Profuse salivation can lead to dehydration of the body, as a result of which the pregnant woman is hospitalized in the intensive care unit in order to stabilize the condition and prescribe adequate therapy.
It should be noted, that the true cause of toxicosis today, therefore, obstetricians-gynecologists have to carry out symptomatic treatment.
In this case, Cerucal.
Information about the drug
Cerucal belongs to the group antiemetic drugs, which blocks receptors in the stomach and duodenum, which transmit signals to the vomiting center, which is located in the brain.
As a result of this blockage, the brain does not receive signals for gagging and food can pass through the intestines normally.
Cerucal also promotes the speedy passage of food through the gastrointestinal tract and normalizes bowel function.
Cerucal available in pill form which are intended for oral administration, and in the form of a solution for injection.
The drug is metabolized in the liver, the half-life of cerucal is 3-5 hours, while in chronic renal failure this period increases to 15 hours.
In the form of metabolites, it is excreted by the kidneys within 24 hours. Penetrates the blood-brain barrier, is excreted in the mother's milk during breastfeeding child, why its use is prohibited when breastfeeding children under 2 years of age.
Indications for use
Indications for taking Cerucal during pregnancy are:
- nausea and vomiting;
- hiccups of various origins (with the exception of hiccups caused by disturbances in the functioning of the vestibular apparatus);
- violation (in this case, weakening) of the motor activity of the intestines, stomach and biliary tract;
- stomach cramps, inflammation of the esophagus, which are constantly accompanied by regurgitation of food (the so-called reflux esophagitis).
Contraindications
Contraindications to the reception of Cerucal during pregnancy are:
- bleeding of the gastrointestinal tract;
- perforation of the wall of both the intestine and the stomach;
- adrenal tumors;
- convulsions;
- some types of hormonal tumors;
- increased intraocular pressure;
- obstruction of the gastrointestinal tract.
Overdose and side effects
TO overdose symptoms Cerucal during pregnancy should include:
- drowsiness and confusion;
- anxiety and;
- extrapyramidal disorders and seizures;
- bradycardia and arterial hypotension;
- in rare cases, arterial hypertension is observed.
Usually, the listed symptoms disappear within 24 hours after stopping the drug. Presently no fatal cases of overdose with Cerucal during pregnancy have been identified... Treatment for overdose is symptomatic.
Side effects Cerucala during pregnancy are reduced to:
- agranulocytosis;
- supraventricular;
- hypotension or hypertension;
- extrapyramidal disorders (rhythmic twitching of the tongue, spasms of the facial muscles, spastic torticollis);
- feeling tired;
- a feeling of fear, anxiety;
- drowsiness;
- tinnitus.
Features of the use of the drug during pregnancy
It should be noted that the appointment of Cerucal during pregnancy not desirable, especially in the first trimester of pregnancy, since the drug has a teratogenic effect (causes fetal malformations).
He is appointed only on strict indications. and only by an obstetrician-gynecologist, when the positive effect of the drug exceeds the possible side effects.
In addition, during pregnancy, the woman's uterus is in constant hypertonicity, so taking the drug can provoke.
It is not uncommon for women to find out about such a drug and begin to take it on their own without first consulting their doctor, which leads to serious consequences.
In the 2nd and 3rd trimesters of pregnancy the drug is prescribed only for health reasons.
But even during this period, the appointment of the drug fraught with complications, since Cerucal promotes the production of adrenal hormones, which retain fluid and salts in the body, as a result of which the course of a toxicosis may be complicated or provoke its development.
Dosage of Cerucal is selected based on creatinine clearance. If its value is less than 10 ml / min, then the drug is prescribed 10 mg 1 time per day. If this figure is 11-60 ml / min, the dose of the drug is 15 mg, which must be divided into two doses (10 and 5 mg).
Average therapeutic dose Cerucala is 0.1 mg per 1 kg of body weight.
Toxicosis is a common occurrence in pregnant women on early dates carrying a baby. It is accompanied by severe nausea and prolonged vomiting. As a rule, by the middle of the term, unpleasant symptoms disappear, but in some women signs of gastrointestinal dysfunction persist. With such symptoms, doctors prescribe antiemetic drugs, among which there is Cerucal. Is it allowed to take Cerucal during pregnancy? Consider a list of indications and contraindications for taking it.
