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OTC Medication Use In Pregnancy: Wise or Worrisome?

Medically reviewed on Jun 21, 2013 by L. Anderson, PharmD

How Should I Approach Medication Use in Pregnancy?

There will be times in your pregnancy when you simply don't feel well - you may have a headache, cold, allergy or backache - and you wonder if it's safe to take the same medications you took before you became pregnant. It is important to talk to your doctor before you take any medication - prescription, over-the-counter, herbal or vitamin supplement, during pregnancy.

Women who are just starting to plan a pregnancy should discuss the need for medications with their doctor beforehand. For women with chronic conditions such as asthma, epilepsy or heart conditions, medication may need to be continued throughout pregnancy.

Can I Take My Regular Medications in Pregnancy?

Ask your doctor as soon as possible about your regular medications before you make any changes. Many woman can and should continue their medications for chronic conditions during pregnancy, but each decision is made on a case-by-case basis. Your doctor can weigh the risk and benefits of continuing your medicine in pregnancy.

For some conditions, such as asthma or epilepsy, the risk of NOT taking the medicine might be more harmful to you or your baby than the risk of continuing the medication.

How Common is Medication Use During Pregnancy?

Statistics show that medication use during pregnancy is surprisingly common. Prescription drug use in the first trimester has increased by over 60 percent in the last 30 years. In addition, use of four or more medications in the first trimester tripled.

This raises concern as some medications used during organogenesis (the time period of organ development in the first 12 weeks) can be associated with developmental abnormalities. Although animal studies can provide some information about drug toxicity in pregnancy, these results cannot be safely extrapolated to humans.

What Do the FDA Pregnancy Risk Categories Mean?

About 10 percent of birth defects result from drug exposure in pregnancy. The FDA has established pregnancy risk categories of A, B, C, D or X. Category A is associated with the least risk in pregnancy, while category X is contraindicated (do not use).

Most drugs fall in category C, meaning either animal studies reveal adverse effects on the fetus and there are no controlled studies in women; or studies are not available. Drugs in category C should be given only if the benefit to the mother justifies the potential risk to the fetus as determined by a physician.

Aren't All Drugs Tested for Safety in Pregnancy?

No. The safety of many drugs in pregnancy are not known because pregnant women are excluded from drug research studies due to safety concerns for the unborn baby. However, drug companies may be required to set up pregnancy registries that collect information about women who have used certain medications during pregnancy. Using this data, a research study can outline the benefit-to-risk of using the drug in pregnancy. Health care professionals can look at this published literature to better determine a drug's safety in pregnancy, and compendiums can be published with the available data.

Is Tylenol Safe?

Acetaminophen (Tylenol) is a common over-the-counter (OTC) pain, headache and fever treatment routinely used in pregnancy. Studies have shown acetaminophen to be safe in pregnancy at recommended doses for short-term use. Concerns that acetaminophen may lead to ADHD in children have not been confirmed by the FDA. Acetaminophen has a Pregnancy Risk Category of B. Follow dosing directions, as high doses of acetaminophen can be toxic to the liver or kidney. Acetaminophen is found in many combination cough, cold and flu OTC medicines, so avoid excess dosing. Ask your doctor for advice on acetaminophen, if you have a concern.

Beware with Aspirin Use

Aspirin should be avoided in pregnancy unless specifically recommended by your doctor. Aspirin can interfere with blood clotting and can contribute to bleeding for both the mother and the baby, especially later in pregnancy or during birth. Aspirin used in the 3rd trimester can also lead to the premature closure of a vessel in a baby's heart that may lead to elevated lung pressure in the newborn. In some women, low-dose aspirin may be used for medical conditions, but only under the direct care a physician. If a medication for minor pain, headache or fever is required, acetaminophen (Tylenol) is usually a safer option.

My Back Aches: NSAID Safety in Pregnancy

Nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) are commonly found in OTC medications. Ask your doctor about NSAID use in pregnancy. Some birth defects as well as an elevated risk for miscarriage have been reported with NSAIDs, although the risk for birth defects with brief ibuprofen use early in pregnancy is reported as low.

NSAIDs should NOT be used in the third trimester of pregnancy unless specifically prescribed by your doctor. Like aspirin, NSAIDs may interfere with the closure of the ductus arteriosis in the baby's heart. Acetaminophen is the pain and fever reliever of choice in pregnancy.

Drug Use in Pregnancy: Cough Suppressants

Pregnant women may be more prone to colds and flu because their immune system is slightly lowered in pregnancy. Studies have not found an association between dextromethorphan (Delsym) and an increased risk of birth defects, and it's use has been noted as compatible with both pregnancy and breastfeeding. However, the manufacturer assigns a pregnancy risk category of C to dextromethorphan, meaning it should be given only if the benefit to the mother justifies the potential risk to the fetus. Ask your doctor.

Cough lozenges are safe, or a soothing drink of honey, lemon and warm water may help.

The Stuffy Nose and Pregnancy: What to Do?

