Over-the-Counter Medications
In addition to prescription medications, over-the-counter medications can become a concern during pregnancy. Just because you can buy a product over the counter doesn't necessarily mean it is safe for you to take during pregnancy. Many over-the-counter products can be used safely during pregnancy under your doctor's supervision, but many can also be unsafe. Extensive testing is required for any drug before it can be labeled safe for use during pregnancy. The FDA ranking system categorizes all drugs.
Comprehensive, evidence-based guidelines for determining the safety of over-the-counter medications during pregnancy are not yet available. Ideally, any woman taking medication during pregnancy would be under the supervision of her doctor. Over-the-counter medications should not be used unless the benefits clearly outweigh the risks. Take the best care of yourself by seeking prenatal care, eating a healthy diet, and being physically active to decrease your chances of becoming ill or developing such problems as constipation. Seek alternative methods of relieving headaches, pains, and other problems before taking an over-the-counter medication.
Pain Relievers
Since 1984, all over-the-counter drug products have carried this warning: “As with any other drug, if you are pregnant or nursing, seek the advice of a health professional before using this product.” In July 1990, the FDA issued an additional regulation requiring all oral and rectal nonprescription aspirin and drugs that contain aspirin to include this additional warning: “It is especially important not to use aspirin during the last three months of pregnancy unless specifically directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery.”
Aspirin is among one of the popular pain relievers. It is used for problems such as headaches, aches, pains, arthritis, and fevers. However, aspirin should not be taken during pregnancy unless specifically prescribed by your doctor. Aspirin may cause problems in the developing baby and complications during delivery and is classified as a category D in all three trimesters. Over-the-counter nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil or Motrin), ketoprofen (Orudis), and naproxen (Aleve) also carry a warning that they should be used with caution in the first and second trimester and avoided during the third trimester. Acetaminophen (Tylenol), a category B during the entire course of pregnancy, is the pain reliever of choice recommended by most doctors.
Just as important as what to take is how much to take. Always follow directions on the bottle or take as prescribed by your doctor. If an overthe-counter medication doesn't seem to do the trick, don't take more than directed without first speaking with your doctor. Only take overthe-counter medications as needed. If you have a headache, try lying down in a quiet place to see if you can relieve your headache before taking medication.
Decongestants, Expectorants, and Nonselective Antihistamines
Chlorpheniramine (Chlor-Trimeton), which falls in category B, is the antihistamine of choice for pregnant women. Also categorized as B is diphenhydramine (Benadryl), but it is suggested that you avoid this medication in your first trimester because it is known to cross the placenta. Clemastine fumarate (Tavist) has an unknown safety profile, even though it is classified as B. Pseudoephedrine hydrochloride (Novafed or Sudafed) is the oral decongestant of choice although oral decongestants should not be used unless absolutely necessary.
Topical nasal decongestants, such as oxymetazoline HCL (Afrin), can be recommended safely during pregnancy. Generally, patients should restrict their use to two to three sprays in each nostril twice a day for no more than three consecutive days. The cough suppressant Dextromethorphan hydrobromide (Benylin DM) appears to be safe during pregnancy. The expectorant Guaifenesin (Humibid L.A.) may be unsafe during the first trimester of pregnancy. Topical rubs such as Vicks Vapo Rub are safe during pregnancy.
Some cold medicines contain alcohol, so you should use these sparingly if at all. Many cold medicines also contain pain relievers that may not be recommended, so read labels and ask your doctor before taking them.
Antidiarrheal, Constipation, and Laxative Medications
Kaolin and pectin (Kaopectate) is the antidiarrheal medication of choice for pregnant women because it does not cross the placenta. Pepto Bismol is not recommended because it can cross the placenta. Atropine/ diphenoxylate (Lomotil) is also not recommended due to questionable animal studies. Imodium is probably safe, but it is not recommended during the first trimester.
Bulking agents to help relieve constipation, such as Metamucil and Citrucel, are safe to use. To help relieve constipation, dietary intake, fluids, and regular exercise should be considered as the first course of treatment. If medication is needed, psyllium and bisacodyl (Dulcolax) are both considered safe during pregnancy. Laxatives and stool-softeners that are safe to use include Colace, Dulcolax, and Milk of Magnesia. Hemorrhoid creams safe to use include Tucks, Preparation H, and Anusol.
Indigestion, Gas, and Upset-Stomach Medications
Several forms of antacids are available over the counter, including preparations that contain alginic acid, aluminum, magnesium, and calcium. All of these are generally regarded as safe to take during pregnancy. Antacids for acid indigestion or heartburn that are safe to take include Tums, Rolaids, Mylanta, and Maalox. For gas problems, Gas-X, Mylanta Gas, Mylicon, and Phazyme are considered safe. Histamine H2-receptor blockers are effective in treating symptoms of heartburn and gastroesophageal reflux disease in pregnancy, but most cross the placenta. Their use is not recommended unless lifestyle change and antacids are ineffective in controlling the symptoms. Tagamet and Zantac are generally recommended only after antacids are tried first. Axid is not recommended due to questionable animal studies, and Pepcid is probably safe but more data is needed.