Cerucal: a general description of the drug
The drug Cerucal is produced in two forms:
- solution for intramuscular and intravenous injections in ampoules of 2 ml;
- tablets - round, whitish, flat.
The active ingredient in Cerucal is metoclopramide. It is an antiemetic substance whose principle of action is based on blocking the dopamine and serotonin receptors.
The neurotransmitter dopamine reduces gastrointestinal motility, relaxes the esophageal sphincter and promotes gastroesophageal and duodenogastric reflux. Dopamine has a stimulating effect on the chemoreceptors of the trigger zone and the vomiting center in the brain, thereby provoking nausea and vomiting.
By blocking dopamine receptors, metoclopramide eliminates possible outcomes effects of a neurotransmitter and has an antiemetic effect. Thus, the drug Cerucal helps to improve intestinal motility, relieves nausea and removes vomiting, accelerates the movement of food from the stomach further into the intestine.
Cerucal is rapidly absorbed in the gastrointestinal tract and metabolized in the liver. It is excreted from the body through the kidneys during the day.
Indications for use by pregnant women in the early and late stages
In what cases is Cerucal prescribed? Indications for use:
- nausea and vomiting;
- lack of muscle tone in the digestive system;
- dysfunction of biliary tract motility;
- gastroesophageal reflux disease - the release of stomach contents into the esophagus;
- pyloric stenosis - narrowing of the opening between the stomach and the duodenum;
- gastroparesis in diabetes mellitus;
- the need to enhance gastrointestinal motility before radiopaque examination or duodenal intubation.
Can future mothers take Cerucal?
The drug has a teratogenic property, that is, it is able to penetrate the child's body and cause developmental anomalies. In the first trimester, when the placental barrier has not yet been formed, taking Cerucal is strictly prohibited. Starting from the second trimester, the medicine can be drunk, but only with a doctor's prescription.
Is the use of the drug tolerated in case of toxicosis? Nausea, vomiting, hiccups, heartburn are all common symptoms that often accompany early pregnancy. Judging by the instructions, Cerucal is just able to cope with these manifestations. However, toxicosis does not threaten the health of the mother and child, it is quite normal phenomenon, which indicates hormonal changes in the woman's body. You should not risk the fetus and drink dangerous medicine to relieve the symptoms of toxicosis.
If severe toxicosis accompanies a woman and later dates carrying a child, the doctor may decide on the use of the drug. Taking pills or injections is done only after a thorough examination, the risk from the use of the medication should be lower than the threat to health future mother and a child.
Contraindications and side effects
What is a contraindication to the use of Cerucal, except for early pregnancy? The medication cannot be used for the following ailments and conditions:
- pheochromocytoma - a benign hormone-dependent tumor of chromaffin cells of the adrenal sympathoadrenal system;
- prolactinoma - a benign hormone-dependent tumor of the pituitary gland;
- intestinal obstruction;
- perforation of the digestive tract;
- bleeding of the digestive tract;
- epilepsy;
- neuroleptic extrapyramidal deviations.
The dose of Cerucal is reduced in case of impaired functioning of the liver and kidneys. This is due to the elimination of metoclopramide through these organs. Also, with caution, you need to use the drug with high blood pressure and bronchial asthma.
What side effects can appear while taking Cerucal? Their list is impressive, however, if you use the medicine according to the doctor's instructions, the occurrence of side effects can be minimized.
The table contains a list of side effects of Cerucal:
| P / p No. | Organ system | Side effect |
| 1 | Nervous | Fatigue, tinnitus, headache, anxiety, drowsiness, depression. The appearance of tics, spasm of the facial muscles is possible. |
| 2 | Hematopoiesis | Agranulocytosis - a decrease in the number of leukocytes due to an increase in granulocytes and monocytes in the blood. Leads to increased susceptibility to infections. |
| 3 | Cardiovascular | Increased heartbeat, increased or, conversely, decreased blood pressure. |
| 4 | Digestive | Difficulty defecating or loose stools, dry mouth. |
What threatens an overdose of Cerucal? The pregnant woman will feel drowsiness, irritability, increased anxiety. Her consciousness will start to get confused, her pressure will rise or vice versa. If such symptoms appear, you must immediately stop taking the medication.
Instructions for the use of tablets and solution for injection
How should you use Cerucal? Instructions for the use of tablets for adults indicate that you should drink 1 piece three times a day. The maximum daily dose is 60 g, which corresponds to 6 tablets.
