Q: My wife 24 years old and is pregnant. Her doctor advised her Folinext-D (once daily before meal), Vomipred, Gelusil-MPS and Voranin-200 (Progesterone) Natural, micronised - 200 mg (once daily before meal). This is her first pregnancy. She is almost normal except occasional pain in her right lower abdomen and vomiting tendency. Sometimes she says that she has pain similar to that of menstruation. Please guide me about the prescribed drugs. I would also like to know about necessary immunisations for her. What are the safe drugs for her in case of occasional seasonal fever and diarrhoea? Are paracetemol or metronidazole safe drugs? What is the ideal time to start calcium, iron and folic acid?

A:During pregnancy, except for totally essential medicines such as folic acid and iron (Probofex - one capsule daily) , all other unessential medicines must be avoided. One should also not take multi-ingredient products (i.e. brands that contain many medicines) since there is danger of consuming the same medicine twice (such as Folinext-D and Vomipred). It is not clear why Vomipred is being consumed. If there is nausea and vomiting, it is highly unlikely to be of much use. It is also not clear as to why Gelusil-MPS is being taken, though this is harmless. Voranin-200 (progesterone) is to be used only, if there is proven, documented deficiency of this hormone before conception to facilitate pregnancy in some selected women who are unable to conceive. It is used in assisted reproductive techniques (ART) such as IVF, never in normal conception. Unfortunately due to aggressive marketing by drug companies, progesterone products are being used as if they are tonics. This is dangerous. Its side effects include cramps, headache, nausea, depression, nervousness, somnolence, breast changes, weight increase, fluid retention and rarely death of the foetus in uterus. These are prohibited for use during pregnancy. Their use during early pregnancy can lead to birth defects in the baby such as cleft palate, cleft (hare) lip, heart defects. Rare cases of foetal death and spontaneous abortion have been reported in women given progesterone. Besides, this hormone can cause virilisation (unwanted hair on face etc) of female fetus. Metronidazole is not allowed to be used either during early pregnancy or during breast feeding. One also needs to be careful in selection of brands. There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 60,000 brands. Most manufacturers do not have quality testing laboratories. Hence selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines. Most of the vaccines required by adult females such as MMR, polio etc are given during childhood. If tetanus toxoid has not been given in the past 10 years, then it is recommended. Other immunisations such as hepatitis B depend on individual cases whether there is risk or not.