Which Medications Can I Take While Pregnant?

Wondering which tummy soothers and pain relievers you can take while pregnant? Here’s your medication safety cheat sheet for pregnancy.

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Illnesses, injuries, and good old aches and pains don't go away just because you're pregnant; in fact, they may even intensify. But your unpleasant symptoms may not be your only concern. Many pregnant people worry about how they can treat their symptoms and what medications are safe to take during pregnancy.

"One of the biggest things my pregnant patients are afraid of is ingesting something that may cause birth defects or negatively impact their baby's development," says Alane Park, MD, mother of two sons and co-author of The Mommy Docs' Ultimate Guide To Pregnancy and Birth. "The truth is that most medications are actually OK, and while you want to minimize drug use as much as possible, the consequences of not taking a medication usually outweigh any potential risk."

To get relief and feel more at ease throughout your pregnancy, read on to learn about which medications and pain relievers you can take while pregnant.

What Pain Relievers Can You Take During Pregnancy?

Speaking of pregnancy aches and pains, knowing which painkillers you can take during pregnancy is important. If non-drug options, rest, and cold compresses aren't doing the trick and you need a painkiller, a health care provider may recommend acetaminophen (Tylenol). In fact, it's one of the most commonly recommended over-the-counter (OTC) pain relievers during pregnancy.

Though Tylenol is generally considered safe during pregnancy, multiple studies suggest that acetaminophen may negatively impact childhood development, but more research needs to be done. For example, a 2022 study published in PLoS One found that prenatal exposure to acetaminophen was associated with attention and sleep problems at age 3.

That said, the American College of Obstetricians and Gynecologists (ACOG) says that many factors contribute to neurodevelopmental disorders, and there is no direct evidence supporting a direct correlation between acetaminophen exposure and fetal development.

So, they advise people not to be scared away from the pain reliever. Instead, as with all medication, they recommend using Tylenol only as needed, in moderation, and after consulting with a health care provider.

Pain Relievers to Avoid While Pregnant

The Food and Drug Administration (FDA) recommends avoiding drugs in the NSAID class after 20 weeks gestation, including:

  • Aspirin
  • Ibuprofen (Motrin, Advil)
  • Naproxen (Aleve)
  • Diclofenac
  • Celecoxib

These drugs pose a risk of rare but severe kidney problems in a fetus, leading to low amniotic fluid levels. Decreasing amniotic fluid levels in the third trimester means less cushioning for the baby and more pressure on its lifeline, the umbilical cord, says Dr. Park. After 30 weeks, NSAIDs can also contribute to fetal heart issues.

What Constipation Medications Can You Take During Pregnancy?

Pregnancy constipation is common. In fact, some studies have found that as many as 40% of people experience constipation while pregnant.

If you're feeling a little plugged up, blame it on a surge in the hormone progesterone that slows down your smooth muscle cells so your bowel movements aren't as regular. (Or blame it on your growing uterus for pushing on your intestines.)

For constipation, there are some medications you can take while pregnant, but you may want to try diet and lifestyle modifications first. For example, try upping your fiber intake by eating more fruits and veggies and drinking plenty of fluids. With a health care provider's approval, exercise can also help to keep constipation at bay.

A health care provider might give the green light for certain constipation medications, such as stool softeners like docusate sodium (Colace), non-stimulant laxatives like polyethylene glycol (Miralax), bulk-forming fiber supplements like psyllium fiber (Metamucil), or some over-the-counter magnesium.

There is limited data to support the safety and effectiveness of constipation medication during pregnancy. That said, a 2015 Cochrane Review found that stimulant laxatives are more effective but produce more abdominal discomfort than bulk-forming laxatives. In addition, fiber supplementation may increase how frequently you poop. Since the evidence is unclear, talk to a health care provider about which constipation treatment options are best for you during your pregnancy.

What Heartburn Medicines Can You Take During Pregnancy?

Reflux affects up to 80% of pregnant people. Progesterone is the culprit again, causing heartburn by affecting your smooth muscle cells and relaxing the sphincter between your stomach and esophagus so acid comes up. (And your growing uterus also pushes on your stomach to add to the heartburn.)

