10 Over-the-Counter Drugs to Avoid During Pregnancy

10 over-thecounter drugs
to avoid
during pregnancy
These surprising, safer alternatives
may be a better choice
1
September 2014
We were surprised to discover research suggesting that pregnant women may be more
likely to turn to over-the-counter (OTC) drugs to treat coughs and colds or aches and
pains than they might otherwise. Women may believe these drugs are safer to use,
while pregnant, than prescription medications.
In fact, many of the OTCs are not good choices for pregnant women. Yet we found
little reliable, clear information available about which ones are safe for a pregnant
woman to take and which she should avoid. The enclosed report, “10 over-the-counter
drugs to avoid during pregnancy,” is our answer to consumers’ need for better
information about these everyday medications.
The recommendations are based on our assessments of data from the Organization
of Teratology Information Specialists, a nonprofit organization that provides
evidence-based information on medications and exposures to other potential toxins
during pregnancy and while breast feeding.
Consumer Reports’ Best Buy Drugs consumer education program, from which this
report was developed, is housed in the Consumer Reports Health Ratings Center.
The program aims to help consumers understand the safety, effectiveness, and cost of
medications. We do not accept funding from any industry, including pharmaceutical
companies, and our staff (including writers and editors) does not have any relationships with industry. Because of our independence, consumers can be confident that
they are receiving unbiased advice, based on the best available evidence.
We hope you will find the article informative and share it with others who may
find it useful. We also look forward to hearing your feedback via email at
HealthImpact@cr.consumer.org.
Doris Peter, PhD
Director, Consumer Reports Health Ratings Center
Consumer Reports
Headquarters
101 Truman Avenue
Yonkers, New York 10703-1057
914-378-2000
2
10 over-the-counter drugs to
avoid during pregnancy
These surprising, safer alternatives may be a better choice
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.
to pose risks to the developing fetus at different stages of
pregnancy.
“There’s a misperception that if a drug is available overthe-counter, that it’s approved by the Food and Drug
Administration, so it must be safe for everyone, including
pregnant women,” Allan Mitchell, M.D. professor of pediatrics and epidemiology at the Boston University School
of Public Health and Medicine, said. “Even doctors can
fall for this idea.” But some OTC drugs have been shown
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.
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.
3
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.
Tension Headache, is indeed, free of aspirin, but still
contains caffeine.
“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—is 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.
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.
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.
Tips to consider before
taking an OTC drug
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
Where to find reliable
information on the web
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.
4
10 OTC drugs to avoid when you’re pregnant
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.
Consumer Reports
Recommendation
Possible Alternative
Drug
Found In
Aspirin
Bayer; Excedrin Migraine
Not recommended1
Tylenol (acetaminophen)
Bismuth Subsalicylate
Kaopectate; Pepto Bismol
Before 20 weeks:
Use with caution
After 20 weeks:
Not recommended
Imodium (loperamide)
Brompheniramine
Dimetapp Cold and Allergy
Before 36 weeks:
Use with caution
After 36 weeks (9th month):
Not recommended
Claritin (loratadine);
Zyrtec (cetirizine)
Caffeine
Anacin Regular Strength;
Excedrin Extra Strength;
Excedrin Migraine
Use with caution; To reduce
risk of miscarriage, do not
exceed 200 milligrams
daily, including caffeine from
coffee, tea, or soda.
None
Castor Oil
-----
Do not take
Unacceptable risk
Increase physical activity,
drink more fluids and
eat fiber-rich foods.
Consider psyllium- based
fiber supplements.
Chlorphen-iramine
Chlor-Trimeton;
Combination products: Advil
Allergy & Congestion Relief;
Alka-Seltzer Plus Cold
Formula; Dristan Cold
Before 36 weeks:
Use with caution
After 36 weeks (9th month):
Not recommended
Claritin (loratadine);
Zyrtec (cetirizine)
5
Drug
Found In
Consumer Reports
Recommendation
Ibuprofen
Advil, Motrin
Weeks 14 - 26
(2nd trimester):
Use with caution
Before 14 weeks & after
27 weeks (1st and 3rd
trimester):
Not recommended
Tylenol (acetaminophen)
Naproxen
Aleve
Weeks 14 to 26
(2nd trimester):
Use with caution
Before 14 weeks & after
27 weeks (1st and 3rd
trimester):
Not recommended
Tylenol (acetaminophen)
Nicotine
Cigarettes and all other
forms of tobacco; Nicorette
gum; Nicoderm CQ patches
Not recommended;
however the benefits of
gum or patches to help stop
smoking may exceed risks of
smoking during pregnancy.
None
Phenylephrine and
Pseudo-ephedrine
Products containing
Pseudo-ephedrine2:
Advil Cold & Sinus;
Claritin-D; Sudafed 12 Hour
Before 14 weeks
(1st trimester):
Not recommended
After 14 weeks
(2nd and 3rd trimester):
Use with caution
Drink plenty of fluids,
consider using steam
to relieve congestion,
avoid irritants like
tobacco smoke
Products containing
Phenylephrine:
Alka-Seltzer Plus Day;
Sudafed PE Pressure + Pain;
Tylenol Cold Multi-symptom; Vicks Dayquil Cold and
Flu Relief
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.
Possible Alternative
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.
6
Consumer Reports
James A. Guest, President, Consumer Reports
Chris Meyer, Vice President, External Affairs
Tara Montgomery, Senior Director, Consumer Reports Health
John Santa, Medical Director, Health Ratings Center
Doris Peter, Director, Health Ratings Center
Kristina Mycek, Statistician
Lisa Gill, Deputy Content Editor, Best Buy Drugs
Steve Mitchell, Associate Editor, Best Buy Drugs
Teresa Carr, Associate Editor, Best Buy Drugs
Ginger Skinner, Associate Editor, Best Buy Drugs
Kathleen Person, Project Manager
Lisa Luca, Web Editorial Associate
Health Impact
Dominic Lorusso, Director, Health Partnerships Development
Lesley Greene, Associate Director, Health Impact Programs
David Ansley, Senior Analyst, Health Product Development
Beccah Rothschild, Senior Outreach Leader, Health Partner Development
Pamela Austin, Senior Marketing Associate
Lane Rasberry, Wikipedian-in-Residence
Claudia Citarella, Senior Administrative Assistant
Health and Food Content Development
Nancy Metcalf, Senior Editor
Joel Keehn, Deputy Content Editor, Health and Food
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