Non-prescription or over the counter medicines in pregnancy

Most women are aware that during pregnancy they need to avoid as many non-essential medicines as possible. Yet these same women are just as likely to suffer from minor conditions as anyone else, as well as being more likely to suffer pregnancy-related symptoms such as constipation or heartburn. So, should you have to smile and bear those headaches, coughs and colds? Or are there over-the-counter medicines that are actually safe to use in pregnancy?

The problem caused by medicines taken by the mother is that they can cross the placenta and enter the baby’s bloodstream. This is because the medicine particles are small enough to cross the placental barrier along with the nutrients needed for the baby’s development. The effect any medicine has on the developing baby depends on the medicine itself and the trimester of pregnancy the medicine is taken in.

How does a medicine affect the developing baby?

The trimester of pregnancy is often very important. Some medicines can be dangerous to take in the first three months but safe in the second or third, or vice versa.

  • The first trimester is the period of greatest risk for the baby. This is because during this stage the baby’s organs are developing. Medicines taken during this time have the potential to affect this development, which could result in malformations or birth defects. If a defect is very severe this could cause a miscarriage.
  • During the second trimester medicines can interfere with the development of the baby’s nervous system or with the growth of the baby, resulting in a low birth weight. However, generally, experts believe that the second trimester is the safest period to take medicines.
  • Medicines taken in the final three months of pregnancy can cause complications such as breathing difficulties for the baby after birth. This is because the medicine remains in the baby’s body after birth and the newborn baby may not be able to cope with the medicine in its bloodstream the way the mother can.

Medicines taken by the mother can also indirectly affect the baby by interfering with the environment within the womb. Some medicines can cause contractions of the womb, decreasing the blood supply to the baby, while others may cause early, delayed or even prolonged labor, all of which pose a threat to the baby.

How do we know which medicines are safe?

The answer is that often we don’t. Pharmaceutical companies rarely perform clinical trials or actual studies of their medicines on pregnant women. As a result, few medicines are actually licensed for use during pregnancy. Most information we get about safety in pregnancy often comes from practical experience with the medicine over time. Often, when a medicine has been in wide use for many years without causing adverse effects on pregnancies, we can conclude that it is not harmful. Information will also come from women who have been accidentally exposed to a medicine during pregnancy and from animal studies.

So, some medicines are known to be safe while others are known to be definitely harmful. But in a large number of cases there isn’t the firm evidence to conclude safety or risk. This applies to all medicines, be they prescription only or over-the-counter.

Taking any medicine during pregnancy is all about weighing up the pros and cons. The decision should, ideally, be made by your doctor, who will be able to weigh up the benefits of a particular medicine to the mother against the risks of that same medicine to the baby. If the benefits outweigh the risks, then the medicine may be given to the mother. If the risks to the baby are too great, then alternative treatment options need to be sought. The final decision about taking a medicine should be made in conjunction with you.

Is there anything I can take to treat minor illnesses?

The best way to minimize any risks for your baby is to avoid all non-essential medicines, especially in the first trimester. However, what follows is a general overview of what you can and can’t take safely to treat common minor illnesses. Remember: always consult your doctor or pharmacist before taking any medicine during pregnancy.


  • Try increasing exercise and dietary measures such as drinking more fluids and eating more fiber first. If these are not effective, there are over-the-counter laxatives that can be taken in pregnancy.
  • Bulking agents should be tried first if dietary changes haven’t worked.
  • Lactulose or the stimulant laxatives, bisacodyl can also be used if necessary.

Heartburn and indigestion

  • Antacids are generally safe, though sodium bicarbonate is absorbed into the bloodstream and so antacids containing this ingredient should be avoided in pregnancy, since your sodium intake should not be too high.
  • Medicines such as Gaviscon that contain alginates are safe, and can be especially useful for heartburn caused by the pressure of the baby on the stomach. They form a raft on the stomach contents and prevent them passing back up the food pipe.

Pain such as headache or backache

  • Try non-drug methods first. A head massage can help relieve headache, while backache can be eased by gentle stretching to relieve tight muscles, or a soak in a warm bath.
  • Paracetamol is generally regarded as safe for short-term use in all three trimesters. It is widely used in all stages of pregnancy for pain relief and reducing fever.
  • Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are not recommended during pregnancy, as there are safer alternatives available. They should particularly be avoided in the last trimester, because they can delay labor, increase the length of labor and cause complications in the newborn baby. Painkilling doses of aspirin can also increase the risk of bleeding in the mother and baby if taken in the third trimester. Evidence suggests these medicines should also be avoided in the first trimester and by women attempting to conceive, as they may increase the risk of miscarriage or malformations.
  • Codeine and dihydrocodeine can affect the baby’s breathing if taken in the last trimester, or during labor in large amounts. Heavy use may also cause a withdrawal syndrome in the newborn infant. However, small doses for a short period of time to treat specific pain can be taken in the first and second trimesters, but only on the advice of a doctor. Be aware that some over-the-counter painkillers contain codeine or dihydrocodeine. Consult your doctor or pharmacist before taking any medicines during pregnancy.