Fortunately, most first-line treatments, including antacids, alginates, and sucralfate are usually safe to take during pregnancy. According to researchers, most heartburn medicines are FDA category B drugs, meaning there are no adequate human studies, but animal studies have found no risk to a fetus. However, there are some riskier heartburn drugs that should be avoided.

Heartburn medicines that are safer

Studies have found the following are safer heartburn medications to take while pregnant:

  • Antacids containing aluminum salts or calcium carbonate such as Tums or Rolaids
  • Alginates such as Gaviscon
  • H2 blockers such as Pepcid AC (famotidine) and Zantac (ranitidine)
  • Some prescription medications such as sucralfate

While calcium-containing antacids are generally considered safe during pregnancy, avoid overdoing it, as excess calcium can lead to calcium-alkali syndrome, resulting in loss of kidney function.

Heartburn medicines to avoid

According to researchers, you may want to avoid the following OTC heartburn medications while pregnant:

  • Antacids with magnesium trisilicate, which are associated with heart, respiratory, poor muscle tone, and kidney problems
  • Antacids with sodium bicarbonate, which are associated with fluid overload
  • Nizatidine, which has been found to be teratogenic (resulting in birth defects) in animal studies
  • Proton pump inhibitors (PPIs) such as Prilosec (omeprazole), which is a Category C drug due to risks found in animal studies

Some PPIs are category B drugs; however, health care providers usually reserve these medications for those with GERD complications or who are not responding to other therapies.

Lifestyle changes to try first

When it comes to heartburn, health care providers often suggest lifestyle changes before turning to medications. For example, many people find that the following helps with pregnancy heartburn:

  • Eating smaller and more frequent meals
  • Avoiding eating two to three hours before you lay down
  • Steering clear of rich, fried, or spicy foods
  • Sleeping on an incline

What Antibiotics Can You Take During Pregnancy?

Antibiotic use is pretty common during pregnancy. Studies have found that antibiotics account for 80% of prescription use in pregnancy, and up to a quarter of pregnant people take an antibiotic during pregnancy.

If you have a bacterial infection that calls for antibiotics, such as a urinary tract infection (UTI), rest assured that there are antibiotics you can take while pregnant. Since untreated bacterial infections, like UTIs and some STIs, run the risk of miscarriage, prematurity, and low birth weight, it is safer to take antibiotics to treat the infection than not.

Safer antibiotics

Health care providers prescribe antibiotics during pregnancy based on the potential risks based on the FDA drug category. Fortunately, many common antibiotics are category B, meaning they are generally considered safe during pregnancy. Some of these include:

  • Penicillins
  • Azithromycin
  • Erythromycin
  • Clindamycin

"There have never been any birth defects associated with the penicillin family or any other issues," says Dr. Park.

Antibiotics to avoid

Health care providers may also prescribe category C drugs if a category B drug doesn't treat the infection or the benefits outweigh the risks. However, you'll want to avoid category D drugs, which have shown risks to the fetus in animal studies. Some of these include:

  • Aminoglycosides
  • Tetracycline
  • Minocycline
  • Doxycycline
  • Tigecycline

Discuss the risks and benefits of antibiotics with a health care provider. Most antibiotics probably pose far fewer risks than the effects of an untreated illness or infection.

What Antifungal Medications Can You Take During Pregnancy?

If you have a yeast infection during pregnancy, you can likely take antifungal medications under the guidance of a health care provider. "There is some absorption of vaginal creams into the body and bloodstream, but doses are low, and no studies show any effect on baby," says Dr. Park.

Topical antifungals

Studies have found the following as safer first-line topical antifungals during pregnancy:

  • Clotrimazole
  • Miconazole
  • Nystatin

Researchers recommend avoiding econazole in the first trimester and using sparingly in the second and third trimesters. Ketoconazole is likely safe but should be used in limited areas and for a short period of time.

Oral antifungals

Oral medications are a different story, though. The Food and Drug Administration (FDA) changed the classification of fluconazole (Diflucan) from Category C to Category D due to the risk of birth defects with high doses of this medication. However, the medication remains a Category C for single low doses of the medication.

Yeast infections are common during pregnancy, and while the condition won't harm the baby, the last thing you want to do is suffer through the itchy discomfort.

