Medications during Pregnancy

Your body goes through various changes, both from the inside and out, during the nine months you carry your baby. The hormone levels in your body go up while the immune system is suppressed to prevent your body from refusing the baby as a harmful foreign object. This naturally makes you more prone to various common disorders and infections. However, the regular medicines used for treating common ailments, like cough and cold, are not always safe to be taken during pregnancy.

You are responsible for providing your baby with all the nourishment he needs through the placenta. Now, some medicines may cross the placenta and reach the baby’s bloodstream, leading to various birth defects and complications. Due to this reason, FDA has categorized all drugs and medicines into five categories depending on their potential harmful effects on the mother and baby.

The FDA Pregnancy Category Chart [1]

Pregnancy category A

Adequate research has been done with the conclusion that drugs in this category are not likely to cause any harm to the fetus in the first trimester as well as later in pregnancy.

Pregnancy Category B

Studies carried out on animals have shown no adverse effects on the fetus; however, there is a lack of controlled studies on human pregnancy.

Pregnancy category C

Animal studies have shown evidence of harmful effects on the fetus; however, no controlled study has been done on a human pregnancy. The medicines may be prescribed in cases where the potential benefits outweigh the possible adverse effects.

Pregnancy category D

Studies done on human pregnancy have shown positive risks to the fetus. However, doctors might prescribe them in certain cases where the potential benefits outweigh the risks.

Pregnancy category X

Both human and animal studies have shown positive risks to the fetus, with the adverse effects extending to serious birth defects, miscarriage and fetal death. The possible risks of using these medicines outweigh any potential benefits.

List of POSSIBLY SAFE medications during pregnancy

It is recommended to consult your doctor or midwife before using even the safe over-the-counter medicines as your body may respond differently to them during pregnancy.
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Vitamin B6

 

Thyroid medicationWesthroid, Armour Thyroid (thyroid desiccated)Category A [76]no serious side effects have been reported apart from hair loss in some individuals [81]

Common Pregnancy Complaints

Pregnancy-Safe Medications

FDA Category

Common Side Effects

Cold, cough, flu and sore throat medicines during pregnancy

Mucinex, Glytuss (guaifenesin) – expectorant [2] Category C [3]
  • Dizziness
  • Headache
  • Diarrhea
  • Skin Rash
  • Hives
  • Nausea/Vomiting
  • Stomach Pain
Robitussin DM, Balminil DM (dextromethorphan) – cough suppressant [4] Category C [5]
  • Blurred vision
  • Confusion, restlessness
  • Drowsiness
  • Nausea/vomiting
  • Slowed breathing
  • Stomach pain
  • Shakiness/palpitation [6]
Benylin Expectorant (guaifenesin-dextromethorphan) [7] Category C
  • Dizziness
  • Stomach Upset
  • Drowsiness [8]
  • Allergic reactions (skin rash, itching, swelling of the face/mouth [9])
Benadryl (Diphenhydramine) – cough suppressant [10] Category B [11]
  • Fatigue, dizziness
  • Headache
  • Dry mouth
  • Allergic reactions (skin rash, itching, difficulty breathing, swelling of the face/mouth, lips and tongue [12])
Sucrets lozenges (over-the-counter dyclonine) sore throat relief [13] Category C No common side effects have been reported [14] Contact your doctor in case of allergic reactions (hives, itching, breathing difficulty, swelling of the face/mouth)
Cough drops [15] No common side effects have been reported

Pain medication

Tylenol, Panadol, Anacin Aspirin-Free (acetaminophen/paracetamol) [16,17] Category B oral and rectal use [18]Category C in IV form [19]
  • Skin rash
  • Hives
  • Blisters or skin peeling
  • Itching
  • Difficulty breathing
  • Swelling of the face, mouth, throat, hands and feet

A long-term study associated the use of acetaminophen (Tylenol) in pregnancy with an increased risk of having a child with ADHD. However, conclusive research is still required [20].

Fever, headache and migraine medicines

Tylenol (acetaminophen)

Morning sickness, vomiting, nausea medicines for pregnancy

Emetrol (phosphoric acid/ fructose/dextrose) [21] Category C Fructose intolerant women may experience –

  • Fainting
  • Swelling of face, legs and arms
  • Weight loss
  • Vomiting
  • Yellow eyes or skin

Large doses may lead to abdominal pain and diarrhea [22].

