland); Edemox (Spain); Genephamide (Peru); Glaucomed (Colombia); Glaucomide (New Zealand); Glaupax (Denmark, Ireland, Japan, Netherlands, Norway, Sweden, Switzerland, Thailand); Huma Zolamide (Hungary); Ledamox (Japan); Lediamox (Portugal); Ledimox (Japan, Portugal); Stazol (Paraguay) # Drug Class .......................... Carbonic anhydrase inhibitors; Diuretics # Indications ......................... Glaucoma, open and closed angle; altitude sickness, prevention and treatment; epilepsy; CHF; drug induced edema; urinary alkalinization # Mechanism ......................... Carbonic anhydrase inhibitor # Dosage with Qualifiers ....... Glaucoma 125 250mg PO/IV bid to qid Altitude sickness 250 500mg PO bid beginning 48h before ascent Epilepsy 375 1000mg (8 30mg/kg/d) PO qd if sole agent; begin 250mg qd if with other agents Congestive heart failure 250 375mg PO/IV qd (for best results, take on alternate days) Drug induced edema 250 375mg PO/IV qd (for best results, take on alternate days) Urinary alkalinization 5mg/kg PO/IV bid or tid to maintain alkaline urine pH Contraindications hypersensitivity to drug or class, hyponatremia, hypokalemia, depressed respiratory function, cirrhosis, hyperchloride acidosis, adrenocortical insufficiency Caution hepatic and/or renal dysfunction # Maternal Considerations ..... There are no adequate reports or well controlled studies of acetazolamide in pregnant women. Pregnancy is not known to alter the impact, efficacy, and dosing of acetazolamide. Side effects include aplastic anemia, Stevens Johnson syndrome, toxic epidermal necrolysis, fulminant hepatitis, paresthesias, loss of appetite, taste changes, dyspepsia, and polyuria. 6 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 There are no adequate reports or well controlled studies in human fetuses. Acetazolamide apparently crosses the human placenta. There is no suggestion of teratogenicity in humans despite a long clinical experience. A single case report documents a preterm infant whose mother was treated for glaucoma throughout pregnancy with oral acetazolamide. When renal tubular acidosis developed, acetazolamide was detected in the child’s serum, confirming transplacental passage. In some rodents, acetazolamide is teratogenic (skeletal abnormalities consisting variably of ossification defects or some form of postaxial forelimb ectrodactyly in rats, urinary malformations in mice when combined with amiloride). The prevalence of defects is enhanced when combined with ibuprofen. # Breastfeeding Safety .......... Acetazolamide is not concentrated in the milk, and the neonatal exposure is <0.5% of the maternal dose. It is generally considered compatible with breastfeeding. # Drug Interactions ................ Acetazolamide may modify phenytoin metabolism and increase serum level of phenytoin. By decreasing the GI absorption of primidone, it may decrease serum concentrations of primidone. Acetazolamide reduces urinary excretion of quinidine and may enhance its effect. It increases lithium excretion. Acetazolamide may elevate cyclosporine levels. PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL # Fetal Considerations ........... # References ......................... Academy of Pediatrics. Pediatrics 1994; 93:137 50. Lee GS, Liao X, Cantor RM, Collins MD. Birth Defects Res A Clin Mol Teratol 2006;76:19 28. Nakatsuka T, Komatsu T, Fujii T. Teratology 1992; 45:629 36. Ozawa H, Azuma E, Shindo K, et al. Eur J Pediatr 2001; 160:321 2. # Summary ........................... Pregnancy Category: C Lactation Category: S Acetazolamide should be used during pregnancy and lactation only if the benefit justifies the potential perinatal risk. Acetohexamide—(Dimelin; Dimelor; Dymelor; Gamadiabet; Ordimel; Toyobexin) International Brand Name Dimelin (Japan); Dimelor (South Africa, Taiwan); Toyobexin (Japan) # Drug Class .......................... Carbonic anhydrase inhibitors; Oral hypoglycemics; Sulfonylureas # Indications ......................... Diabetes mellitus, type II # Mechanism ......................... Acutely stimulates the release of pancreatic insulin and thus requires islet activity # Dosage with Qualifiers ....... Diabetes mellitus, type II begin 250mg/d before breakfast in women not receiving another hypoglycemic agent; increase by 250 500mg every 5 7d until desired control Contraindications hypersensitivity to drug or class, ketoacidosis, type I diabetes mellitus Caution pregnancy 7 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132 There are no adequate reports or well controlled studies of acetohexamide in pregnant women, and no publications within the last 3 decades. Some oral hypoglycemic drugs are associated with an increased risk of CV death compared to diet and insulin control of glucose. Side effects include hypoglycemia, cholestatic jaundice, GI upset, allergic skin reactions, SIADH, hemolytic anemia, various cytopenias, and hepatic porphyria. # Fetal Considerations ........... There are no adequate reports or well controlled studies in human fetuses. Although acetohexamide apparently crosses the placenta, there are no reports of teratogenicity in humans. Prolonged neonatal hypoglycemia associated with hyperinsulinism is reported. Differences in the extent of the placental transport of various sulfonylureas are reported. Embryotoxicity is noted in rodent studies. # Breastfeeding Safety .......... There is no published experience in nursing women. It is unknown whether acetohexamide enters human breast milk as other sulfonylureas do. PR SA O M PE PL R E TY C O O F N E TE L N SE T V - N IE O R T FI N AL # Maternal Considerations ..... # Drug Interactions ................ The hypoglycemic action of sulfonylureas can be enhanced by some drugs, including NSAIDs and other drugs that are highly protein bound, salicylates, sulfonamides, chloramphenicol, probenecid, coumarins, MAOIs, and b blockers. Women treated with both should be observed closely for hypoglycemia. Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid tend to produce hyperglycemia and may lead to loss of control or hypoglycemia when withdrawn. Severe hypoglycemia was reported following concurrent use of oral miconazole and oral hypoglycemic agents. It is not known whether this interaction occurs with IV, topical, and vaginal preparations of miconazole. # References ......................... Kemball ML, McIver C, Milner RD, et al. Arch Dis Child 1970; 45:696 701. # Summary ........................... Pregnancy Category: C Lactation Category: U Insulin and diet regulation remain the standard treatments for glucose intolerance during pregnancy. There is growing interest in the use of oral hypoglycemic agents during pregnancy, and acetohexamide might be a candidate for future study. If a patient is maintained on acetohexamide during pregnancy, she should be switched to insulin 1 2w prior to delivery in hopes of reducing the risk of neonatal hypoglycemia secondary to hyperinsulinism. 8 http://www.us.elsevierhealth.com/product.jsp?isbn=9781416040132
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