The professor lecturing today is getting over being sick from last week and had this great idea to have us students break into groups and go over her PowerPoint in order to teach the class in her place. While working on our portions of this Multiple Sclerosis lecture, my group was to cover Azathioprine and this led to a couple of us talking about how the retail pharmacies we’ve been in don’t warn about drugs that pregnant (or trying to conceive) women shouldn’t handle. I work for a large independent and we do fill some medications that other corporate pharmacies won’t such as some of the antiviral and cancer medications. From class we’ve learned that some patient counseling points to include with such medications like these are actually missed while working with the medication itself. I’ve filled Temozolomide (Temodar) and Dutasteride (Avodart) at my pharmacy and it has been clearly noted to the technicians filling that females of child bearing age should avoid touching the medication at all costs. We’ll put on rubber gloves or just give to one of the male technicians or pharmacists to dispense. But how many other medications should pregnant women (or those planning on becoming pregnant) avoid touching? According to Pharmacist Letter’s article, Drugs with Handling Concerns Due to Reproductive Risk, drugs such as some antivirals, chemotherapy agents, immunosuppressants, and 5-Reductase inhibitors used for Benign Prostatic Hyperplasia (BPH) are medications that women should avoid handling if pregnant or planning on become pregnant.
Antivirals such as entecavir (Baraclude) and valganciclovir ( Valcyte) are both dispensed at my pharmacy in unit dose packages, so luckily we are able to avoid the possibility of having to touch the medication. Both medications are a category C pregnancy rating urging prescribers to only use these medications if the potential benefit outweighs the risk to the fetus. Entecavir hasn’t been shown to induce mitochondrial dysfunction in pregnancy but it’s highly suggested since many Nucleoside Reverse Transcriptase Inhibitors (NRTIs) do this. Valganciclovir is potentially teratogenic in humans because it’s a prodrug of ganciclovir (Cytovene); which at high doses (ganciclovir) is teratogenic in humans and was found to be mutagenic during animal studies.  With the unit dose packaging, there isn’t a reason to have to open the medication bottle to dispense so this is one class that we don’t have to worry about exposure to.
Chemotherapy agents are a rarity, but we do dispense Temodar occasionally. As mentioned before this is one that we have been somewhat educated about as to not handing without special precautions. I have to say even if we weren’t told to not touch the antivirals mentioned before; it’s a good thing this one medication is definitely drilled into our heads as to not touch. Temozolomide is classified as FDA pregnancy risk category D-a worse pregnancy risk than the other two. This medication is used for certain types of brain tumors, and has shown teratogenic effects in animal studies but hasn’t been studied in pregnant females yet. 
It was when looking up Azathioprine (Imuran) for my group assignment that I decided to write this blog entry. This is one common medication I see at work and had no idea the effects of handling in pregnant (or trying to conceive) females. This drug also has a FDA pregnancy risk category D rating. It’s indicated for Rheumatoid arthritis but is used off label for Multiple Sclerosis (the topic of today’s class, yay!). In some disease states there may be a potential benefit to the mother that outweighs the risk to the fetus, but it’s contraindicated in rheumatoid arthritis treatment of pregnant females.
Avodart is a 5-reductase inhibitor that we’ve been told to not handle without gloves, but what about the other medication in that class, finasteride (Proscar/Propecia)? I’ve yet to be told in the 5 years I worked as a Certified Pharmacy Technician (3 of those being before I started pharmacy school) that we should handle this medication with care like we do with Avodart. Category X drugs such as ACE inhibitors, ARBs, and statins don’t seem to pose a risk when directly handling them if pregnant. But how many pregnant technicians and pharmacists really wash their hands after handling these drugs to avoid hand to mouth exposure?
I could say the take home point of this is to state that drugs are bad little objects that we need to be mindful of, which in fact they can be in the wrong hands. But shouldn’t we counsel not only our patients but our pharmacy staff of the dangers of these medications since they are in fact handling these agents every day? You may not know how dangerous that little white pill is in your hand when you’re pregnant if you’re not sure of its exact drug mechanism. Education is essential-especially when it comes to your pregnancy and future of your child.
*Please don’t take my writing as medical advice; when in doubt, please ask your local pharmacist-not some pharmacy student who writes on her blog.