The drug that is never advised in pregnancy is:
Methotrexate is a analogue of folic acid and it prevents the synthesis of DNA by inhibiting the enzyme dihydrofolate reductase. It has been extensively used in medical termination of pregnancy, ectopic pregnancy, gestational trophoblastic disease and placenta accreta. It has been included in the "Category X" of the FDA risk categories classification. The commonly repoed side effects are leukopenia, thrombocytopenia, bone marrow aplasia, ulcerative stomatitis, hemorrhagic enteritis, elevated liver enzymes, alopecia, pneumonitis and diarrhea. It produces cranio-facial abnormalities in the fetus though it is not teratogenic. It is better to be avoided in women who are pregnant or in those who are planning for a pregnancy in the near future. Cyclosporine is a immunosuppressant that can be safely used in pregnancy. It is used in conditions like SLE, Multiple Sclerosis and renal transplant (associated with pregnancy). The other immunosuppressants that can be used in pregnancy are cyclophosphamide, prednisone and azathioprine. As malaria is a life threatening infection in pregnancy, the benefits obtained outweighs the risks that evolve from the use of anti-malarials. Chloroquine is used both in the treatment and in the prevention of malaria in pregnancy. Pyrazinamide is used in the treatment of active tuberculosis in pregnant mothers. It is given along with isoniazid, rifampicin and ethambutol for a period of nine months. Ref: Berek and Novak's Gynecology, Issue 935, Volume 2007 By Emil Novak, Page 622 ; Textbook of Obstetrics by D.C. Dutta, 6th Edition, Pages 510-13, 282-83, 295-96
Methotrexate
Cyclosporine
Chloroquine
Pyrazinamid