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Upper Respiratory Medications in Pregnancy
Aka: Upper Respiratory Medications in Pregnancy, Cold Preparations in Pregnancy
- See Also
- Medications in Pregnancy
- Over-The-Counter Medications in Pregnancy
- Background
- Pregnancy Categories will be replaced on medication bottles with specific warnings and precautions by 2020 in U.S.
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm425317.htm
- Although FDA Pregnancy Categories are no longer FDA designated, they are included here
- As of 2018, succinct guidance (to replace ABCDX) on specific drugs in pregnancy is lacking
- Class B: No risk in controlled animal studies
- Ammonium Chloride
- Azatadine
- Chlorpheniramine (Chlor-Trimeton)
- Antihistamine of choice in pregnancy (but sedating, limit to night-time)
- Clemastine (Tavist)
- Cyproheptadine
- Diphenhydramine (Benadryl)
- Oxytocin-like effect at high dose
- Crosses placenta
- Doxylamine (Unisom)
- Loratidine (Claritin)
- Best to avoid in first trimester
- Cetirizine (Zyrtec)
- Avoid in first trimester
- Meclizine (Antivert)
- Intranasal Budesonide (Rhinocort)
- Safe in pregnancy (but use lowest effective dose)
- Class C: Small risk in controlled animal studies
- Guaifenesin (Robitussin)
- Early use may be associated with Neural Tube Defects
- Avoid combination products containing Alcohol
- Avoid in first trimester
- Dextromethorphan (Robitussin DM)
- No increased risk in Collaborative Perinatal Project
- Intranasal Beconase AQ (beclomethasone)
- Benzonatate (Tessalon Perles)
- Codeine
- Avoid in first trimester
- Hydrocodone
- Diphenhydramine (Benadryl)
- Avoid in first trimester
- Pseudophedrine (Sudafed)
- Associated with Gastroschisis, small Intestinal Atresia and hemifacial microsomia (avoid in first trimester)
- Avoid in first trimester
- Brompheniramine
- Hydroxyzine (Atarax)
- Promethazine (Phenergan)
- Oxymetazoline (Afrin)
- Avoid in pregnancy (especially in first trimester)
- Significant absorption from the nasal mucose
- Fexofenadine (Allegra)
- Appears as safe in pregnancy as other Non-Sedating Antihistamines that are category B (Cetirizine, Loratadine)
- Andersson (2020) JAMA Pediatr 174(8): e201316 [PubMed]
- Class D: Strong Evidence of Risk to the Human Fetus
- Terpin Hydrate
- Iodides
- References
- Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
- Black (2003) Am Fam Physician 67(12):2517-24 [PubMed]
- Larimore (2000) Prim Care 27(1):35-53 [PubMed]