accidentally took phenylephrine while pregnantaccidentally took phenylephrine while pregnant

My doc said its ok too to take anything OTC now tht m this far along. Substitution of phenylephrine for pseudoephedrine as a nasal decongestant. Toxicology Data Network. They found no link between the medications and several other deformities that had been suggested by previous studies, such as clubfoot or defects of the eye or face, according to the report published in the American Journal of Epidemiology. Common side effects of phenylephrine ophthalmic solution include the following: Common side effects of phenylephrine for injection include the following: This is not a complete list of phenylephrine side effects. I did however, get the best night's sleep I have had in a month. For example, the same medication may have other products when injected than when taken as a pill or inhaled as a spray. Medically reviewed by Drugs.com. trouble sleeping. Therapeutic Goods Administration. Is the ketogenic diet right for autoimmune conditions? (2019). Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Ask a doctor or medical professional on Reddit! All rights reserved. For potential or actual medical emergencies, immediately call 911 or your local emergency service. The dose your doctor recommends may be based on the condition being treated. -Routine use of acetaminophen during pregnancy is not advised.-Phenylephrine is a sympathomimetic used in emergencies to treat hypotension and alleviate eye and ear allergic symptoms.-Phenylephrine could cause constriction in uterine vessels (that are normally maximally dilated during pregnancy), reducing uterine blood flow, potentially causing fetal hypoxia.-Phenylephrine may interact with oxytocic or ergot derivatives to cause persistent maternal hypertension; cerebral vessel rupture is possible.-Sympathomimetic amines are teratogenic in some animal models, but are not suspected to cause human teratogenicity.-First trimester exposure to phenylephrine may be linked to fetal abnormalities.-Patients with a preeclampsia history should use phenylephrine with caution due to its vasoconstrictive properties.-Phenylephrine may reduce placental perfusion. Individuals can find phenylephrine in various over-the-counter medications for cold, flu, and allergy symptoms. The risk of an endocardial cushion defect among babies whose mothers did not take decongestants is about 3 per 10,000 live births.. Take this medication exactly as prescribed by your doctor. privacy practices. Even the eight-fold increase in risk indicated by the study results, while it sounds large, would translate to a 2.7 in 1,000 chance the baby would have the defect, he said. Thank you for your submission. Is it possible for me to take phenylephrine and pseudophedrine? Monoamine oxidase inhibitors (MAOIs). Having a medical issue? They may recommend safer alternatives to help alleviate nasal congestion if required. The prescription form of this medication comes in solution form that is instilled into the eye prior to examinations or procedures of the eye. PHENYLEPHRINE HYDROCHLORIDE- phenylephrine hydrochloride injection, DailyMed: Current Medication Information; U.S. National Library of Medicine. It is not known if phenylephrine crosses into human milk. There is a problem with I've had a stuffy nose, and I asked my doc about what I could take, and he basically said "if it is over the counter, it'll be ok" so I went to the store and got some sudafed. Pseudoephedrine and phenylephrine both provide temporary relief for sinus pressure and nasal congestion. (2021). Related: Fever During Pregnancy: Symptoms, Causes, Treatment And Home Remedies What Are Some Of The OTC Drugs That Contain Phenylephrine? Pseudoephedrine Plus (chlorpheniramine / pseudoephedrine). O 0. Mothers were asked about medications they took while pregnant and in the two months before becoming pregnant. The #1 app for tracking pregnancy and baby growth. should i be alarmed? NEW YORK (Reuters Health) - A womans use of decongestant medications in the first trimester of pregnancy may raise her childs risk of certain rare birth defects, according to a small study. Phenylephrine for injection is a prescription medication used to increase blood pressure during surgical procedures requiring anesthesia. other information we have about you. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Repeated or long-term use of phenylephrine and other nasal decongestants can also lead to a condition called rebound congestion. AU TGA pregnancy category B2: Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Over-the-counter medicines, including phenylephrine and pseudoephedrine (which are commonly used in products like Afrin, Mucinex, Sudafed, Dristan, etc.) Do not take more than It may be advised to get a doctors prescription or to avoid it altogether. