Which over-the-counter cold medications are safe during pregnancy?

Most people experience two to three colds during the winter and spring, and pregnant women are no exception. Colds are caused by viruses for which there is no real cure – you can treat the symptoms that make you feel crummy, but medicine doesn’t actually make the cold go away sooner.

Many over-the-counter (OTC) medications you can buy without a prescription come as multi-symptom formulas. These drugs are meant to treat every cold symptom: body aches, congestion, coughing, fever, headache, and sneezing. But not everyone develops every symptom of a cold, and pregnant women should avoid taking unnecessary drugs during pregnancy. 

Instead of reaching for a multi-symptom drug, use the guidelines below to find an effective drug that’s safe for the symptoms you’re facing. And, as always, let your Ob/Gyn or nurse know about any OTC drug you take.

What to take for common cold symptoms

Cough

Dextromethorphan is a cough suppressant used in OTC medications such as Robitussin to reduce coughing. Cough suppressants can come in immediate-release and extended-release preparations. The maximum dose for pregnant women is 120 mg in 24 hours. The multi-symptom preparations that contain dextromethorphan often include “DM” in their name.

Guaifenesin is another medication frequently found in cough medications, such as Mucinex. It is an expectorant, so it helps thin mucus from your chest or throat so you can cough it up easier. It comes in immediate-release or extended-release formulations. The maximum dose you should take is 2,400 mg in 24 hours.

Cold medicines containing codeine were used in the past for cough suppression. I don’t recommend these for pregnant women because studies show they really don’t work well, and the fewer opioid-containing medications in our medicine cabinets, the better. For children, there is some evidence that honey can improve nighttime coughing. I certainly think this is an option for pregnant women as well. If you want to try honey, I suggest a spoonful of the real stuff – it’s not as clear that cold medicine with honey listed as a flavoring or ingredient is as effective. 

Stuffy nose and sinus pressure

Decongestant medications reduce stuffiness and sinus pressure by constricting the blood vessels in your nose, which reduces swelling. Pseudoephedrine and phenylephrine are available over the counter as Sudafed and are safe for many women to use during pregnancy. However, women who have high blood pressure should not take pseudoephedrine without first talking to a doctor. The drug can raise blood pressure and can cause jitters and racing heartbeats. 
Because pseudoephedrine can be used to manufacture methamphetamine, it’s now kept behind the pharmacy counter. You’ll have to provide identification to purchase it, and stores track how much you purchase. The maximum dose of a typical decongestant is 240 mg in 24 hours.

Sneezing, runny nose, and watery eyes

These symptoms are the result of histamine release, which is an immune response to an invading virus. Chlorpheniramine, such as Triaminic Allergy, and diphenhydramine, such as Benadryl, are safe to take during pregnancy. However, both can cause drowsiness, so these are best taken at bedtime. The maximum dosage for chlorpheniramine is 32 mg in 24 hours.

When compared to placebos, antihistamines have the most successful results within the first couple days of treatment. Patients didn’t report any relief of symptoms between days three and 10. Newer antihistamines, such as loratadine (Claritin), are approved for allergies, not colds, so there isn’t information about how well they work for cold symptoms.

Sore throat

Pregnant women can take acetaminophen (Tylenol) for a sore throat with a limit of 3,000 mg in 24 hours. An antihistamine may help if the sore throat is due to postnasal drip because it can dry up those secretions.
Sprays or lozenges that contain benzocaine, a local anesthetic, can help numb the throat. Menthol and phenol, such as Chloraseptic, are antiseptics that also help soothe throat discomfort. Sucking on hard candy can keep saliva flowing, which might reduce throat irritation. 

A word about antibiotics

So many patients call asking for antibiotics for a cold, usually when they’ve had symptoms for several days. There are a few times when antibiotics are appropriate, for instance, strep throat or sinus infections caused by bacteria. But antibiotics simply don’t work against viruses that cause the common cold. Overprescribing antibiotics for viral illnesses leads to antibiotic resistance, which means the bacteria grow stronger over time and become tougher to beat with antibiotics.
If a doctor prescribes an antibiotic for cold symptoms, it’s usually a short, three-day round of drugs. The patient often feels better after finishing the medication but probably would have recovered in that timeframe anyway without the drug.

To sum up …

If you come down with a cold while pregnant and you want to take something for symptom relief, look for medications that are formulated for your specific symptoms. Avoid multi-symptom formulas, especially those containing acetaminophen. It can be easy to take more acetaminophen in a day than is safe because it’s in so many medications. Finally, be patient with cold symptoms – it can take a week or more for a cold to go away.

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