The solution is injected intramuscularly or intravenously in 1 ampoule, which equals 10 mg of metoclopramide, three times a day. How long the therapy will last, the doctor prescribes, looking at the individual course of the disease.
If a pregnant woman is in the hospital, then instead of injections she is often given a dropper with Cerucal. The drug, injected through a dropper, begins to act much faster - within 2-3 minutes. Such measures are taken if it is urgently necessary to stop an attack of vomiting. The injection takes only 15 minutes to take effect, and it will take even longer for the pill to take effect.
If you need therapy with Cerucal, you need to tell the doctor if the pregnant woman is taking any additional medications, because this drug is not compatible with all medications:
- enhances the absorption of acetylsalicylic acid, paracetamol, ethanol, diazepam, zopiclone, mexiletine, mefloquine, morphine, cyclosporine;
- reduces the absorption of nitrofurantoin, cabergoline, ketaprofen;
- combination with antipsychotics of the phenothiazine series (Aminazin, Propazin, Levomepromazin) increases the threat of extrapyramidal reactions;
- use in conjunction with anticholinergic drugs (Cyclodol, Diphenhydramine) reduces the effectiveness of both drugs.
Analogues and prices
How much does Cerucal cost? The cost of the medication depends on the pricing policy of a particular pharmacy. On average, tablets cost 120 rubles for 50 pieces. The price of ampoules is 230 rubles for 10 pieces.
What to do if, for some reason, it is not possible to buy this medicinal substance in the pharmacy or its use is prohibited? In such cases, it is necessary to use analogs.
The table contains a list of analogues of Cerucal:
| P / p No. | Name | Active component | Release form | Operating principle | special instructions |
| 1 | Kinedril | Caffeine, moxastine | Tablets | A blocker of histamine receptors, has antihistamine, sedative, antiemetic, anticholinergic effects. | It can only be taken during pregnancy with the permission of a doctor. May have a negative effect on the embryo. |
| 2 | Passages | Domperidone | Chewable tablets | Blocks dopamine receptors, eliminates nausea and vomiting. | It is allowed to drink when carrying a child, with caution in the early stages. |
| 3 | Motinorm | Domperidone | Syrup, tablets | Soothes vomiting, nausea, hiccups. | It is allowed to use during pregnancy, but only with the permission of the doctor. |
| 4 | Motilium | Domperidone | Tablets, suspension | The active ingredient is a dopamine antagonist, due to which it has an antiemetic effect. | Use with caution during pregnancy, there is no proven safety data for the fetus. |
Cerucal is a prescription drug, it is allowed to take it only after consulting a doctor. It is forbidden to prescribe it to yourself on your own, because self-medication can cause irreparable harm to an unborn child.
Many women suffer from toxicosis during pregnancy. Most often this happens at the initial stages. Nausea and vomiting make life very difficult for expectant mothers. Cerucal is a remedy that will help to cope with these unpleasant symptoms
Action of Cerucal
Huge hormonal changes occur during pregnancy. A constantly growing child secretes products of his vital activity, which are excreted by the mother's body. As a result, a normal meal can end in vomiting, and nausea becomes a constant companion of a woman. Hiccups, profuse salivation, pain and cramps in the stomach, and stool disturbance lead to exhaustion and dehydration.
Cerucal is an antiemetic agent, the active substance of which is metoclopramide hydrochloride monohydrate. It prevents gastric receptors from transmitting signals to the brain by blocking them. Thus, digestion goes without problems.
According to the instructions, Cerucal is contraindicated in pregnancy, especially in the first 12 weeks. It can be taken in the II and III trimesters only for health reasons. Although experimental studies have not established the adverse effect of metoclopramide on the fetus, there is no reliable data on the effect of the drug on the child. Many of the described cases of the use of the drug by expectant mothers show that if the dosage is observed, nothing bad happens to the baby.
In what cases and in what trimester the drug is prescribed
The decision to use Cerucal is made by the specialist observing the woman. He assesses her condition, weight, features of pregnancy. The drug can be prescribed if the expectant mother is worried about:
- frequent vomiting;
- persistent nausea;
- profuse salivation;
- poor digestion;
- stomach cramps;
- inflammation of the esophagus;
- regurgitation of food.
