Over the Counter (OTC) Drugs in Pregnancy
Just because a medication is available in any pharmacy does not necessarily make it safe for
use in pregnancy. Following is a list of commonly used drugs and the precautions, warnings
and safety during pregnancy.
Acetaminophen (Tylenol)
When used according to the directions, Tylenol is widely considered safe during pregnancy.
It should be used short term only. It would be wise to stay as far below the adult dosage as
possible. Tylenol is very hard on the liver, and your baby’s liver is very immature. Any
drugs you take will get to the baby in varying degrees. The maximum dose is 4 gm over 24-
48 hours. This would be 8 extra-strength tablets. Many other OTC medications contain
acetaminophen also, so read labels. It would be easy to take too much.
If you need a pain reliever, try massage, warm compresses, meditation or visualization, ice
packs or sitting quietly in a dark room, before reaching for the bottle.
Ibuprofen (Advil, Motrin)
Two studies have found increased risk of miscarriage with the use of ibuprofen in the first
trimester. There are some concerns that early Ibuprofen usage can interfere with the
implantation of the baby. The third trimester has the greatest risk for Ibuprofen use. The
greatest concern is for the premature closing of the ductus arteriosus (a blood vessel in the
baby’s heart) which can lead to high blood pressure in the baby’s lungs. The use of
Ibuprofen in late pregnancy can inhibit the start of labor and lead to low levels of amniotic
fluid, which increases the risk of fetal distress.
It is best to avoid Ibuprofen during pregnancy.
Diphenhydramine (Benadryl)
Stillbirth has been reported following a combination of diphenhydramine and temazepam
(an anti-anxiety drug). Diphenhydramine has been shown to cause uterine contractility or
irritability when used in high doses late in pregnancy. Some midwives feel that a small dose
of Benadryl can help to stop “false labor” and help a mother sleep. Dosing right before
birth could cause excessive sleepiness in the newborn. The manufacturer considers this
medication incompatible with breastfeeding.
Psuedoephedrine (Sudafed)
A handful of studies has shown and increase in birth defects in babies who were exposed to
psuedoephedrine in pregnancy, especially when combined with acetaminophen (Tylenol
Cold & Sinus). Other studies have found no link. The ACOG recommends avoiding oral
decongestants during the first trimester unless the benefit will be large and unique.
Cough Syrup
Cough syrups containing only the expectorant Guiafenesin are widely considered safe during
pregnancy. However, cough syrups containing Dextromethorphan have been shown to
cause severe birth defects in chicken and rat embryos. Some researchers have questioned
the transferability of this information to humans. As with most things, it is best to try
natural remedies first.
Alka Seltzer
This medicine contains aspirin, sodium bicarbonate (baking soda) and citric acid. Because it
contains aspirin, this medicine is not safe during pregnancy. Aspirin can affect blood
clotting ability, increase bleeding after birth, and cause problems with labor and delivery.
Taking large amounts later in pregnancy can lead to fetal hypomagnesemia, increased deep
tendon reflexes and increased muscle tone. Also, the form of calcium in Tums, calcium
carbonate, is poorly used by the body. A recent Cochrane review has shown that calcium
supplementation has shown to reduce the risk of pre-eclampsia and hypertension disorders.
The studies were done using calcium carbonate.
Mylanta is usually a calcium/magnesium medicine with aluminum hydroxide in it.
Aluminum is a heavy metal that has been linked with brain damage and alzheimer’s.
Magnesium salts may cause CNS depression and diarrhea.


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