Oral vitamin B6 [23] Category A(assigned to category C when the daily intake is higher than the RDA) Large doses may cause clumsiness and numbness or tingling sensation in the hands and feet [24]
Dramamine (over the counter dimenhydrinate) anti-nausea and vomiting medicine [23] Category B
  • Blurred vision
  • Drowsiness
  • Headache, dizziness
  • Ringing of the ears
  • Dryness of the mouth
  • Palpitation
  • Incoordination [25]

Constipation medicines and stool softeners

 Colace 50mg/100mg (docusate) [15] Category C  [26]
  • Bloating
  • Gas
  • Bitter taste in the mouth
  • Stomach pain
  • Diarrhea
  • Rectal irritation
  • Throat irritation
  • Allergic reactions [27]
Metamucil (psyllium) Category B [28]
  • Minor gas and bloating
  • Abdominal discomfort [29]
Unifiber, Citrucel (methylcellulose) [16] Not classified (should be used only when absolutely necessary)
  • Abdominal fullness and discomfort

Severe side effects

  • Allergic reactions (rashes, itching, breathing problems)
  • Chest pain
  • Nausea, vomiting
  • Difficulty swallowing [30]
Ex-Lax Milk of Magnesia (milk of magnesia) [31] Category A [32]
  • Diarrhea
  • Allergic reactions (rashes, itching, difficulty breathing)
  • Appetite loss
  • Nausea, vomiting

Diarrhea medicine

Imodium (loperamide) Category C[33]
  • Dizziness
  • Vomiting
  • Constipation
  • Dry mouth
  • Stomach pain

Serious side effects

  • Skin rash
  • Itching
  • Difficulty breathing
 Parepectolin (attapulgite oral) Not classified; not absorbed after oral administration and therefore is believed to be harmless [34]
  • Constipation
  • Bloating
  • Flatulence
  • Stomach Upset
  • Nausea [35]

Heartburn, acid reflux or acid indigestion and upset stomach

Zantac (ranitidine) Category B [36]
  • Constipation
  • Nausea
  • Stomach pain
  • Headache [37]
Mylanta (aluminum/magnesium/simethicone) Category C [38]
  • Nausea
  • Constipation/diarrhea
  • Headache
  • Allergic reactions (skin rash, hives, itching, breathing difficulty) [39]
Tums (calcium carbonate) Category C [40] No common side effects have been reported. Some may develop allergic reactions (skin rash, itching, difficulty breathing, swelling of the face/mouth) [41]
Riopan (magaldrate-oral) Category C [42]
  • Loss of appetite
  • Diarrhea/constipation [43]
Gaviscon (aluminum/magnesium trisilicate) Category C [44] There are usually no side effects except for constipation or diarrhea [45]. Allergic reactions may occur in some individuals

Gas and bloating medications

Gas X, Mylanta Gas (simethicone) Category C [46] No serious side effects have been reported. Contact your doctor in case of any suspected adverse effects. [47]

Decongestants and sinus medications

Ocean Mist Nasal Spray (OTC intranasal sodium chloride) [48] Category A No serious side effects have been reported
Sudafed (pseudoephedrine) [49] Category C [50] in second and third trimestersNot recommended during the first trimester
  • Headache
  • Restlessness
  • Insomnia
  • Nausea, vomiting
  • Nervousness
  • Increased blood pressure [50]

Sleeplessness and insomnia

Benadryl (Diphenhydramine) [16] Category B
Unisom Sleep-Aid (Doxylamine succinate) [51] Category B [52]
  • Drowsiness
  • Dizziness and headache
  • Constipation
  • Stomach upset
  • Decreased coordination
  • Dry mouth [53]

Blood pressure medication

Methyldopa (prescription medication) Category B [54]
  • Headache
  • Drowsiness
  • Swelling of the feet and ankles
  • Vomiting
  • Upset stomach
  • Muscle weakness
  • Diarrhea
  • Dry mouth [55]
Trandate (Labetalol, prescription medication) [56] Category C [57]
  • Fatigue
  • Headache and lightheadedness
  • Tingling sensations on the skin
  • Upset stomach
  • Stuffy nose [58]

Allergy medicines while pregnant

Chlor-Trimeton (chlorpheniramine, an antihistamine) Category C [59]
  • Constipation/diarrhea
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headache
  • Loss of appetite
  • Nausea
  • Anxiety
  • Trouble sleeping
  • Vomiting [60]
Benadryl (Diphenhydramine, an antihistamine) Category B
Claritin (loratadine, an antihistamine) Category B
  • Headache
  • Fatigue
  • Dry mouth [82]

Yeast infection and other fungal infections (e.g. athlete’s foot)

Monistat-1 (tioconazole) Category C [61]
  • Headache
  • urethral or vaginal pain/burning/itching [62]
Terazol 7 Vaginal (terconazole) Category C [63]
  • Headache

Serious side effects

  • Burning or irritation in the vagina
  • Fever
  • Stomach pain
  • unusual vaginal discharge [64]
Mycelex 7, Lotrimin AF (Clotrimazole vaginal cream) [16] Category B [65]
  • Burning, swelling, irritation, redness, pimple-like bumps and flaking of the treated skin area
  • Stomach pain
  • Fever
  • Foul-smelling discharge [66]
Topical Mentax (butenafine) Category C [67] Irritation, burning, redness and itching of the treated skin area [68]

