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Naproxen / pseudoephedrine Pregnancy and Breastfeeding Warnings

Naproxen / pseudoephedrine is also known as: Aleve-D Sinus & Cold, Aleve-D Sinus & Headache, Sinus & Cold D, Sudafed 12 Hour Pressure+Pain

Medically reviewed by Last updated on Aug 3, 2020.

Naproxen / pseudoephedrine Pregnancy Warnings

Animal studies are not available for the combination product. There are no controlled data in human pregnancy.

Naproxen: Animals studies at 0.23 to 0.28 times the expected human dose showed no fetal harm or impaired fertility. An investigation of several nonsteroidal anti-inflammatories (NSAIDs), including naproxen, in mice found they induced cleft palate in mice. Naproxen crosses the placental barrier (molecular weight is about 230). A surveillance study with 1448 first trimester naproxen exposures did not support an association with major birth defects: 70 (4.8%) major birth defects occurred (62 expected). A combined population-based observational cohort and case control study found no association with NSAID use and congenital malformations, prematurity, or low birth weight, but a positive association with miscarriage, while a similar study showed association with cardiac defects and orofacial clefts. A 2003 study found significant association of early pregnancy NSAID exposure and miscarriage.

Pseudoephedrine: A monitoring study of 50, 282 mother/child pairs (3082 first trimester sympathomimetic drug exposures, 9719 any time pregnancy exposures) suggested a link to categories of minor malformations (non-life-threatening, no major cosmetic defects) including inguinal hernia and clubfoot. Pseudoephedrine may be associated with gastroschisis, but this may also be caused by maternal health factors. First trimester oral decongestant exposure or maternal smoking may increase the risk of gastroschisis, small intestinal atresia (SIA), and hemifacial microsomia.

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. Pregnancy categories A, B, C, D, and X are being phased out.

Avoid use during last trimester of pregnancy.

US FDA pregnancy category: Not assigned

-Nonsteroidal anti-inflammatory (NSAID) use, including naproxen use, during the first trimester may increase the structural anomaly (primarily cardiac/septal, but also oral cleft) and spontaneous abortion risk; absolute risk appears to be low.
-Third trimester NSAID use may cause premature closure of the ductus arteriosus, possibly leading to primary pulmonary hypertension of the newborn (PPHN).
-Use of NSAIDS as tocolytics increased the risk of neonatal complications (including necrotizing enterocolitis, patent ductus arteriosus, and intraventricular hemorrhage); the magnitude of the increase requires confirmation.
-Do not use late in the third trimester.
-Animal models indicate prostaglandin synthesis inhibitors (including naproxen) block blastocyst implantation; use is not recommended in patients attempting to conceive.

See references

Naproxen / pseudoephedrine Breastfeeding Warnings

Naproxen: One 5-month postpartum patient on 250 mg twice daily had peak milk levels of 1.1 to 1.3 mg/L (2.4 mg/L with 375 mg twice daily); peak occurred at 4 to 5 hours and fell slowly over 12 to 24 hours; estimated maximum intake from milk (exclusively breastfed infant) is about 2.2 to 2.8% of the maternal weight-adjusted dose.

The manufacturer makes no recommendation regarding use during lactation.

Excreted into human milk: Yes (naproxen, pseudoephedrine)

-Naproxen levels in milk are low and adverse effects appear uncommon.
-There is a case report of naproxen possibly causing prolonged bleeding time, thrombocytopenia, and acute anemia in a 7-day old; the parent was also on bacampicillin.
-Alternatives to naproxen during breastfeeding may be warranted based on possible bleeding time prolongation and naproxen's long half-life.
-A survey of 20 infants exposed to naproxen during breastfeeding had 2 reports of drowsiness and one report of vomiting in the infants, neither requiring medical care.
-The small amounts of pseudoephedrine (about 4.3 to 5.5% of maternal dose) may cause occasional irritability.
-A single pseudoephedrine dose acutely decreases milk production (average 24%); repeated use interferes with lactation.
-Do not use pseudoephedrine in patients with insufficient milk production or in those just establishing lactation.

See references

References for pregnancy information

  1. Briggs GG, Freeman RK. "Drugs in Pregnancy and Lactation. 10th ed." Philadelphia, PA: Wolters Kluwer Health (2015):
  2. "Product Information. Aleve-D Sinus & Cold (naproxen-pseudoephedrine)." Bayer Pharmaceutical Inc, West Haven, CT.

References for breastfeeding information

  1. United States National Library of Medicine "Toxnet. Toxicology Data Network. Available from: URL:" ([cited 2013 -]):
  2. "Product Information. Aleve-D Sinus & Cold (naproxen-pseudoephedrine)." Bayer Pharmaceutical Inc, West Haven, CT.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.