Upper Respiratory Medications in Pregnancy

Aka: Upper Respiratory Medications in Pregnancy, Cold Preparations in Pregnancy, URI Medications in Pregnancy

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II. Background

  1. Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
    1. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
    2. Although FDA Pregnancy Categories are no longer FDA designated, they are included here
      1. As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
  2. Safest options in pregnancy are non-medication strategies
    1. See Upper Respiratory Infection
    2. Nasal Saline for congestion
    3. Cool mist humidifiers
    4. Honey 1-2 tsp as needed for cough

III. Class B: No risk in controlled animal studies

  1. Ammonium Chloride
  2. Azatadine
  3. Chlorpheniramine (Chlor-Trimeton)
    1. Antihistamine of choice in pregnancy (but sedating, limit to night-time)
  4. Clemastine (Tavist)
  5. Cyproheptadine
  6. Diphenhydramine (Benadryl)
    1. Oxytocin-like effect at high dose
    2. Crosses placenta
  7. Doxylamine (Unisom)
  8. Loratidine (Claritin)
    1. Best to avoid in first trimester
  9. Cetirizine (Zyrtec)
    1. Avoid in first trimester
  10. Meclizine (Antivert)
  11. Intranasal Budesonide (Rhinocort)
    1. Safe in pregnancy (but use lowest effective dose)

IV. Class C: Small risk in controlled animal studies

  1. Guaifenesin (Robitussin)
    1. Early use may be associated with Neural Tube Defects
    2. Avoid combination products containing Alcohol
    3. Avoid in first trimester
  2. Dextromethorphan (Robitussin DM)
    1. No increased risk in Collaborative Perinatal Project
  3. Intranasal Beconase AQ (beclomethasone)
  4. Benzonatate (Tessalon Perles)
    1. Lack of evidence of safety in pregnancy
  5. Codeine
    1. Avoid in first trimester
  6. Hydrocodone
  7. Diphenhydramine (Benadryl)
    1. Avoid in first trimester
  8. Pseudophedrine (Sudafed)
    1. Associated with Gastroschisis, small Intestinal Atresia and hemifacial microsomia
    2. Avoid in first trimester (and avoid in general due to low efficacy)
  9. Brompheniramine
  10. Hydroxyzine (Atarax)
  11. Promethazine (Phenergan)
  12. Oxymetazoline (Afrin)
    1. Avoid in pregnancy (especially in first trimester)
    2. Significant absorption from the nasal mucosa
  13. Fexofenadine (Allegra)
    1. Appears as safe in pregnancy as other Non-Sedating Antihistamines that are category B (Cetirizine, Loratadine)
      1. Andersson (2020) JAMA Pediatr 174(8): e201316 [PubMed]

V. Class D: Strong Evidence of Risk to the Human Fetus

  1. Terpin Hydrate
  2. Iodides

VI. References

  1. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
  2. Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
  3. Larimore (2000) Prim Care 27(1):35-53 [PubMed]

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