Pseudoephedrine and phenylephrine (Sudafed, Sudafed PE) are OTC medicines used to relieve nasal congestion caused by colds and hay fever. Decongestants can cause blood vessel narrowing and elevate blood pressure. It is best to avoid decongestants in pregnancy, although the risk for birth defects is low.

Alternatives to oral decongestants, like nasal saline solutions (Ayr) or a decongestant spray (Neo-Synephrine) may be safer options, but limit use of decongestant sprays to no more than 3 days in a row to prevent rebound congestion.

Caffeine: Can I Still Have My Latte?

Caffeine has not been linked to birth defects, but most health experts agree that moderate caffeine consumption in pregnancy is key, meaning roughly 200 to 300 milligrams (mg) of caffeine per day (1-3 eight oz. cups of coffee). There have been reports of an increased risk of miscarriage with higher caffeine doses (over 300 mg per day), especially if mixed with alcohol or smoking. Guarana is a caffeine-containing herbal supplement often found in energy drinks, and some medications may contain caffeine, too. Caffeine will cross the placenta and stimulate a baby the same way it does an adult.

General Use of Vitamin and Herbal Supplements

In general, it is best to avoid OTC herbal and dietary supplements in pregnancy. These products are not regulated by the FDA for safety and may have variable quality. Over-the-counter "natural" dietary supplements may contain unknown substances and few studies describing their use in pregnancy are available.

Prenatal vitamins that contain iron, calcium and folic acid are important in pregnancy, so don't skip those supplements. Regular over-the-counter supplements may not have the right dose of vitamins you need, so ask your doctor for recommendations.

It's Flu Season - Should I Get a Shot?

Certain vaccines are actually encouraged for pregnant woman. Vaccines that are inactivated (killed vaccines) may be given during pregnancy if needed. Vaccines that contain live viruses are not generally recommended. Suggested vaccines in pregnancy include the inactivated influenza shot, and the Tdap vaccine (tetanus toxoid, diphtheria toxoid and acellular pertussis). The FluMist nasal vaccine contains a live virus and should not be used.

If you're planning a pregnancy, talk to your health care provider beforehand about any vaccines you may need. Live vaccines should be given at least a month before attempting to get pregnant.

Is Any Amount of Alcohol Okay in Pregnancy?

There is no established safe level of alcohol (wine, beer, or liquor) you can drink during any trimester in pregnancy. Alcohol easily crosses the placenta. Studies have found higher rates of miscarriage, stillbirth, and birth defects with alcohol use during pregnancy.

Regular use or large amounts of alcohol during pregnancy can lead to Fetal Alcohol Syndrome, which can result in birth defects, and behavioral or learning problems. Be sure to check over-the-counter medication bottles for the presence of alcohol. If you are concerned about avoiding alcohol intake during your pregnancy, speak with a health care provider as soon as possible.

Pregnancy During Allergy Season

First generation OTC antihistamines such as diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton) are reported as compatible with pregnancy, and should be considered first if an allergy medicine is needed in pregnancy.

Loratadine (Claritin) is a nonsedating antihistamine also used to relieve the symptoms of seasonal allergies like sneezing, runny nose, and watery eyes. Clinical studies suggest loratadine has a low risk for birth defects, and may be used when the benefits to the mother outweigh the fetal risks of taking the drug.

Can I Use My Acne Medication?

Over-the-counter (OTC) topical acne treatments are medications applied directly to the skin. Common ingredients found in OTC acne medications include benzoyl peroxide, glycolic acid and salicylic acid. The OTC topical acne products do not appear to increase the risk for birth defects in pregnancy as so little of the medication gets through the skin to the baby. It is safe to breast feed while using these products, as long as the product does not come into contact with the baby.

Prescription Retin A, either taken by mouth (isotretinion) or used as a cream (tretinoin), should not be used in pregnancy due to the risk of birth defects.

Stomach Symptoms in Pregnancy

Stomach complaints, such as heartburn, gas, and constipation are common in pregnancy. Simethicone (Gas-X, Mylanta Gas), an antiflatulent for gas that is not absorbed into the bloodstream, is compatible with pregnancy. Heartburn is experienced by more than 50 percent of women in pregnancy. Lifestyle changes or calcium-based antacids (Tums) might be the best first choice, but the OTC acid blockers ranitidine (Zantac) or cimetidine (Tagamet HB) are low risk in pregnancy. Adequate fluids is always important to combat constipation, but both docusate sodium (Colace) and magnesium hydroxide (Milk of Magnesia) been determined to be compatible with pregnancy.

In the Outdoors: How to Stay Bug-Free.

If possible, avoid mosquitoes and ticks while you are pregnant. Insect repellents are important to help avoid serious diseases such as malaria, West Nile Virus, or Lyme Disease which may be dangerous to both the mother and baby. According to the CDC, insect repellents registered with the EPA, such as DEET, can be used on pregnant women. To minimize exposure, use the lowest concentration of DEET to provide protection only for the time spent outdoors. Cover up if preferred - wear long pants and sleeves and apply DEET to clothes instead of skin to minimize exposure.

Finished: OTC Medication Use In Pregnancy: Wise or Worrisome?

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