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Evidence summaries

The Safety of Antimalarial Drugs in Pregnancy

Chloroquine and proguanil, probably also mefloquine, may be reasonably safe during pregnancy. Level of evidence: "C"

A systematic review 1 including 26 studies of quinoline derivatives, 7 studies of dihydrofolate and sulphones, 9 studies of antibacterials, and 6 studies of other drugs was abstracted in DARE. High doses of quinine were reported to cause simulation of the pregnant uterus, deafness and optic nerve hypoplasia in children. High dose of chloroquine: rare case reports of ototoxicity, no congenital abnormalities. Mefloquine: no overall increase in congenital malformations. Primaquine: increased risk of intravascular haemolysis in fetus/infant. Proguanil and chlorproguanil: no evidence of toxic effects, reduced plasma concentrations. High doses of pyrimethamine: protective effect of drug on fetuses of women with toxoplasmosis. High doses of sulphonamides: no clear increase in congenital abnormalities, no evidence of kernicterus. Dapsone: see sulphonamides. Tetracycline: abnormal skeletal and dental development.

    References

    • Phillips-Howard PA, Wood D. The safety of antimalarial drugs in pregnancy. Drug Saf 1996 Mar;14(3):131-45. [PubMed][DARE]

Primary/Secondary Keywords