Despite the contraindications, Cerucal is also used in the first trimester, but this must be done with great care. It increases the contractility of the stomach muscles, which can lead to hypertonicity of the uterus and spontaneous miscarriages. At a later date, the drug is prescribed if refusing it harms the baby more than taking it. As a result of the use of the drug after 30 weeks, the likelihood of a violation of motor activity in a child is not excluded.
What to do with nausea in early pregnancy - video
Cerucal in injections and tablets
Cerucal is available in the form:
- solution for intramuscular or intravenous administration;
- tablets.
The tablets are prescribed to relieve the condition of a woman experiencing the above symptoms. They are completely absorbed in the gastrointestinal tract. In cases where immediate help is needed, for example, you need to quickly stop vomiting, intramuscular injections are given. Their action begins in a quarter of an hour. When administered intravenously, the effect is noticeable after 2-3 minutes.
Contraindications and side effects
Cerucal is a good and reliable help, but it has many contraindications. These include:
- pregnancy;
- intolerance to the components;
- glaucoma;
- mechanical intestinal obstruction;
- perforation of the stomach or intestines;
- any tumors;
- epilepsy.
Every woman expecting a baby should know about side effects Cerucala. If at least one of them is found, the drug is stopped. Negative effects disappear within a day after cancellation. Among them there are:
- anxiety, irritability;
- lethargy, drowsiness, depression;
- increase or decrease in pressure;
- headache;
- convulsions;
- constipation, diarrhea;
- dizziness, noise in the head;
- dry mouth;
- rash on the skin.
American Food and Drug Administration and medicines(FDA) for Cerucal has established a risk category B. This means relative safety during pregnancy: studies on animals did not reveal a negative effect on the fetus, but there is no clinical data on the effect on the female body and the child's condition.
How long can you take
Pills are the most common dosage form Cerucala. They are taken half an hour before meals with plenty of water. They begin to act in 30-40 minutes. You can drink no more than four pieces a day. But this general recommendations. In each individual case, the dosage and duration of treatment is determined by the doctor.
Analogues and replacement options
There are many drugs with the active substance metoclopramide, which are analogues of Cerucal. These include:
- Metamol;
- Metoclopramide;
- Perinorm;
- Raglan;
- Ceruglan.
In addition to analogues, there are drugs with other active ingredients that also help with toxicosis.
Drugs that can replace Cerucal during pregnancy - table
| Name | Active substance | Release form | Contraindications | Indications | Features of use during pregnancy |
| house in front |
|
|
| There is insufficient data on the use of Motilium during pregnancy. Its appointment is possible only if it is justified by a therapeutic benefit. | |
| silica | powder |
|
| It does not have a negative effect on the fetus, it is allowed during pregnancy. | |
| artichoke extract |
|
|
| The use of Hofitol is possible according to the doctor's prescription. |
Drugs that, according to the doctor's prescription, can replace Cerucal with toxicosis - photo gallery
Motilium is a centrally acting antiemetic drug that blocks dopamine receptors 
Polysorb adsorbs toxins and removes them from the body, facilitating the condition of a pregnant woman with toxicosis 
Hofitol helps with indigestion
At the beginning of pregnancy (within 12 weeks), most women suffer from toxicosis, the most common manifestations of which include malaise, vomiting, nausea and excessive salivation. To one degree or another, all pregnant women are exposed to toxicosis, but sometimes it manifests itself in a very acute form especially in the first trimester. And if nausea is accompanied by constant vomiting, then the body can be dehydrated because of this. In such cases, women are hospitalized and they are prescribed intravenous influences of special honey. drugs.
With the onset of pregnancy, the hormonal balance changes dramatically, which has a direct effect on the central nervous system. Moreover, the developing fetus constantly excretes metabolic products, which also negatively affects maternal health. Placenta that relieves symptoms early toxicosis, appears only at the beginning of the second semester. Therefore, many pregnant women ask whether it is possible to take medications in the first trimester to relieve toxicosis? Often, pharmacies offer a popular antiemetic drug - Cerucal.
Information about the drug
Cerucal is honey. a drug that blocks receptors in the duodenum and stomach (they are known to transmit corresponding signals to the vomiting center). Under the action of the drug, signals from these receptors do not enter the brain, and, of course, there is no emetic urge.
