Medications

• Phenytoin
  • Neural tube defects, microcephaly, orofacial clefts, dysmorphic facial features, distal digit/nail hypoplasia
• Lithium
  • Ebstein anomaly, nephrogenic diabetes insipidus, hypothyroidism
• Valproate
  • Neural tube defects
• Isotretinoin
  • Microcephaly, thymic hypoplasia, small ears, hydrocephalus
• Methotrexate
  • Limb & craniofacial abnormalities, neural tube defects, abortion
• ACE inhibitors
  • Renal dysgenesis, oligohydramnios
• Warfarin
  • Nasal hypoplasia, stippled epiphysis

Antiepileptic drugs

• Neural tube defects, cardiac defects, cleft palate, skeletal abnormalities (eg, phalanx/nail hypoplasia, facial dysmorphism).
• Most commonly due to valproate, carbamazepine, phenytoin, phenobarbital; high-dose folate supplementation recommended.