Upper Respiratory Medications in Pregnancy

1. See Also
   1. Medications in Pregnancy
   2. Over-The-Counter Medications in Pregnancy
2. 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
3. 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)
4. 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)
   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 (avoid in first trimester)
      2. Avoid in first trimester
   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 mucose
   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]
5. Class D: Strong Evidence of Risk to the Human Fetus
   1. Terpin Hydrate
   2. Iodides
6. 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]