10 over-the-counter drugs to avoid during pregnancy

Mothers-to-be get headaches and upset stomachs just like everyone else. So it’s not surprising that most pregnant women have used over-the-counter medications. In fact, some data suggest that, overall, women are actually more likely to use certain medications—including cough and cold drugs and acetaminophen (Tylenol, generic)—after they become pregnant.

“There’s a misperception that if a drug is available over-the-counter, that it’s approved by the Food and Drug Administration, so it must be safe for everyone, including pregnant women,” Allen Mitchell, M.D. professor of pediatrics and epidemiology at the Boston University School of Public Health and Medicine, said. “Even doctors may think this is the case.” But some OTC drugs have been shown to pose risks to the developing fetus at different stages of pregnancy.

To help you and your doctor make more informed choices about which medications to take, we’ve identified 10 common ingredients used in OTC drugs that are risky for pregnant women, as well as safer alternatives.

Even then, you should use alternatives judiciously, and only as advised by your health care provider. Experts refer to safer medications because for 98 percent of prescription and OTC drugs, there simply isn’t enough data to say for sure that a drug is entirely safe to take during pregnancy. Due to ethical concerns, most FDA-approved medicines have not been tested in pregnant women.

For example, acetaminophen has long been considered a safer way for pregnant women to reduce fever and alleviate pain than nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil and generic), and naproxen (Aleve and generic.) But children whose mothers use the pain reliever during pregnancy may be at higher risk for asthma, behavior problems, and attention deficit disorder, according to preliminary research.

“For women who use acetaminophen only occasionally, the risk appears to be quite small,”  Mitchell said. But frequent use—more than three times a month throughout pregnancy—may be cause for more concern, according to Mitchell. So, while it’s reasonable to treat a fever or the occasional severe headache with medication, women who find themselves needing to take a pain reliever several days in a row or more than once every few weeks should consult their providers to help find and address the underlying cause of their symptoms.

Bottom line: If you are pregnant or may become pregnant, you should be extremely cautious about anything you take, including OTC and prescription medications, and all vitamins, supplements, and herbals.

• Try nondrug measures. For complaints commonly handled by OTC products, nondrug measures can help alleviate symptoms without the risk. For example, stress busters such as massage, meditation, relaxation exercises, or even a walk around the block, can help with tension headaches. And rest, fluids, and chicken soup are a much safer way for pregnant women to deal with symptoms of a cold than antihistamines and decongestants.
• Consult your healthcare provider. Don't take anything without first discussing it with your practitioner. “There are trade-offs with OTC products,” Mitchell said. “You have to balance your need to take something with any possible risks.”
• Avoid combination products. Multi-symptom cold and allergy medications typically contain ingredients from the “off-limits” list. For example, while Tylenol pain reliever (acetaminophen) is relatively safe for occasional use during pregnancy, Tylenol Sinus Congestion and Pain and Tylenol Cold Multi-Symptom liquid contain the decongestant phenylephrine, which is not.
• Read labels. Ingredients such as alcohol and caffeine turn up in surprising places. For example, Vick’s Nyquil Cold & Flu Liquid contains alcohol. And CVS Aspirin-Free Tension Headache, is indeed, free of aspirin, but still contains caffeine.

An Internet search will turn up lots of websites with advice on “safe medications to use during pregnancy.” But the advice is inconsistent and recommendations are often based on a lack of data, rather than evidence for safe use according to a study of Web-based information published in 2013.

For up-to-date, reliable information, we recommend www.MotherToBaby.org, the consumer website of the Organization of Teratology Information Specialists, a nonprofit organization dedicated to providing evidence-based information on medications and exposures to other substances during pregnancy and while breastfeeding. You can also call toll-free at 1-866-626-6847 to talk to an information specialist free of charge.

Note: This chart does not list every drug that is unsafe to take during pregnancy. Always talk to your healthcare provider before taking any drug or supplement.

Information from Briggs GG, Freeman RK, Yaffe SJ eds. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 9th ed. Wolters.

1. Low-dose aspirin (40 to 150 mg daily) may be prescribed for certain conditions associated with pregnancy such as gestational high blood pressure and pre-eclampsia.

2. Sold behind the counter without a prescription.