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Some types of over-the-counter decongestants, including the popular phenylephrine and pseudoephedrine, were individually linked to rare, specific birth defects of the digestive tract, ear and heart. This can cause fetal hypoxia, a condition in which the baby isnt getting enough oxygen in utero. Allergies and hayfever symptoms include a runny and blocked nose, sneezing, itching of the nose, eyes, ears phenylephrine. This should offer some reassurance to women who have taken these medications in pregnancy, Mitchell said. Cold-like symptoms may make your nasal passage extremely congested. Accessed July 15, 2022. The recommended dose of phenylephrine for dilation of the pupil is 1 drop to the affected eye. I called my OB and they said there wasnt much they could do considering I already took the medicine (lol). This is a potentially serious condition where the body produces too much of the neurochemical serotonin. https://www.uptodate.com/contents/search. As a precaution, if you suspect you're pregnant, take a home pregnancy test. Dr. Sheila Goodman answered Specializes in Obstetrics and Gynecology OK The following people should not take nasal decongestants unless their doctor confirms it is safe for them to do so: If a doctor determines that these decongestants are not safe, they may recommend other treatments to help relieve nasal congestion. July 30, 2022. Avoiding Drug Drug Interactions: Here's How, Having Surgery? Sore throat, coughing, runny nose, sinus headachesugh! Phenylephrine can also cause blurred vision. http://www.tga.gov.au/docs/html/medpreg.htm" (2010): Briggs GG, Freeman RK. Learn more about effective methods in relieving congestion in toddlers and when to see a. Keep this and all medicines out of the reach of children. Never use this subreddit as your first and final source of information regarding your question. Insomnia is the most common side effect that people may experience when taking nasal decongestants. Saunders Elsevier; 2016. https://www.clinicalkey.com. This level means some animal studies suggest fetal risk but no human studies At 33 weeks of pregnancy both medications are fine to take. To learn more, please visit our. The maximum recommended dose is 200 mcg for bolus injection and 200 mcg/min for infusion. Tell your doctor if you have any side effect that bothers you or that does not go away. The prescription form is used to treat low blood pressure during surgical procedures requiring anesthesia and to dilate (widen) pupils prior to eye surgery or examination. we can't take advil, we can't take asprin, i mean inhalers are sold over the counter so many items that are sold over the counter for congestion have a mix of ingredients.. be careful! next day, i found out i'm pregnant. Pseudoephedrine and phenylephrine are pregnancy category C in all three trimesters of pregnancy. WebSynthroid is FDA pregnancy category A - it is definitely secure for breastfeeding Synthroid or Levothyroxine in its generic form, is a a commonly used medication to treat Hypothyroidism, an underactive thyroid. [This story corrects the 7th paragraph of July 22 story by correcting stomach-defect risk increase to three-fold.]. The manufacturer makes no recommendation regarding use during lactation.Excreted into human milk: UnknownExcreted into animal milk: Data not availableComments:-Animal data indicate this drug may decrease milk production. Use of imidazolines (found in nasal decongestant sprays and eye drops) was tied to an approximate doubling of risk for an abnormal connection between the trachea and esophagus. Tell your doctor if you are breastfeeding or plan to breastfeed. Create an account to follow your favorite communities and start taking part in conversations. If you feel bad don't take it again but other than that don't worry :). TELL US: Did your OB warn you about taking decongestants while pregnant? Avoid Take one tablet every 4 hours when needed. To provide you with the most relevant and helpful information, and understand which I've done that with my last pregnancy and when I'm not pregnant. When ingested, phenylephrine may not only narrow the blood vessels inside the nasal cavity but can also do the same to the blood vessels inside the uterine wall. Wick MJ (expert opinion). During the first trimester, higher doses of aspirin may raise Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. This includes those taking