What Allergy Medicine Is Safe During Pregnancy – The website will be down intermittently for maintenance from 8:00 AM CT on Saturday, March 2 through 10:00 AM CT on Sunday, March 3.
Although there are no randomized controlled trials to guide the use of OTC medications during pregnancy, women frequently use them for skin, allergic, respiratory, and gastrointestinal conditions in addition to general analgesia. All physicians who care for women of childbearing age should understand the indications, risks, and benefits of OTC medications in pregnancy. Given the limited data regarding the variety of OTC medications available, physicians need to counsel pregnant women regarding the potential risks, and it would be beneficial to discuss all OTC medications the patient is taking at the preconception visit and all other routine visits. Table 1 lists online sources for more information about the use of OTC medications during pregnancy.
What Allergy Medicine Is Safe During Pregnancy
Acetaminophen as a single agent does not increase fetal risk in any trimester and is considered safe for use in pregnancy.
Types Of Allergy Relievers
Use of nonsteroidal anti-inflammatory drugs during pregnancy has potential risks. The risk-benefit ratio is best determined with a doctor’s consultation.
Http://www.cdc.gov/pregnancy/meds (fact sheet for patients; link to LacMed, a database of medications that may be used during breastfeeding)
Since 1979, a standard five-letter nomenclature developed by the US Food and Drug Administration (FDA) has been used to assign pregnancy risk categories to prescription and OTC medications (Table 2).
In response to ongoing criticism regarding the confusing and oversimplifying nature of this system, in 2011, the FDA proposed new rules for labeling aimed at providing more detailed safety data on use in pregnancy and in turn improving clinical decision making.
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The new rule divides information into pregnancy and breastfeeding categories, each with subcategories of risk summaries, clinical considerations, and data. The five-letter system and the new system are both available today.
Controlled studies in pregnant women have failed to show any risk to the fetus in the first trimester, there is no evidence of a risk in later trimesters, and the likelihood of fetal harm appears to be small.
Either animal reproduction studies have shown no risk to the fetus but there have been no controlled studies in pregnant women, or animal reproduction studies have shown adverse effects (other than reduced fertility) that have not been confirmed in controlled studies in women in these countries. first trimester (and there is no evidence of any risk in later trimesters).
Animal studies have suggested adverse effects on the fetus (teratogenic, embryocidal, or other) and there have been no controlled studies in women, or studies in women and animals are not available. Medications should be given only if the potential benefit outweighs the potential risk to the fetus.
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There is positive evidence of risk to the human fetus, but the benefits of use in pregnant women may be acceptable despite the risks (for example, if the drug is needed in a life-threatening situation or for a serious illness for which safer drugs are not amenable or are ineffective).
Animal or human studies have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risks of using the drug in pregnant women clearly outweigh the possible benefits. This drug is contraindicated in women who are or may become pregnant.
OTC drugs that are not available as a prescription often do not receive safety ratings, and the FDA website is often not updated after a product receives initial approval. Multiple websites and databases with conflicting data make counseling women more difficult. Using the lowest dose for the shortest period of time possible and trying to avoid use of the drug during the first trimester is a sensible approach.
Research consistently shows no risk of significant fetal malformations when using first-generation antihistamines, and these drugs are considered safe.
What Cold Medicine Can You Take While Pregnant?
The second-generation antihistamines loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) do not appear to increase overall fetal risk. Four studies (n = 1,290) found no significant fetal risk with cetirizine use.
A slightly higher incidence of hypospadias with loratadine use was demonstrated in one study (n = 1, 700), but not in another study (n = 2, 147).
Fexofenadine has been associated with early miscarriage in animal studies but has not been studied in human pregnancies. Fexofenadine is a metabolite of terfenadine, which was removed from the market in 1998 due to the risk of cardiotoxicity. Studies (n = 2, 195) on the safety of terfenadine in human pregnancy did not show a significant risk of congenital malformations.
Data addressing the safety of topical antihistamines in pregnancy are limited to one study of the ophthalmic agent pheniramine, which is contained in some OTC combinations with naphazoline. No significant malformations were observed in 831 women who took the drug in the first trimester.
Which Nasal Allergy Sprays Are Safe To Use During Pregnancy?
There are no data for other topical antihistamines, such as those in anti-itch creams; however, significant fetal risk is unlikely due to lack of systemic absorption. Table 3 summarizes the safety of antihistamines in pregnancy.