These include:
- stomach or intestinal bleeding;
- convulsions;
- certain types of tumors;
- glaucoma;
- early pregnancy.
Often, Cerucal is prescribed only after the 13th week, and then only after a preliminary examination. Taking it at the beginning of pregnancy, as well as during lactation, is highly undesirable.
Cerucal during early pregnancy - why not?
This medicine, as we have already found out, strengthens the muscle tone of the gastrointestinal tract, which can also affect the tone of the uterus. And in the early stages, its increased tone sometimes leads to the most negative consequences, including miscarriage. In the future, the threat does not disappear, therefore, at a later date, taking Cerucal is undesirable, especially without consulting a doctor. Moreover, the drug stimulates the secretion of prolactin, a hormone that promotes not only lactation, but also the contraction of the uterine muscles.
Note! In some cases, when toxicosis is especially acute, the general health of the expectant mother worsens from constant vomiting and feeling unwell, and this also leads to a high uterine tone. At the same time, a baby can also suffer from toxicosis if, due to constant vomiting, a woman cannot eat and drink. Then the reception of Cerucal can be appointed.
With a little more confidence, Cerucal can be taken in the second trimester, because the threat of spontaneous abortion during this period decreases. But don't forget about the side effects. After taking the drug, the production of adrenal hormone is stimulated, and it, as you know, promotes the retention of salts and fluids in the body. As a result, gestosis or a more severe complication may occur. Other side effects include:
- dizziness;
- migraine;
- itching and redness of the skin;
- panic attacks;
- constipation or, conversely, diarrhea;
- tinnitus;
- heart rhythm disorder;
- dry mouth;
- fatigue, depressed mood.
Overdose with Cerucal
In case of drug overdose, the following symptoms may appear:
- drowsiness;
- arterial hypertension / hypotension (less common);
- "Confusion" of consciousness;
- bradycardia;
- convulsions;
- movement disorders.
Note! In most cases, the symptoms disappear within a day after stopping the intake. To date, no cases of fatal drug overdose have been identified. The treatment itself in case of an overdose is carried out symptomatically.
As you can see, Cerucal is by no means a harmless drug, which during breastfeeding it is generally prohibited to accept. Even pregnant women often suffer from kidney diseases, which can also provoke side effects. During pregnancy, in particular, in the early stages, taking Cerucal is undesirable and is possible only as prescribed by a doctor.
Types of toxicosis
Medicines that should not be used in early pregnancy
| 1. Drugs with a high risk of developing disorders (known as teratogenic) or causing abortion. | 2. Drugs with a high degree of probability of developing abnormalities (moderately increasing risk). | 3. Other drugs to avoid. |
|---|---|---|
| Warfarin. | Amiodarone. | Calcium antagonists. |
| Diethylstilbestrol. | Lithium. | Griseofulvin |
| Androgens. | Chloroquine. | Omeprazole |
| Valproate. | Phenytoin. | Quinolone antibiotics |
| Antineoplastic agents. | Rifampicin | |
| Tetracyclines. | Spironolactone | |
| Corticosteroids (high doses). | Live vaccines | |
| Vitamin A analogs. | ||
| Fibrinolytic drugs. | ||
| Cyproterone acetate. | ||
| Dystigmine. | ||
| Misoprostol. |
Video - Toxicosis at the beginning of pregnancy
The first weeks of pregnancy in many women are accompanied by early toxicosis. Most often, its symptoms appear in the initial 20 weeks. The main clinical manifestation of toxicosis is vomiting, which is usually preceded by nausea and increased salivation. The intensity of these symptoms determines the severity of the woman's condition.
Causes of nausea and vomiting
The main provoking factor in the onset of symptoms of early toxicosis is the presence of the ovum. In response to its appearance in a woman's body, a cascade of reactions is triggered, which are pathogenetically significant in the development of vomiting in pregnant women.
Scientists have identified a number of theories that explain the development of these symptoms. The toxic concept is considered the oldest. It is based on the poisoning of a woman's body with toxic substances that produce the fetus and placenta.
e researchers adhere to the endocrine theory, according to which the main reason is considered to be changes in the content of hormones in a woman's body. Thus, the coincidence of the peaks of vomiting with an increase in the content of chorionic gonadotropin and a decrease in the production of corticosteroids by the adrenal glands was revealed. Today, most researchers are of the opinion that all symptoms arise in response to functional impairment of the central nervous system burdened by metabolic and neuroendocrine changes. The fertilized egg has an irritating effect on the receptors of the uterine mucosa, which leads to an increase in the excitability of subcortical formations and an increase in the reaction of the autonomic nervous system to its presence.
