When you’re pregnant, the list of forbidden things seems to grow and change as much as the unborn baby does. Many things are general knowledge, such as illegal substances, smoking and alcohol.

It isn’t always considered, however, that over-the-counter drugs can be included in the things that can threaten your baby.

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Some OTC drugs should not be taken at all during the pregnancy and breastfeeding, while others are only safe to take during specific times of gestation.

#1 Aspirin

Aspirin is a common drug that is used as a pain reliever and fever reducer. It is also often recommended in small doses during or as a preventative for heart attacks and blot clotting. There are many OTC drugs that contain aspirin, including those labeled for migraine relief. Aspirin has blood thinning properties and is not recommended at any time while pregnant or breastfeeding unless it is used for specific conditions and supervised by a doctor. If taken, you or the unborn baby can experience random internal bleeding. You may also bleed excessively during the birth.

Possible Alternative: Tylenol (acetaminophen)

#2 Bismuth Subsalicylate

Heartburn and other gastrointestinal issues are common for many pregnant women, but before you reach for the pink liquid stuff or the chalky chewables consider how far along you are. These aids should only be used under strict monitoring by your doctor until the 20 week mark. From 20 weeks on, they are not recommended. Bismuth subsalicylate can cause the ductus arteriosis, a blood vessel that allows blood flow to bypass an unborn baby’s non-working lungs, to close prematurely, resulting in respiratory failure, and possibly death.

Possible Alternative: Imodium (loperamide)

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#3 Brompheniramine

If you are suffering from a cold or seasonal allergies, products containing brompheniramine should be avoided. Brompheniramine can lower blood pressure and cause constipation or difficulty urinating. With constant monitoring, they may be safe until the 36 week gestational period but only as needed and in the minimum dosage amounts possible. At 36 weeks and while breastfeeding, it should not be taken.

Possible Alternative: Zyrtec (cetirizine) and/or Claritin (loratadine) 

#4 Caffeine

Most women are aware that caffeine from beverages such as coffee and soda should be consumed in very small amounts. Unfortunately, there are several OTC drugs that contain caffeine. Look for pain and migraine relievers that contain this ingredient. They will often also contain aspirin. Consuming more than 200 milligrams of caffeine per day can be dangerous for your unborn baby, and can increase the chances of miscarriage. It is best to keep your caffeine intake much lower and count the amounts that are included in OTC products.

Possible Alternative: No Alternative

#5 Castor Oil

There’s an old wives tale that says a spoonful of castor oil can help trigger labor for pregnant women who have passed their due date. It is also known to help alleviate constipation. Additionally, it is well-known for its retched taste. Castor oil should not be taken at any point during pregnancy, even to help induce labor, or while breastfeeding. During pregnancy, the baby can also experience diarrhea which increases the risk of meconium at birth and all of the problems your baby could suffer as a result, such as respiratory distress. While breastfeeding, the baby can quickly become dehydrated from diarrhea.

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Possible Alternative: Increase exercise, fluid and fiber intake; may want to consider taking psyllium-based fiber supplements. 

#6 Chlorpheniramine

In the group of pregnancy blacklisted OTC drugs for allergies and colds, chlorpheniramine is included. Up to 36 weeks, it can be used with your doctor’s supervision. After that, it is no longer recommended for use. Several antihistamines, such as this one, carry the risk of causing the baby to experience serious side effects, such as seizures.

Possible Alternative: Zyrtec (cetirizine) and/or Claritin (loratadine) 

#7 Ibuprofen

Another fever reducer and pain reliever makes it to the forbidden list. Again, there are many OTC products that contain ibuprofen. Some products are otherwise safe but the ibuprofen makes them dangerous. The risk for bleeding, for both you and your baby, is too great.

Possible Alternative: Tylenol (acetaminophen)

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#8 Naproxen/Naproxen Sodium

Naproxen is a nonsteroidal anti-inflammatory drug. For many people, it works better in relieving pain for a longer period and requires less doses. Unfortunately, it can be harmful and should be avoided during certain gestational periods. Naproxen should not be taken during the first and third trimesters or while breastfeeding. It is only recommended during the second trimester and with strict medical supervision. If it is taken within the last three months of pregnancy, it can cause problems with the labor and delivery of the baby.

Possible Alternative: Tylenol (acetaminophen)

#9 Nicotine

Smoking can be very dangerous for your developing baby, including during breastfeeding. The same rule applies to cigarette alternatives such as patches and electronic cigarettes. It is the nicotine, among other chemicals, that presents the problem. Nicotine can cause your baby to suffer from low birth weight, premature birth, and an increased risk of lung problems. From smoking, a fetus can suffer from oxygen deprivation, which can cause numerous problems with brain development and motor function after birth.

Possible Alternative: No Alternative

#10 Phenylephrine/Pseudophedrine

These two drugs are found as the primary active ingredients in many well-known OTC antihistamine and decongestant products that are used to alleviate symptoms of the flu, colds, and allergies. Both of these drugs should be completely avoided during the first trimester. In the second and third trimesters, they should be used sparingly and with doctor supervision. Both of these drugs constrict blood vessels, which restricts blood flow to the baby. This can leave the baby susceptible to developing certain birth defects, such as gastroschisis, a condition that causes an opening in the abdominal wall.

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Possible Alternative: Increase fluid intake, avoid any tobacco or smoke irritants and consider using a steam to relieve any congestion.

Alternatives to Prohibited OTC Drugs Recap

Talk with your doctor about possible alternatives to the OTC drugs that are not recommended during pregnancy. Cold, flu, and allergy alternatives include loratadine and cetirizine.

An alternative for fever reducers and pain relievers includes acetaminophen. For gastrointestinal issues such as heartburn, diarrhea, and constipation, effective alternatives include loperamide and increasing fluid and fiber intake using psyllium-based fiber supplements.

Although there may be safer alternatives, you should always consult your doctor if you experience symptoms of a condition or illness that persist or worsen. There may be a different underlying condition present that needs to be properly addressed.

Quick Tips Before Taking Any OTC Drug

There are a few things to keep in mind before you take any over-the-counter drug during pregnancy. Many ailments can be addressed using non-drug methods, such as steam to alleviate stuffiness and a hot bath for achy muscles.

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In addition to consulting with your doctor, be sure to read the labels on the drugs completely to determine all the ingredients, whether they’re active or inactive. Consider the type of OTC drug. For example, vitamin and herbal supplements can also contain ingredients that aren’t safe.

Lastly, avoid multi-symptom products, such as those that can treat the symptoms of the flu, a cold, or allergies. While there might be something in them that is safe to use during pregnancy, there are likely more ingredients that are in the list of forbidden things.

Pregnancy takes a toll on a woman’s body. It is not uncommon to experience aches and pains. Many women also find they are more prone to sicknesses during pregnancy. Unfortunately, many of the over-the-counter drugs that would usually help become dangerous while you’re pregnant or breastfeeding.

Before you take any medication, always consult with your doctor to find out what’s safe and so he or she can monitor the health of you and your baby. There are some instances where the health and safety of the mother and the baby depend on the use of some medications, but you will need to thoroughly discuss all benefits and risks with your doctor.

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