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10 over-the-counter drugs to avoid during pregnancy

These surprising, safer alternatives may be a better choice

Last updated: June 2014

Mothers-to-be get headaches and upset stomachs just like everyone else. So it’s not surprising that most pregnant women have used over-the-counter medications. In fact, some data suggest that, overall, women are actually more likely to use certain medications—including cough and cold drugs and acetaminophen (Tylenol, generic)—after they become pregnant.

“There’s a misperception that if a drug is available over-the-counter, that it’s approved by the Food and Drug Administration, so it must be safe for everyone, including pregnant women,” Allen Mitchell, M.D. professor of pediatrics and epidemiology at the Boston University School of Public Health and Medicine, said. “Even doctors may think this is the case.” But some OTC drugs have been shown to pose risks to the developing fetus at different stages of pregnancy.

To help you and your doctor make more informed choices about which medications to take, we’ve identified 10 common ingredients used in OTC drugs that are risky for pregnant women, as well as safer alternatives.

Even then, you should use alternatives judiciously, and only as advised by your health care provider. Experts refer to safer medications because for 98 percent of prescription and OTC drugs, there simply isn’t enough data to say for sure that a drug is entirely safe to take during pregnancy. Due to ethical concerns, most FDA-approved medicines have not been tested in pregnant women.

For example, acetaminophen has long been considered a safer way for pregnant women to reduce fever and alleviate pain than nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil and generic), and naproxen (Aleve and generic.) But children whose mothers use the pain reliever during pregnancy may be at higher risk for asthma, behavior problems, and attention deficit disorder, according to preliminary research.

“For women who use acetaminophen only occasionally, the risk appears to be quite small,”  Mitchell said. But frequent use—more than three times a month throughout pregnancy—may be cause for more concern, according to Mitchell. So, while it’s reasonable to treat a fever or the occasional severe headache with medication, women who find themselves needing to take a pain reliever several days in a row or more than once every few weeks should consult their providers to help find and address the underlying cause of their symptoms.

Bottom line: If you are pregnant or may become pregnant, you should be extremely cautious about anything you take, including OTC and prescription medications, and all vitamins, supplements, and herbals.

Tips to consider before taking an OTC drug

  • Try nondrug measures. For complaints commonly handled by OTC products, nondrug measures can help alleviate symptoms without the risk. For example, stress busters such as massage, meditation, relaxation exercises, or even a walk around the block, can help with tension headaches. And rest, fluids, and chicken soup are a much safer way for pregnant women to deal with symptoms of a cold than antihistamines and decongestants.
  • Consult your healthcare provider. Don't take anything without first discussing it with your practitioner. “There are trade-offs with OTC products,” Mitchell said. “You have to balance your need to take something with any possible risks.”
  • Avoid combination products. Multi-symptom cold and allergy medications typically contain ingredients from the “off-limits” list. For example, while Tylenol pain reliever (acetaminophen) is relatively safe for occasional use during pregnancy, Tylenol Sinus Congestion and Pain and Tylenol Cold Multi-Symptom liquid contain the decongestant phenylephrine, which is not.
  • Read labels. Ingredients such as alcohol and caffeine turn up in surprising places. For example, Vick’s Nyquil Cold & Flu Liquid contains alcohol. And CVS Aspirin-Free Tension Headache, is indeed, free of aspirin, but still contains caffeine.

Where to find reliable information on the web

An Internet search will turn up lots of websites with advice on “safe medications to use during pregnancy.” But the advice is inconsistent and recommendations are often based on a lack of data, rather than evidence for safe use according to a study of Web-based information published in 2013.

For up-to-date, reliable information, we recommend www.MotherToBaby.org, the consumer website of the Organization of Teratology Information Specialists, a nonprofit organization dedicated to providing evidence-based information on medications and exposures to other substances during pregnancy and while breastfeeding. You can also call toll-free at 1-866-626-6847 to talk to an information specialist free of charge.

 

10 OTC drugs to avoid when you're pregnant

Note: This chart does not list every drug that is unsafe to take during pregnancy. Always talk to your healthcare provider before taking any drug or supplement.

Drug

Found in

Consumer Reports'

recommendation

Possible

alternative

Aspirin

Bayer; Excedrin

Migraine

Not recommended1

Tylenol

(acetaminophen)

Bismuth subsalicylate

Kaopectate; Pepto

Bismol

Before 20 weeks:

Use with caution

After 20 weeks:
Not recommended

Imodium

(loperamide)

Bromphen-iramine

Dimetapp Cold

and Allergy

Before 36 weeks:
Use with caution

After 36 weeks

(9th month):
Not recommended

Claritin (loratadine);

Zyrtec (cetirizine)

Caffeine

Anacin Regular

Strength; Excedrin

Extra Strength;

Excedrin Migraine

Use with caution; To reduce risk of miscarriage, do not exceed 200 milligrams daily, including caffeine from coffee, tea, or soda.   None
Castor Oil

    —

Do not take—

unacceptable risk

Increase physical activity, drink more fluids and eat fiber-rich foods. Consider psyllium- based fiber supplements.   
Chlorphen-iramine

Chlor-Trimeton; 

Combination

products: Advil Allergy & Congestion Relief;

Alka-Seltzer Plus Cold Formula; Dristan Cold

Before 36 weeks:
Use with caution

After 36 weeks

(9th month):
Not recommended

Claritin (loratadine);

Zyrtec (cetirizine)

Ibuprofen Advil, Motrin

Weeks 14 to 26

(2nd trimester):
Use with caution

Before 14 weeks

and after 27 weeks

(1st and 3rd trimester):
Not recommended

Tylenol

(acetaminophen)

Naproxen Aleve

Weeks 14 to 26

(2nd trimester):
Use with caution

Before 14 weeks

and after 27 weeks

(1st and 3rd trimester):
Not recommended

Tylenol

(acetaminophen)

Nicotine Cigarettes and all other forms of tobacco; Nicorette gum; Nicoderm CQ patches  

Not recommended;

however the benefits

of gum or patches to help stop smoking

may exceed

risks of smoking during pregnancy.

None
Phenylephrine and pseudo-ephedrine*

Products containing pseudo-ephedrine2: Advil Cold & Sinus; Claritin-D; Sudafed 12 Hour

 

Products containing phenylephrine: Alka-Seltzer Plus Day; Sudafed PE Pressure + Pain; Tylenol Cold Multi-symptom; Vicks Dayquil Cold and Flu Relief

Before 14 weeks: (1st trimester):
Not recommended

After 14 weeks (2nd and 3rd trimester):
Use with caution
Drink plenty of fluids, consider using steam to relieve congestion, avoid irritants like tobacco smoke  

Information from Briggs GG, Freeman RK, Yaffe SJ eds. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 9th ed. Wolters.

1. Low-dose aspirin (40 to 150 mg daily) may be prescribed for certain conditions associated with pregnancy such as gestational high blood pressure and pre-eclampsia.

2. Sold behind the counter without a prescription.

 

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
   

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