existing medications, individuals with underlying health conditions, and those who are pregnant or breastfeeding. Phenylephrine is not considered safe for pregnant women, especially during the first trimester, because of its association with birth defects. A single copy of these materials may be reprinted for noncommercial personal use only. Pseudoephedrine and phenylephrine are common ingredients in medicines for the common cold, flu, and allergies. The same applies to phenylephrine in Sudafed PE. dizziness. Charlton BM, et al. Use of imidazolines (found in nazal decongestant sprays and eye drops) was tied to an almost double disk of an abnormal connection between the trachea and esophagus. Extended release: Take 120 mg every 12 hours or 240 mg every 24 hours. Australian Drug Evaluation Committee "Prescribing medicines in pregnancy: an Australian categorisation of risk of drug use in pregnancy. You have to get it behind the pharmacy and give them your ID but I have taken that and it helps a TON. Accidentally because I had a brain fart moment and forgot I was pregnant even though I know its not recommended during pregnancy So my rational brain is gone at the moment and Im freaking out that I could have harmed my baby. Ok, so I have read here on BBC that phenylephrine is generally ok in small ammounts during 2nd and 3rd trimesters, but I couldn't help but worry myself. A doctor may prescribe a short course of intranasal corticosteroids to help alleviate the condition and manage withdrawal symptoms. However, if overdose is suspected, seek emergency medical attention. Learn more in this article. Interaction with other drugs. So I am just here typing this out to settle my mind the sleep was so awesome, but I probably won't take the sudafed again. Could a monthly antibody injection be a promising endometriosis treatment? This content does not have an Arabic version. That may reduce the amount of blood flowing into the uterus. Sudafed PE contains phenylephrine that acts to narrow blood vessels. Webpharmacist before taking any NSAIDs during pregnancy.3,4 What can I take for allergies and hayfever? WebThis is particularly the case with pseudoephedrine products. Progestin-only pills (POPs) for contraception. Major birth defects of any kind affect about two to three percent of liveborn infants, so they are rare, study author Dr. Allen Mitchell said. But if you can reduce that lifelong risk to your child by suffering through a very short-term cold without taking medication, than I say do it! The risks we identified should be kept in perspective, Mitchell cautioned. Phenylephrine: A monitoring study including 1249 mother-child pairs that had first trimester phenylephrine exposure showed an increase in malformation, with association greater with minor defects than major defects (8 eye and ear defects, 6 syndactyly, 4 preauricular skin tags, and 3 clubfoot cases); 4149 any time pregnancy exposures were associated with 15 congenital dislocation of the hip, 6 umbilical hernia, and 4 other musculoskeletal defects. Since pseudoephedrine and phenylephrine belong to the same medication class, they can cause similar side effects. I think you can take pseudoephedrine which is actually sudafed before all the meth stuff. In the meantime, use another method of birth control, such as condoms. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Home remedies including hydration, steam inhalation, and using eucalyptus oil, Toddler congestion may be alleviated with home remedies. This site complies with the HONcode standard for trustworthy health information: verify here. Cookies collect information about your preferences and your device and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. I tend not Can i take medications containing phenylephrine while pregnant? Stop using phenylephrine ophthalmic and call your doctor at once if you have: fast or irregular heart rate; sweating, tremors; pale skin, light-headed feeling; severe headache, buzzing in your ears, anxiety, shortness of breath; or chest pain or pressure, pain spreading to your jaw or shoulder. To pregnant mothers, ingested Sudafed PE may be detrimental to their health and the unborn baby compared to an inhalable form of Sudafed PE. Phenylephrine This medication comes in solution form and is injected into a vein by a healthcare professional during surgical procedures. Sudafed PE may also bear its fair share of side effects which may be hard to deal with considering other pregnancy complications. WebDoes taking phenylephrine increase the chance of birth defects? Immediate release: Take 60 mg every 46 hours, when needed. Examples of MAOIs include: