What's safe, what's not, and what to use instead — based on FDA data and ACOG guidance.
| Condition | Safe Options | Avoid | Notes |
|---|---|---|---|
| Pain / Fever | Acetaminophen (Tylenol) — usual doses | Ibuprofen (Advil, Motrin), Aspirin, Naproxen (Aleve) | Ibuprofen/naproxen especially risky in 3rd trimester (premature ductus closure). Aspirin OK only at low-dose if prescribed by OB. |
| Nausea | Vitamin B6 (25 mg 3×/day) + doxylamine (Unisom SleepTabs) · Ginger supplements · Diclegis (prescription B6/doxylamine) | Zofran (ondansetron) — prescription required; avoid first trimester if possible | B6 + doxylamine is ACOG first-line. Zofran is commonly used but discuss risks/benefits with OB. |
| Heartburn / Reflux | Calcium carbonate antacids (Tums, Rolaids) · Famotidine (Pepcid AC) · Omeprazole (Prilosec) for severe reflux | Baking soda, aspirin-containing antacids (Alka-Seltzer) | Tums also provides calcium. Famotidine and PPIs considered safe when needed. |
| Constipation | Docusate sodium (Colace) · Psyllium (Metamucil) · Polyethylene glycol (MiraLax) · Increased water and fiber | Castor oil, senna (stimulant laxatives) — limited use only | Increase fiber and water first. Colace is safest stool softener. |
| Allergies / Runny Nose | Diphenhydramine (Benadryl) · Loratadine (Claritin) · Cetirizine (Zyrtec) · Saline nasal spray | Pseudoephedrine (Sudafed) — avoid first trimester; use sparingly after | Saline spray is always safest for congestion. Second-gen antihistamines (Claritin, Zyrtec) preferred over Benadryl for daytime use. |
| Cough / Cold | Honey (soothe cough) · Guaifenesin (Mucinex) — 2nd/3rd trimester · Saline gargle · Steam inhalation | Dextromethorphan (DM)-containing products — conflicting data, avoid first trimester · Decongestants in first trimester | No OTC cold remedy has been proven safe in all trimesters. Supportive care (rest, fluids, honey) is often best. |
| Yeast Infection | Topical azole creams (Monistat 7) — vaginal application only | Oral fluconazole (Diflucan) — avoid, especially first trimester (cardiac defect risk) | Always confirm diagnosis with OB before treating. Use 7-day course (not 1- or 3-day) during pregnancy. |
| Hemorrhoids | Witch hazel (Tucks) · Hydrocortisone cream (up to 1%) short-term · Sitz baths · Dietary fiber | — | Topical treatments are safe. Oral steroids require OB guidance. |
| Medication / Class | Risk | Category |
|---|---|---|
| ACE Inhibitors (lisinopril, enalapril) / ARBs (losartan, valsartan) | Fetal kidney damage, oligohydramnios, skull defects — especially after first trimester | Contraindicated (2nd/3rd trimester) |
| Isotretinoin (Accutane) | Severe birth defects (craniofacial, cardiac, CNS) — iPLEDGE pregnancy prevention program required | Absolutely contraindicated |
| Methotrexate | Miscarriage, fetal death, multiple birth defects (folic acid antagonist) | Absolutely contraindicated |
| Warfarin (Coumadin) | Fetal bleeding, embryopathy (especially weeks 6–12) | Avoid — use LMWH (enoxaparin) instead |
| Valproic acid (Depakote) | Neural tube defects, cognitive impairment; highest teratogenic risk among antiepileptics | Avoid if alternatives exist |
| Tetracyclines (doxycycline, minocycline) | Bone and tooth discoloration after first trimester; hepatotoxicity in mother | Avoid after 1st trimester |
| Fluoroquinolones (ciprofloxacin, levofloxacin) | Joint/cartilage concerns in animal studies; avoid if alternatives available | Use only when benefits outweigh risks |
| NSAIDs (ibuprofen, naproxen) | Premature closure of ductus arteriosus (3rd trimester); oligohydramnios; reduced fertility (early pregnancy) | Avoid especially after 20 weeks |
| High-dose Vitamin A (retinol > 10,000 IU/day) | Teratogenic at high doses — linked to craniofacial and cardiac defects | Use beta-carotene form instead |
If you accidentally received a live vaccine early in pregnancy, contact your OB — the risk is theoretical and often low.