ASK THE DOCTOR:
Policing your pregnancy; Nonprescription drugs can pose risk

Q - What over-the-counter medications are safe during pregnancy?

A - Since the drug thalidomide caused birth defects in the 1960s, people are much more cautious about what medications to take during pregnancy. Because a drug is available over-the-counter does not necessarily mean that it is safe for the fetus.

It is best to be cautious and minimize medication use during pregnancy. Especially try to avoid taking medication during the first trimester of pregnancy or when trying to conceive since the fetus is most vulnerable when the organs are developing during the first three months.

Knowledge about medication safety in pregnancy is quite limited. Older drugs are often recommended since we have more experience with them. The science is imprecise in rating the safety of the drugs that is based mostly on animal studies and occasional human studies. Most human information is collected from large data bases of women exposed to different medications during pregnancy.

Drug safety during pregnancy is rated by the letters A, B, C, D and X. A is proven to be safe. Few drugs have been studied extensively to get this label. Most drugs are category B or C. Category B means no known risks but limited human studies. C means there may be some risk in laboratory animals with this category drug with limited human data available but is generally considered safe. Category D drugs can be harmful and category X is dangerous.

Cold or allergy medicines

Cold medications do not cure or speed recovery. They are used to relieve symptoms such as nasal congestion or cough. Cold medications should be used sparingly during pregnancy since they are not necessary.

Cough suppressants containing dextromethorphan are safe during pregnancy. Avoid combination cough medicines that contain several drugs and stick with a product that contains only dextromethorphan such as Benylin or Delsym. Be careful to avoid cough syrups with alcohol. The expectorant, guaifenesin, is considered safe but is not a very effective medication and, therefore, should be avoided.

The decongestant, pseudoephedrine, is safe to take after the first trimester. It may cause rare birth defects if taken during the first three months. Nasal decongestant sprays such as Afrin or Neosynephrine can be safely used after the first trimester for no more than four days at a time to relieve sinus pain or pressure. Decongestant nasal sprays should be avoided if there are concerns about placental blood flow to the fetus.

Chlorpheniramine (Chlor-Trimeton) is the preferred antihistamine for allergy symptoms since it has been around the longest. Benadryl is also safe. For people who cannot tolerate the older antihistamines, Loratadine (Claritin) is category B and considered safe but has limited experience since it is newer.

Heartburn

Antacids such as Tums, Maalox, Mylanta or Gaviscon are considered safe. If acid reflux symptoms are not well controlled with antacids, you can add Zantac (category B) to cut down acid secretion. Tagamet is also category B but I think should be avoided since it has a higher risk of drug interactions and may feminize developing male laboratory rats.

The stronger acid medications (called proton pump inhibitors) such as Prilosec (Omeprazole) or Prevacid should only be used under medical supervision for severe heartburn late in pregnancy that has not responded to antacids and Zantac. Prilosec (category C) has caused some problems with laboratory animals. The prescription drug, Prevacid, is category B and is preferred over Prilosec during pregnancy. Other medications in this class have not been around long enough to determine safety in pregnancy.

Pain medicines, fever reducers

Acetaminophen (Tylenol) is category B and considered safe throughout pregnancy. The nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil or Motrin), Napoxen (Aleve) and aspirin should be avoided during pregnancy unless under medical supervision. NSAIDs may increase the risk of miscarriage during the first trimester. NSAIDs may decrease amniotic fluid levels and may cause heart problems in the newborn if the medicine is used during the last months of the pregnancy.

Nausea Pyridoxine (Vitamin B6) can be quite helpful in reducing morning sickness during the first few months of pregnancy (category A). Take one-half to one 25 mg pill three times a day for nausea. If no relief, add the antihistamine, doxylamine (Unisom Nighttime). Other Unisom products do not contain doxylamine.

Diarrhea

Most diarrhea is limited and resolves after several days and rarely needs treatment. If symptoms are quite bothersome, Imodium can be taken after the first trimester. Pepto Bismol and most Kaopectate products contain Bismuth subsalicylate that should not be used because it is an aspirin derivative.

Yeast infections

The antifungal creams - Femstat, Lotrimin, Monistat - are safe to apply in the vagina for a yeast infection during pregnancy.

Mosquito repellants

DEET is safe during pregnancy. Other products such as citronella have not been tested in pregnancy and are not as effective as DEET.

Nicotine

Smoking during pregnancy can cause multiple problems. Nicotine substitutes such as the gum or patch are considered safer than smoking and can be briefly tried if you need help to quit smoking during pregnancy.

Herbals and supplements

Supplements and herbal medicines should also be taken with caution during pregnancy and like other over-the-counter medications should be avoided whenever possible. In fact, herbals often have less data to support their safety during pregnancy.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, May 11, 2004