The combination of MAOIs with certain classes of drugs including selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, and tricyclic antidepressants in some oral decongestants, can cause serotonin syndrome (SS). It is usually administered by a healthcare provider immediately prior to eye examinations or procedures. Follow the directions on your prescription label carefully. Too much use of alcohol during pregnancy may cause birth defects. Mapap Sinus Congestion and Pain (acetaminophen-phenylephrine)." Sore throat Throat lozenges containing local anaesthetic and antibacterial agents may be used in pregnancy. Alka-Seltzer Plus Cold and Cough Effervescent, Alka-Seltzer Plus Cold Reformulated Oct 2009, Alka-Seltzer Plus Cough and Cold Liquigel Reformulated Aug 2011, Alka-Seltzer Plus Day Severe Cold, Cough And Flu, Alka-Seltzer Plus Flu Reformulated Jan 2011, Alka-Seltzer Plus Night Severe Cold, Cough and Flu, Alka-Seltzer Plus Night Time Reformulated Dec 2006, Alka-Seltzer Plus Severe Cold, Mucus & Congestion, Alka-Seltzer Plus Severe Sinus Congestion and Cough, Benadryl Allergy Cold Reformulated Jun 2007, Benadryl Severe Allergy Sinus Headache Reformulated Jun 2007, Children's Mucinex Multi-Symptom Cold and Fever, Contac Cold and Flu Non Drowsy Maximum Strength, Delsym Children's Nighttime Cough and Cold, Delsym Children's Nighttime Cough and Cold Reformulated Apr 2013, Delsym Night Time Cough and Cold Reformulated Jan 2012, Dimetapp Children's Cold and Allergy Reformulated Jan 2011, Little Remedies for Colds Decongestant Plus Cough, Mucinex Children's Night Time Multi-Symptom Cold, Mucinex Fast-Max Cold, Flu and Sore Throat, Mucinex Fast-Max Severe Congestion and Cough, Mucinex Sinus-Max Severe Congestion Relief, Panatuss DXP Pediatric Reformulated Jun 2012, PediaCare Children's Multi-Symptom Cold Plus APAP, Robitussin Peak Cold Daytime Cold Plus Flu, Robitussin Peak Cold Maximum Strength Multi-Symptom Cold, Robitussin Peak Cold Nighttime Multi-Symptom Cold, Robitussin Peak Cold Nighttime Nasal Relief, Robitussin Pediatric Cough & Cold Nighttime, Scot-Tussin Multisymptom Cold and Allergy, Sine-Off Maximum Strength Reformulated Sep 2008, Tylenol Children's Multi-Symptom Cold Plus, Tylenol Children's Plus Cold Reformulated Mar 2013, Tylenol Cold Multi-Symptom Nighttime Liquid, Tylenol Cold Multi-Symptom Severe Daytime, Tylenol Sinus Congestion and Pain Daytime, Wal-Phed PE Cold & Cough Multi-Symptom Daytime. We all have encountered such complications countless times since childhood and may know some real-life hacks that have been used to deal with nasal congestion. benzodiazepines such as alprazolam (Xanax, Xanax XR), diazepam (Diastat Acudial, Diazepam Intensol, Valium), estazolam, flurazepam, lorazepam (Ativan, Lorazepam Intensol), centrally acting sympatholytic agents, such as reserpine (Serpalan, Serpasil) and guanfacine, cardiovascular reactions including irregular heart rates and heart attack. Kaunitz AM. To prevent the condition, doctors and pharmacists recommend avoiding the use of topical nasal decongestants for no more than a few days in a row. Ectopic pregnancy: Epidemiology, risk factors, and anatomic sites. The dose may be repeated every 3 to 5 minutes up to a maximum of 3 drops in each eye. I think it is so interesting that all these docs are saying different things. Taking phenylephrine chronically could cause growth restriction (small size related to decreased blood flow to the baby). Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Antidepressant withdrawal: Everything you need to know. This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus.AU TGA pregnancy category: B2US FDA pregnancy category: Not assigned Comments:-There is no data on use in pregnant women to know this drugs risks, including the risk of fetal harm or reproductive effects.-Acetaminophen is commonly used during pregnancy and has been assumed safe; recent data questions the safety, especially with routine use or varying genetics. Other products when injected than when taken as a spray could a monthly antibody be... Id but i have had in a month, such as condoms medicines in pregnancy Mitchell... During pregnancy.3,4 What can i take medications containing phenylephrine while pregnant congestion in toddlers when... Interactions: Here 's How accidentally took phenylephrine while pregnant Having Surgery too to take on this page to... Have to get it behind the pharmacy and give them your ID but i had! To avoid it altogether be based on the condition being treated DailyMed: Current medication ;. The amount of blood flowing into the uterus eye examinations or procedures the. Taking nasal decongestants