What Cold and Allergy Medicines Can You Take During Pregnancy?

If cold or allergy symptoms interfere with your ability to eat or sleep, it's normal to wonder whether you just have to suffer through. But according to Dr. Park, "Pretty much all of the over-the-counter meds for the common cold are thought to be safe."

The ingredients are the biggest thing to watch out for in cold and allergy medicines since many contain multiple active ingredients, including pain relievers. So, be sure any combination medicines you choose have a pain reliever you can take while pregnant such as acetaminophen.

"Rather than taking meds you don't actually need, target only the symptoms you want to treat by buying drugs for each of your specific concerns," says Dr. Park.

Safer cold and allergy medicines

An older 2008 review analyzed the safety of cold medicines and found most to be OK to take during pregnancy, including:

  • Dextromethorphan (Robitussin)
  • Chlorpheniramine (Chlor-Trimeton)
  • Guaifenesin (Mucinex)

For allergies, a health care provider might recommend:

  • Cetirizine (Zyrtec)
  • Diphenhydramine (Benadryl)
  • Loratadine (Claritin)

Sudafed (pseudoephedrine) has been associated with a slight increase in birth defects. So, the American College of Obstetricians and Gynecologists (ACOG) recommends avoiding it in the first trimester.

Vicks VapoRub (camphor/eucalyptus oil/menthol) is also safe to use on the skin; however, according to Poison Control, it can cause miscarriage when swallowed. So, be sure to wash your hands well after use.

Non-drug cold remedies

The safest way to ease the discomfort of colds during pregnancy is via non-drug remedies. Be sure to rest, drink lots of fluids—especially warm ones—and use a saline nasal spray to help relieve stuffiness.

What Antiviral Medicines Can You Take During Pregnancy?

The flu and COVID-19 vaccines are recommended during pregnancy. Since your immune system isn't as strong when you're pregnant, these viruses can hit you much harder—and even lead to pneumonia or death in extreme cases. That's why it's so important to get the vaccines.

Antivirals for flu

The Centers for Disease Control and Prevention (CDC) recommends treatment with Tamiflu (oseltamivir) or Relenza (zanamivir) for the flu in those in any trimester of pregnancy. These are Category C drugs because they have not been studied in pregnant people. However, due to the illness's risks, health officials believe the benefits of the medication outweigh the risks of not treating the infection.

"Tamiflu is thought to be safe for pregnant people, and the risks of skipping it are far greater than taking the meds," says Dr. Park. "That's because the baby's temperature is always going to be a degree higher than yours, so if you have a high fever, it may cause birth defects during early development stages and pre-term labor during later stages of pregnancy."

Antivirals for COVID-19

Similarly, due to the risk of COVID-19 during pregnancy, some health officials recommend considering antiviral therapy with Paxlovid (nirmatrelvir/ritonavir).

For example, the National Institutes of Health recommends pregnant people with an active COVID-19 infection discuss Paxlovid with a health care provider. Since the drug is newer, there is limited research, but animal model studies support its use in pregnancy.

What Medicines for Chronic Conditions Can You Take During Pregnancy?

If you take medication for preexisting health conditions, discussing whether they are safe during pregnancy is essential. You can take many prescription medications during pregnancy, but some are unsafe.

Some known medications linked to an increased risk of birth defects include:

  • Isotretinoin (Accutane)
  • Opioids such as such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, and morphine
  • Thalidomide (Thalomid)
  • Warfarin (Coumadin)
  • ACE inhibitors such as lisinopril (Zestril, Prinivil), benazepril (Lotensin), and enalapril (Vasotec)
  • Some antidepressants and antipsychotics like paroxetine (Paxil), fluoxetine (Prozac), and lithium
  • Some anticonvulsant medicines for seizures

Discuss which medications to continue during pregnancy at a preconception consultation with your OB-GYN or specialist. Suddenly stopping a drug during pregnancy may cause more harm than good, so discuss it with a doctor before making any medication changes.

The goal is always to give the minimum dosage necessary to keep your symptoms under control because there may be greater risks if you're affected by asthma or seizures than by the effects of taking those medications on the baby.

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Sources
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