Over the Counter Medications
for Cold & Cough During Pregnancy
Charts reprinted with permission from U.S. Pharmacist
Pre-pregnancy, a cold or cough might not have stopped you in your tracks. You would stop by your local pharmacy and pick up an over-the-counter medication to help you get on with your day.
But now that you're pregnant, even a sniffle can cause more discomfort than before, especially since you might not be sure what you can - or can't - take. Of course, you should always check with your health care provider, but we have reprinted the following chart from U.S. Pharmacist to give you an overview on the safety of OTC medications during pregnancy.
| THERAPEUTIC CATEGORY | PREGNANCY CATEGORY | DOSAGE | POTENTIAL CONCERNS IN PREGNANCY
(Evaluate for contraindications
prior to use.) |
| Analgesics |
Acetaminophen
(Tylenol) | B | 325-1,000 mg (every 4-6 hrs - max 4,000 mg/day) | Preferred analgesic in pregnancy. |
NSAIDs
(multiple) | B (1st and 2nd triemsters)
D (3rd trimester) | Ibuprofen 200-400 mg every 4-6 hours (max 1,200 mg/day); naproxen 200 mg every 8-12 hours (max 600 mg/day); ketoprofen 12.5 mg every 6-8 hours (max 75 mg/day) | Avoid in first trimester.
Use smallest effective dose. |
| Salicylates |
Aspirin
(Anacin, others) | D | N/A | Not recommended unless under direct approval and supervision of physician. |
| Decongestants |
Pseudoephedrine
(Sudafed) | C | 30-60 mg every 4-6 hours (max 240 mg/day) | Oral decongestant of choice in pregnancy but avoid in first trimester. Possible link to gastroschisis. |
Oxymetazoline
nasal | C | 2-3 sprays per nostril every 10-12 hours (max 2 doses/day) | Nasal decongestant of choice in pregnancy. Avoid use for longer than 3 days. |
| Antitussive/Expectorant |
| Guaifenesin (Robitussin) | C | 200-400 mg every 4 hours (max 2,400 mg/day) | Avoid in first trimester.
Possible link to inguinal hernia.
Questionable efficacy. |
| Dextromethorphan (Robitussin CoughGels) | C | 10-20 mg every 4 hours (max 120 mg/day) | Unknown role of N-methyl-o-aspartate receptor antagonism on fetal brain growth.
Questionable efficacy. |
Antihistamines
(Avoid in third trimester due to possible link to retrolental fibroplasias and convulsions) |
| Brompheniramine (Dimetapp combination product) | C | 4 mg every 4-6 hours (max 24 mg/day) | Possible link to malformations. |
| Chlorpheniramine (ChlorTrimeton) | B | 4 mg every 4-6 hours (max 24 mg/day) | Antihistimine of choice in pregnancy. |
| Clemastine (Tavist) | B | 1.34 mg every 12 hours (max 2.68 mg/day) | Possible link to limb reduction defects. |
| Diphenhydramine (Benadryl) | B | 25-50 mg every 4-6 hours (max 300 mg/day) | Possible stimulation of uterine contractions at higher doses; possible like to polydactyly |
| Tripolidine (available in certain Actifed products) | C | 2.5 mg every 4-6 hours (max 10 mg/day) | Possible malformations due to triprolidine or combination with pseudoephedrine. |
| Miscellaneous |
| Menthol/Camphor | Unknown | N/A | Due to insufficient information, patient should contact physician prior to use. |
| Echinacea | N/A | N/A | Avoid use in pregnancy. |
| Zinc and Vitamin C | Acceptable in appropriate doses | N/A | For cough/cold treatment, doses are higher than the recommended doses used for vitamin supplementation (e.g., prenatal vitamins) Use with caution, if at all. |
What do those letters in 'Pregnancy Category' mean?
FDA Pregnancy Categories
| PREGNANCY CATEGORY | CATEGORY DESCRIPTION |
| A | Human: Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities in any trimester of pregnancy.
Animal: N/A |
| B | Human: No adequate, well-controlled studies in pregnant women AND
Animal: No evidence of harm to the fetus OR
Human: Adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester AND
Animal: Studies have shown an adverse effect. |
| C | Human: No adequate, well-controlled studies in pregnant women AND
Animal: Studies have shown an adverse effect OR
Human: No adequate, well-controlled studies in pregnant women AND
Animal: No studies have been conducted. |
| D | Human: Adequate, well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential rish. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective. |
| X | Adequate, well-controlled, or observational studies in animals pregnant women have demonstrated positive evidence of fetal abnormalities or risks. The use of the product is contraindicated in women who are or may become pregnant. |
From Pregnancy and OTC Cough, Cold, and Analgesic Preparations, posted 3/15/06 in U.S. Pharmacist.
Patricia Rozek Wigle, PharmD, BCPS Asst. Prof, Clinical Pharmacy Practice
Univ. of Cincinnati College of Pharmacy | Stacey M. McNeal, PharmD
Patient Care Pharmacist
Kroger Pharmacy Patient Care Ctr Cincinnati | Katie Tibbs, PharmD
Patient Care Pharmacist
Target Pharmacy, Cincinnati |
Again, always consult your health care practitioner
before taking any medication.
This chart has been provided for informational purposes only.