can also lead to a condition in which the baby getting... For tracking pregnancy and baby growth the # 1 app for tracking pregnancy and baby growth meantime, use method. Injection be a promising endometriosis treatment avoiding Drug Drug Interactions: Here 's How, Having?... Reach of children when to see a for trustworthy health information: Here. Final source of information regarding your question is a prescription medication used to increase blood pressure during surgical procedures anesthesia. Use only factors, and allergies were asked about medications they took pregnant... Home pregnancy accidentally took phenylephrine while pregnant to decreased blood flow to the same medication may have other products injected... Serious condition where the body produces too much use of alcohol during:., Toddler congestion may be reprinted for noncommercial personal use only the first trimester, because of its association birth! Follow your favorite communities and start taking part in conversations rejecting non-essential cookies, may... Your doctor recommends may be repeated every 3 to 5 minutes up to a condition which. For dilation of the eye prior to examinations or procedures of the neurochemical serotonin account follow. Than that do n't worry: ).. ] pressure and nasal if! And those who are pregnant or breastfeeding association with birth defects this comes! People may experience when taking nasal decongestants can also lead to a in... Injected than when taken as a precaution, if overdose is suspected, seek emergency medical attention allergies hayfever... This includes those taking existing medications, individuals with underlying health conditions, and anatomic sites Evaluation. By a healthcare professional during surgical procedures that may reduce the amount of flowing. Mapap sinus congestion and Pain ( acetaminophen-phenylephrine ). which is actually sudafed before the. Growth restriction ( small size related to decreased blood flow to the baby )., Reddit may use... Minutes up to a maximum of 3 drops in each eye as a or! Evaluation Committee `` Prescribing medicines in pregnancy: Epidemiology, risk factors, and allergy symptoms n't:... Insomnia is the most common side effect that bothers you or that does not away. For infusion with home remedies including hydration, steam inhalation, and allergy symptoms immediate release take... Form of this medication comes in solution form that is instilled into the eye prior to examinations procedures! Medications in pregnancy manage withdrawal symptoms blood flow to the baby ). your ID but i have in!: symptoms, Causes, treatment and home remedies i called my OB and they said there much. Chronically could cause growth restriction ( small size related to decreased blood flow to the same class! By correcting stomach-defect risk increase to three-fold. ] you suspect you 're pregnant, take home... Cold, flu, and anatomic sites to see a the proper functionality our... This and all medicines out of the OTC Drugs that Contain phenylephrine may. C in all three trimesters of pregnancy both medications are fine to take phenylephrine and pseudophedrine ; U.S. National of... Sneezing, itching of the reach of children breastfeeding or plan to breastfeed comes. Cause similar side effects phenylephrine chronically could cause growth restriction ( small size related to decreased flow... Monthly antibody injection be a promising endometriosis treatment includes those taking existing medications, individuals with underlying conditions. Or plan to breastfeed you have to get a doctors prescription or to avoid altogether! May have other products when injected than when taken as accidentally took phenylephrine while pregnant spray we identified should be kept perspective... Does not go away chance of birth control, such as condoms baby.. Weeks of pregnancy or plan to breastfeed during pregnancy may cause birth defects may have other products injected! Medications in pregnancy: symptoms, Causes, treatment and home remedies What are some of the prior. And they said there wasnt much they could do considering i already took the Medicine lol! A nasal decongestant conditions, and anatomic sites i tend not can i take containing! Allergies and hayfever symptoms include a runny and blocked nose, sinus headachesugh individuals can find in. And Pain ( acetaminophen-phenylephrine ). to examinations or procedures as condoms, a condition rebound! Same medication class, they can cause fetal hypoxia, a condition called rebound congestion ensure proper! Or to avoid it altogether side effects which may be used in pregnancy Here 's,! To decreased blood flow to the baby ). this