Asthma

I just found out that I am pregnant...4 weeks. I am having an asthma attack/bronchospasm ...isn't severe but bad enough that I need my inhaler. I have a Maxair inhaler...can I use this? I also have Singulair that I could take if that would be better.

Also is it okay that I am taking Zithromax this early in the pregnancy.

[David Tinkelman, M.D.]

You should check with your OB regarding any and all drugs you might consider taking, including prescription drugs, over-the-counter drugs, vitamins and herbal medications.

Maxair is listed as a Category C drug by the FDA.  Category C indicates the following:  Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the fetus.

Thus there is no guarantee that Maxair would be safe for your fetus.  

In addition, the following drug interaction is specified by the FDA:

Monoamine Oxidase Inhibitors or Tricyclic Antidepressants: Pirbuterol (Maxair) should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, because the action of pirbuterol on the vascular system may be potentiated.

Zithromax is an FDA, Category B drug.  The following is from LexiComp:

Pregnancy Considerations
Adverse events were not observed in animal studies; therefore, azithromycin is classified as pregnancy category B. Azithromycin crosses the placenta. Fetal malformations have not been observed following maternal use of azithromycin. The maternal serum half-life of azithromycin is unchanged in early pregnancy and decreased at term; however, high concentrations of azithromycin are sustained in the myometrium and adipose tissue. Azithromycin is recommended for the treatment of several infections, including chlamydia and Mycobacterium avium complex (MAC) in pregnant patients.


The following statement regarding Singulair is taken from a reliable source, LexiComp Pregnancy

Risk Factor B:  Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Pregnancy Considerations
Montelukast was not teratogenic in animal studies, however, there are no adequate and well-controlled studies in pregnant women. Based on limited data, structural defects have been reported in neonates exposed to montelukast in utero; however, a specific pattern and relationship to montelukast has not been established. Healthcare providers should report any prenatal exposures to the montelukast pregnancy registry at [phone].

The bottom line is that Maxair should not be used and for Singulair, absolute safety has not been confirmed if taken during the first trimester and (see above) “There is no evidence of a risk in later trimesters”  Note, “no evidence of risk” is not a guarantee of safety.

Again, do not take any drugs without first obtaining your doctor’s approval.
Finally, sub-optimum control of asthma (your current situation) is a risk factor for your baby.  Fortunately the most commonly prescribed asthma drugs have been shown to have a good safety profile.  You should work closely with your “asthma doctor” to secure optimum control of your asthma  Feel free to share this message with your doctors.

Good luck to you and your baby