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10 over-the-counter drugs to avoid during pregnancy

Last updated: October 2008

Some of the best-known medicines from the local drugstore can be harmful to pregnant women, yet many mothers-to-be regularly take them. Studies show that, on average, women take between one and four medications during pregnancy, not including vitamins or minerals. An estimated 60 percent of pregnant women use over-the-counter drugs, not always with physician oversight.

To help you and your doctor make more-informed choices about which medications to take, we've identified 10 commonly used ingredients found in OTC drugs that are risky for pregnant women, and offer safer alternatives. For example, moms-to-be should not take castor oil and should avoid aspirin during all stages of pregnancy. During the first and second trimesters of pregnancy, they should use the following products with caution and avoid them entirely during their third trimester: bismuth subsalicylate (Pepto Bismol), chlorpheniramine (Actified, Chlor-Trimeton, and many other combination cold medicines), ibuprofen (Advil, Motrin), and naproxen (Aleve).

When choosing an OTC medicine, you'll need to be a careful label reader since brand names can be deceiving. For example, while acetaminophen (Tylenol) is considered relatively safe for use in pregnancy, some combination products that include the brand name "Tylenol," such as Tylenol Allergy Sinus Maximum Strength, contain chlorpheniramine.

Most medicines approved by the Food and Drug Administration are not tested on pregnant women because of ethical concerns. In fact, there is no pregnancy safety data for more than 80 percent of prescription and OTC drugs, making it extremely difficult for doctors and pharmacists to provide guidance. Currently, the FDA uses a rating system for more than 270 active ingredients in prescription and OTC drugs on a scale of A, B, C, D, and X. But in the coming months the FDA will no longer use that rating scale and instead will provide study data on how drugs affect pregnancy, lactation, and fetus development.

Pregnant women and women considering pregnancy should approach the use of all drugs (OTC and prescription) and dietary supplements with caution and use them only after discussion with their physician.

10 OTC drugs to avoid when your're pregnant

Drug	Found in	CR Recommendation	Possible Alternative
Aspirin	Excedrin Migraine	1st, 2nd, 3rd trimester: Not recommended	Tylenol (Acetaminophen)
Bismuth subsalicylate	Kaopectate; Pepto Bismol	1st, 2nd trimester: Use with caution 3rd trimester: Not recommended	Imodium (Loperamide)
Brompheniramine	Dimetapp Cold and Fever; Dimetapp Elixir	1st, 2nd trimester: Use with caution 3rd trimester: Not recommended	Claritin (Loratadine); Zyrtec (Cetirizine)
Caffeine	Excedrin Aspirin-Free; Excedrin Quicktabs	1st, 2nd. 3rd trimester: Use with caution CR Recommends: Do not exceed 200 milligrams per day to reduce risk of miscarriage	None
Castor Oil	—	1st, 2nd. 3rd trimester: Do not take—unacceptable risk	None
Chlorpheniramine	Chlor-Trimeton; Combination products: Actifed Cold and Allergy; Actifed Cold and Sinus; Alka-Seltzer Plus Cold Medicine; Dristan Cold; Sinutab Sinus Allergy Maximum Strength; Sudafed Cold and Allergy; TheraFlu Flu and Cold Medicine; Triaminic Cold and Allergy; Tylenol Allergy Sinus Maximum Strength; Tylenol Cold Mulit-Symptom Children's	1st, 2nd trimester: Use with caution 3rd trimester: Not recommended	Claritin (Loratadine); Zyrtec (Cetirizine)
Ibuprofen	Advil, Motrin	1st, 2nd trimester: Use with caution 3rd trimester: Not recommended	Tylenol (Acetaminophen)
Naproxen	Aleve	1st, 2nd trimester: Use with caution 3rd trimester: Not recommended	Tylenol (Acetaminophen)
Nicotine	All cigarettes; Nicorette gum; Nicoderm patches	1st, 2nd, 3rd trimester: Not recommended	None
Pseudoephedrine*	Actifed Cold and Sinus, Sudafed Nasal Decongestant, Triaminic AM Decongestant	1st trimester: Not recommended 2nd, 3rd trimester: Use with caution	Nondrug alternatives: Drink plenty of fluids, consider using steam to relieve congestion, avoid irritants like tobacco smoke