Hay fever and allergies

  • For hay fever, first try as much as possible to reduce your exposure to the allergens that trigger it.
  • If this isn’t possible, you can safely use saline or sodium cromoglicate nasal spray or eye drops in all three trimesters.
  • Alternatively, short-term use of nasal sprays containing corticosteroids such as beclomethasone, budesonide or fluticasone is unlikely to cause any harm. With long-term use sufficient steroid could be absorbed to impair the growth of the baby, so these should only be used after discussing any risks with your doctor or pharmacist.
  • Products containing antihistamines, such as brompheniramine, meclozine, diphenhydramine, promethazine and doxylamine should be avoided, as there is insufficient information about their safety. However, your doctor may recommend the non-sedating antihistamines loratadine or cetirizine if the measures mentioned above fail. These have not been shown to cause harm when used in pregnancy. Chlorphenamine can also be used, but not in the latter half of your last trimester, because it could cause problems such as irritability or tremor in the baby after birth. Consult your doctor or pharmacist before taking any medicines during pregnancy.
  • Antihistamine nasal sprays and eye drops should be avoided.
  • Nasal decongestants, such as pseudoephedrine, phenylephrine, xylometazoline, oxymetazoline should also be avoided as there is insufficient evidence of their safety. Steam inhalations should provide some relief from nasal congestion.

Coughs and colds

  • Soothing cough mixtures such as simple linctus, honey and lemon syrups, or sucking lozenges containing honey or glycerol to coat the throat, are the safest option to reduce coughing.
  • Cough and cold remedies often contain a combination of several ingredients, including painkillers, antihistamines and decongestants (see above), so it is important to make sure that each ingredient is safe before taking them. Consult your doctor or pharmacist before taking any medicines during pregnancy.
  • The cough expectorant guaifenesin to help loosen a chesty cough can be used, though drinking lots of water is just as effective for this. You could also try using steam inhalations to help liquify mucus and make it easier to cough up. Cough medicines containing iodine as an expectorant should be avoided, as the iodine can impair the functioning of the baby’s thyroid gland.
  • The cough suppressant dextromethorphan has been in widespread use for many years and is generally considered safe to use during pregnancy, providing it is only taken for short periods of time and using the smallest dose possible. However, it is probably best to avoid it in the first trimester. Cough suppressants containing codeine should be avoided in the third trimester. Consult your doctor or pharmacist before taking any medicines during pregnancy.


  • Short bouts of diarrhea won’t do your baby any harm, but diarrhea lasting longer than a few days can cause dehydration. This can be avoided by taking rehydration salts are safe to use in pregnancy.
  • Kaolin mixture can also be used to increase the bulk of the stools.
  • Loperamide to stop diarrhea should be avoided, as there is insufficient information available to decide if it is safe or not.

Vaginal thrush

  • There is not a great deal of information available about the safety of oral antifungal medicines, such as fluconazole, so you should not take these.
  • Your doctor may prescribe you antifungal cream or pessaries, such as clotrimazole. But these products should only be used after discussion of the risks and benefits with your doctor.
  • If you are prescribed a vaginal preparation, take care with vaginal applicators to avoid damaging the cervix, or avoid using them altogether.

Eczema, dermatitis and skin allergies

  • Moisturizers or soothing products such as calamine lotion should be your first port of call as these are completely safe.
  • Steroid creams such as hydrocortisone can be used during pregnancy, but avoid using them on large areas of skin, for long periods of time, or under dressings, as significant amounts may be absorbed into the bloodstream.

Folic acid

This is the only over-the-counter medicine that is really important to take, both before and during pregnancy. One 400 microgram tablet should be taken every day by women planning a pregnancy and for the first 12 weeks of pregnancy. This is to help the development of the baby’s spinal cord and nervous system and prevent neural tube defects such as spina bifida. Taking folic acid daily also helps prevent birth defects such as cleft lip and cleft palate.

A higher daily dose (5mg) of folic acid is recommended if you or your partner has spina bifida, if you have had a previous child born with neural tube defects, or if you are taking medicines for epilepsy. Discuss this with your doctor.

For medicines not covered here ask the advice of either your pharmacist or doctor. The best way to minimize risk is to minimize your intake of all unnecessary medicines. Remember that herbal remedies are not necessarily safe in pregnancy. If in doubt ask!

Quick recap

  • Are you pregnant and taking any medicines?
  • Have you told your doctor or pharmacist that you are pregnant?
  • If you are pregnant, are you taking your folic acid tablets?
  • Generally, avoid all medicines during pregnancy if possible.
  • Always consult your doctor or pharmacist if you are pregnant and starting a new medicine.
  • Remember some over-the-counter medicines and medicines from the drug stores can be harmful to your baby.
  • Herbal remedies are not necessarily safe alternatives. Ask your doctor or pharmacist for advice about taking these while pregnant too.
  • If you experience any unusual effects after taking your medicine, inform your doctor or pharmacist immediately.
  • Your doctor needs to weigh up the risks versus the benefits of giving a medicine during pregnancy.
  • Everybody is different – one woman may take a harmful medicine and have a healthy baby and another woman may take a so-called safe medicine and end up having a child with a birth defect.
  • Birth defects can occur naturally, even if you do not take any medicines, and no one can really explain why they occur.
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