Hemorrhoid

Anusol HC (hydrocortisone rectal, prescription) Category C Burning sensation after applicationSensitivity reactions (skin rash, scaly skin) [69]
Tucks (pramoxine) Not classified; should not be used unless potential benefits outweigh possible risks [71] Burning or stinging sensation after application [70]
Preparation H (phenylephrine/mineral oil/petrolatum) Category C[72] No serious side effects have been reported. May lead to allergic reactions in some individuals. [73]

Thyroid medication

Westhroid, Armour Thyroid (thyroid desiccated) Category A [76] no serious side effects have been reported apart from hair loss in some individuals [81]
Cytomel, Triostat (liothyronine) Category A [79] Nausea and hair loss are the only common side effects [74]

Seizure medications

Vitamin B6
Aptiom (eslicarbazepine acetate) Category C [75] Consulting your doctor is recommended to assess the potential risks and benefits as leaving seizures untreated can be harmful for both the mother and baby [77]

Antibiotic medications

Penicillin V Category B [80]
  • Fast breathing
  • Joint pain
  • Lightheadedness
  • Fever [78]
Amoxicillin Category B [113]
  • Nausea and vomiting
  • Diarrhea
  • Headache
  • Stomach pain
  • Vaginal discharge [112]

Medicines to avoid during pregnancy

Use of NSAIDs (nonsteroidal anti-inflammatory drugs), anti-depressants and anxiety medications is not recommended at any stage of pregnancy unless absolutely necessary.

Pregnancy ailment

Name of the Medication

FDA Category

Adverse effects during pregnancy

Treatment of fever, headache, pain and inflammation (NSAIDs)

Aspirin Category C in first and second trimestersCategory D in the third trimester [85]
  • Fetalcomplications and birth defects such as pulmonary hypertension in the newborn babies
  • Complications at the time of delivery [89, 90]
Advil, Motrin, Nuprin (ibuprofen) Category C before 30th week of gestationCategory D after 30th week of gestation [83]
Anaprox, Aleve, Naprosyn (naproxen) Category C before week 30Category D for prolonged use after week 30 [86]

Anti-diarrheal medicines

Pepto-Bismol, Kaopectate (bismuth subsalicylate) Category C in first and second trimestersCategory D in third trimester [88]
  • Intrauterine growth problems and serious birth defects
  • Complications during delivery [84]

Depression and anxiety medications

Xanax (alprazolam) Category D [92]
  • Increased risk of congenital defects when taken in the first trimester
  • Birth defects, developmental problems and floppy baby syndrome [94]
Paxil (paroxetine) Category D [87]
  • Use in early pregnancy can lead to serious fetal heart defects [91]
  • Use in third trimester may lead to withdrawal symptoms including feeding problems, breathing difficulty, muscle stiffness, seizures and constant crying [97]
Celexa (citalopram) Category C [95]
  • Congenital malformations
  • signs of withdrawal after birth, like constant crying, feeding difficulties, breathing problems, seizures etc (when used during the third trimester) [93]
Zoloft (sertraline) Category C [98]
  • Increased risk of persistent pulmonary hypertension of the newborn or PPHN
  • Use in the last few months are associated with congenital complications often requiring respiratory assistance and tube feeding [100]
Prozac (fluoxetine) Category C [96] Use in late third trimester may lead to serious breathing problems, feeding difficulty, muscle stiffness and other symptoms of withdrawal in the newborn baby [99]

Bipolar disorder medications

Klonopin (clonazepam) Category D [102] May lead to serious birth defects and problems in the newborn baby. Consulting your doctor is recommended if taking the medication for seizure management as untreated seizure during pregnancy is also harmful for both the mother and baby. [103]
Topamax Category D [101]

FDA Category X medicines

The medicines included in the following list are not recommended in pregnancy under any circumstances due to possible fatal outcomes.

Name of medicine

Use

Adverse effects

Coumadin (warfarin) Anticoagulant or blood thinner used to prevent blood clotting disorders as well as reduce the risks of stroke and heart attack [106] When taken in the first trimester: Bilateral optic atrophy, bone malformations, nasal hypoplasia and learning disabilities (fetal warfarin syndrome) [105]When taken in second and third trimesters: Fatal maternal or fetal hemorrhage, microcephaly, increased risk of miscarriage [104]
Trexall, Rheumatrex (methotrexate) Management of rheumatoid arthritis and psoriasis, treatments of certain cancers including the skin, lungs and breast cancers [109] Serious congenital deformities and fetal death [107]
Claravis, Sotret (isotretinoin) Treatment of severe nodular acne unresponsive to any other treatment options, including antibiotics [108] Spontaneous abortion, premature delivery, birth defects, physical deformities, skull malformations, central nervous system and cardiovascular system defects [110]
Danazol Treating fibrocystic breast disease and endometriosis, preventing hereditary angioedema attacks [111] Life threatening congenital defects
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