Purchase behind the counter; possible association with gastroschisis, small bowel atresia, and hemifacial microsomia; should be avoided in the first trimester
Nearly one in four pregnant women seeks relief from nasal congestion caused by upper respiratory infections, allergic rhinitis, or the common phenomenon known as pregnancy rhinitis.
The safety of oral phenylephrine in pregnancy is unknown. Data now approximately a decade old (n = 2, 730) show an increased risk of congenital malformations (relative risk = 0.6 to 1.2) and mild eye, ear, and limb malformations (relative risk = 2.7) with Phenylephrine use during pregnancy.
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Pseudoephedrine was previously considered low risk in pregnancy based on an older cohort study (n = 1,724) that did not demonstrate significant teratogenicity.
However, its safety has been called into question after a recent case-control study observed a small association between pseudoephedrine and birth defects, including gastroschisis, small bowel atresia, and hemifacial microsomia.
This study is limited by its small sample size; retrospective analysis; and potential confounding factors, such as recall bias. A risk of ventricular septal defects or limb malformations has been observed with decongestants but has not been proven.
Two studies (n = 5, 400) demonstrated a reduced risk of preterm birth, low birth weight, and preterm labor among women who used various oral decongestants during pregnancy.
Natural Remedies For Allergies
There are only a few studies on the safety of topical (nasal and eye) decongestants, none of which have shown an increased risk to the fetus.
Overall, the available evidence suggests that decongestants (and their combination formulations) should be used sparingly in pregnancy, particularly in the first trimester; however, further studies are needed. Saline nasal sprays and adhesive nasal strips are safe OTC alternatives for treating nasal congestion. Table 3 summarizes the safety of decongestants in pregnancy.
Only a few studies have discussed the safety of using cough medicine during pregnancy. The expectorant guaifenesin has been weakly associated with neural tube defects and inguinal hernias. However, the available evidence is insufficient to determine its safety in pregnancy. It is best to avoid this drug in the first trimester unless the potential benefits outweigh the risks.
Dextromethorphan is a nonnarcotic antitussive isomer of codeine that was found to be teratogenic in chicken embryos. However, epidemiological studies in humans and smaller controlled studies have not shown an increased risk of congenital abnormalities.
Is Claritin Safe During Pregnancy And While Breastfeeding?
There are no prospective randomized controlled trials to determine the safety of using acetaminophen, ibuprofen, or naproxen in pregnancy. At least two-thirds of women use acetaminophen during pregnancy, and half of these women use it in the first trimester.
Animal studies suggest that acetaminophen may decrease the diameter of the ductus arteriosus, but experimental conditions prevent reasonable extrapolation to humans.
More recent studies have looked at chronic acetaminophen use during pregnancy and the risk of tetralogy of Fallot, but no definitive link has been made.
A population-based prospective study in Denmark (n = 88, 142) showed that the hazard ratio of congenital defects was 1.01 for 26, 424 women who used acetaminophen in the first trimester.
Medications To Avoid During Pregnancy
In a follow-up analysis, the hazard ratio for cryptorchidism was 1.38, but only with routine acetaminophen use for more than four weeks in the first and second trimesters.
Other more recent cohort studies have looked at possible associations between acetaminophen use and attention-deficit/hyperactivity disorder and other hyperkinetic disorders.
The National Birth Defects Prevention Study (NBDPS), which analyzed data from 16,110 children in the United States who were exposed to acetaminophen in utero, found no increased risk of birth defects from acetaminophen use. In women taking acetaminophen specifically for febrile illness, there is a reduced risk of various skull and facial defects and gastroschisis; acetaminophen may be protective because fever increases the risk of this defect.
A case series of acetaminophen overdose in 300 pregnant women found no increased risk of congenital defects, stillbirth, or spontaneous abortion, regardless of trimester. At six weeks old, the newborn had no evidence of liver or kidney disease.
Pregnancy And Medicines
Many trials studied acetaminophen in combination with cold medications, rather than as a single agent, complicating cause-and-effect relationships. Available information regarding the use of acetaminophen does not indicate a risk to the fetus; therefore, as a single drug, it is safe to use in any trimester, especially as a single dose without regular use.
Meta-analysis of aspirin use in the first trimester did not show an increased risk of congenital abnormalities, except gastroschisis (odds ratio [OR] = 2.37).
Early use of aspirin at the time of conception or during pregnancy
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