Don’t Rely On Meds for Cough and Cold in Pregnancy

Cold weather will continue to raise questions about which cough and cold meds are safe to use during pregnancy and breastfeeding.

Continue to emphasize nondrug humidifiers, plenty of fluids, ice chips for sore throat, etc.

Explain that there’s not much evidence of benefit with any OTC cough and cold med.

But if patients want to try one, think “first, do no harm.”

Cough. Suggest starting with plain honey...up to 2 teaspoons as needed. Or consider cough drops with menthol or pectin...there’s no good evidence, but occasional use doesn’t seem risky.

Explain that dextromethorphan or guaifenesin is okay to use in pregnancy or breastfeeding...but may not help much.

Don’t recommend codeine, due to fetal and newborn risks.

Nasal symptoms. Recommend a saline nasal spray first. Ensure safe use if patients want to try nasal irrigation (neti pot, etc).

If a patient needs a decongestant, consider oxymetazoline nasal spray. It has the most data...but remind not to use for more than 3 days.

Avoid oral decongestants in the first trimester...they’re linked to fetal malformations. If needed later in pregnancy, consider oral pseudoephedrine...oral phenylephrine doesn’t work better than placebo.

Point out that oral decongestants may decrease milk production.

Explain that oral or nasal antihistamines...or nasal steroids...don’t seem to help congestion, runny nose, or sneezing due to colds.

Pain or fever. Continue to recommend acetaminophen at the lowest dose and duration if needed in pregnancy.

Generally avoid NSAIDs in pregnancy. They’re linked to miscarriage, fetal kidney problems, and premature ductus arteriosus closure.

But recommend acetaminophen or ibuprofen if needed in breastfeeding.

Advise reading labels closely. Guide patients toward single-ingredient or short-acting products if possible...and away from those with alcohol.

Point out that most “natural” supplements for cold and flu (echinacea, zinc, etc) lack good evidence, especially during pregnancy and risks are often unknown.

Get our resource, Cough and Cold Meds in Pregnancy and Lactation, for more on the safety of various meds.

Key References

  • Scolaro KL. Colds and Allergy. In: Krinsky DL, Ferreri SP, Hemstreet BA, et al, Eds. Handbook of Nonprescription Drugs: an Interactive Approach to Self-Care. 20th ed. Washington, DC: American Pharmacists Association; 2020.
  • Briggs GG, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation. 12th ed. Philadelphia, PA: Wolters Kluwer, 2022.
  • (3-3-23)

Pharmacist's Letter Canada. March 2023, No. 390306

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