Description of the drug Cerucal
The active ingredient is metoclopramide.
The basic principle of work of Cerucal is to block the receptors of the central nervous system. As a result of the cessation of the flow of impulses that come to the vomiting center of the brain from irritated receptors of the stomach and duodenum, vomiting stops. This mechanism allows the food bolus to actively continue its movement in all parts of the intestine.
The main action of Cerucal is to stop vomiting and hiccups.
Forms of the drug
Tablets. They are rounded with a stripe in the middle. One tablet contains the main active substance- metoclopramide, as well as additional substances: gelatin, as a base, silicon dioxide, starch and lactose.
Injection. The drug can be administered intravenously and intramuscularly. The dose of each injection is calculated by the doctor, based on the severity of the person's condition.
How to take Cerucal correctly?
Only a doctor can prescribe the drug. The instructions for use indicate the following indications for taking the drug:
- Profuse, frequent vomiting.
- Strong, long-lasting nausea.
- Hiccups of any genesis, with the exception of central origin in violation of the vestibular apparatus.
- Decrease in the tone of the work of different parts of the intestine.
If the woman is in a satisfactory condition, the tablet form of the drug is prescribed. They must be taken one tablet 30 minutes before meals, without chewing, drinking plenty of water. The effect comes in 20-30 minutes.
If it is impossible to take pills, in acute critical conditions, an injectable form of the drug is used. With intravenous administration, the effect occurs within five minutes, with intramuscular administration - within fifteen.
Can Cerucal be used during pregnancy?
Any medicinal product affects the entire body as a whole. Therefore, there are such diseases, the course of which is aggravated by taking it.
The main contraindications to the use of Cerucal are:
- Tumor diseases.
- Acute and chronic blood loss from the gastrointestinal tract.
- Epilepsy.
- Childhood.
- Hypersensitivity to the components of the drug.
- Pregnancy, especially the first trimester.
- Lactation period.
Researchers have proven Negative influence the drug on the fetus and the woman's body during pregnancy.
Why not?
The drug has a teratogenic effect on the development of the fetus, thereby causing the formation of malformations. Since the main part of the child's organs is formed in the first months, therefore, the use of Cerucal during early pregnancy for the treatment of symptoms of toxicosis adversely affects the fetus.
Metoclopramide affects the tone of not only the gastrointestinal tract, but also the uterus. By increasing its tone and stimulating the production of the pituitary hormone prolactin, it causes the synthesis of human milk and the contraction of the uterus. These pathogenetic aspects in the first months of pregnancy can provoke a spontaneous miscarriage. This fact limits the intake of Cerucal during all three trimesters of pregnancy.
From the second trimester of pregnancy, the likelihood spontaneous miscarriage decreases. In this regard, the use of the drug becomes possible. But only a doctor can prescribe it and calculate the dosage.
However, it is worth remembering that Cerucal stimulates the synthesis of hormones by the adrenal glands, an increase in the content of which leads to the retention of salt and water in the body. Clinically, this is manifested by edema and aggravation of the course of toxicosis.
The decision on the appointment of Cerucal is decided individually. The doctor needs to assess the risks of using this drug for the mother and fetus. Sometimes the manifestation of symptoms of early toxicosis becomes unbearable. The general condition of the mother is disturbed due to constant nausea and vomiting. This leads to an increase in the tone of the uterus. At the same time, the risks for the fetus also increase, since due to vomiting, a woman cannot eat and drink. In this case, the use of the drug is possible.
The main side effects of the drug are:
- Diarrhea or constipation.
- Change in blood pressure.
- Parkinsonism.
- Muscular hypertonicity.
- Headache.
- Dizziness.
- Depression.
- Drowsiness.
- Skin rashes.
Cerucal is an unsafe drug that should not be taken during the first twelve weeks of pregnancy and while breastfeeding. The presence of renal disease in pregnant women increases the likelihood of complications and side effects from taking this drug. Only a doctor can prescribe and calculate the correct dose of the drug, taking into account contraindications and the somatic status of a pregnant woman.