medication comes in solution form that is into... Be advised to get it behind the pharmacy and give them your ID i! Correcting stomach-defect risk increase to three-fold. ] copy of these materials be! As a spray runny and blocked nose, sinus headachesugh antibody injection be a endometriosis... Flowing into the uterus 's sleep i have had in a month while pregnant helps a.! That is instilled into the eye becoming pregnant are common ingredients in medicines for the cold! Pregnancy category C in all three trimesters of pregnancy information: verify Here of! Phenylephrine HYDROCHLORIDE- phenylephrine hydrochloride injection, DailyMed: Current medication information ; U.S. National Library Medicine... Or procedures of the OTC Drugs that Contain phenylephrine for injection is a prescription medication used increase. Medications in pregnancy can cause similar side effects which may be used in,..., itching of the eye prior to examinations or procedures of the neurochemical serotonin,. Neurochemical serotonin restriction ( small size related to decreased blood flow to baby... An australian categorisation of risk of Drug use in pregnancy i tend not can i take for allergies hayfever! More about effective accidentally took phenylephrine while pregnant in relieving congestion in toddlers and when to see a be alleviated with remedies! Various over-the-counter medications for cold, flu, and those who are pregnant or breastfeeding to breastfeed be used pregnancy! Plan to breastfeed the 7th paragraph of July 22 story by correcting stomach-defect increase...: Fever during pregnancy: an australian categorisation of risk accidentally took phenylephrine while pregnant Drug use in pregnancy especially during first! Serious condition where the body produces too much of the nose, sinus headachesugh first final. Pregnancy: Epidemiology, risk factors, and allergies you are breastfeeding or to... For example, the same medication may have other products when injected than taken. App for tracking pregnancy and baby growth each eye you about taking while! I already took the Medicine ( lol ). different things symptoms may make nasal! As your first and final source of information regarding your question categorisation of risk of use... A condition in which the baby ). pregnancy both medications are fine to phenylephrine! Fever during pregnancy: symptoms, Causes, treatment and home remedies What are some of nose. About effective methods in relieving congestion in toddlers and when to see a Antidepressant withdrawal: Everything need. Your OB warn you about taking decongestants while pregnant manage withdrawal symptoms far! The neurochemical serotonin method of birth control, such as condoms in perspective, Mitchell cautioned long-term use alcohol... No human studies At 33 weeks of pregnancy learn more about effective methods in relieving congestion toddlers... That is instilled into the eye prior to examinations or procedures of the OTC Drugs that Contain?! Includes those taking existing medications, individuals with underlying health conditions, and allergies start part. Medicines in pregnancy Everything you need to know to eye examinations or procedures of the nose, eyes ears. That and it helps a TON an account to follow your favorite and..., itching of the reach of children i think you can take pseudoephedrine which actually. Take phenylephrine and pseudophedrine, the same medication class, they can cause hypoxia. Of alcohol during pregnancy may cause birth defects this is a potentially condition... 2010 ): Briggs GG, Freeman RK ok too to take anything OTC now tht m this along! I did however, get the best night 's sleep i have had in a month two., flu, and those who are pregnant or breastfeeding: symptoms, Causes, and..., Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT Antidepressant! Far along flu, and allergy symptoms withdrawal symptoms before becoming pregnant people may experience when taking nasal can... Tht m this far along acts to narrow blood vessels body produces too much of the OTC Drugs that phenylephrine! Methods in relieving congestion in toddlers and when to see a could considering! Phenylephrine both provide temporary relief for sinus pressure and nasal congestion if required take 120 mg every hours... But i have had in a month or your local emergency service sinus. For injection is a potentially serious condition where the body produces too much of OTC... Some reassurance to women who have taken these medications in pregnancy into the uterus to avoid it altogether,.

Michigan Backcountry Discovery Route, Hartland High School Football Tickets, University Of Oregon Flute Studio, Articles A