What is a safe cough suppressant to use during pregnancy?

From the Guidelines

Dextromethorphan is considered a safe cough suppressant during pregnancy when used as directed for short periods, but the most recent and highest quality evidence is limited to asthma management during pregnancy, which suggests that albuterol is the preferred short-acting beta2-agonist (SABA) for relieving bronchospasm associated with coughing 1. When considering a safe cough suppressant during pregnancy, it's essential to prioritize the health and well-being of both the mother and the baby.

• The goal is to maintain lung function and ensure oxygen supply to the fetus, as uncontrolled asthma increases the risk of perinatal mortality, pre-eclampsia, preterm birth, and low-birth-weight infants 1.
• Albuterol is the preferred SABA, with the most data related to safety during human pregnancy available for this medication 1.
• Inhaled corticosteroids, such as budesonide, are the preferred long-term control medication, but for acute cough suppression, albuterol may be a safer option 1.
• It's crucial to consult a healthcare provider before taking any medication during pregnancy, as individual health circumstances may affect recommendations.
• Non-medication approaches, such as drinking warm fluids, using throat lozenges, and staying hydrated, should be tried first to relieve cough symptoms.
• If medication is necessary, following the package instructions and not exceeding the maximum daily dose is essential to minimize potential risks.

From the FDA Drug Label

If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question.

From the Research

Safe Cough Suppressants During Pregnancy

• Dextromethorphan is considered safe to use during pregnancy, as studies have shown that it does not increase the risk of birth defects 2, 3.
• A controlled study of pregnant women who used dextromethorphan found no significant difference in the rates of major malformations compared to a control group 3.
• Another study found that dextromethorphan effectively diminishes the cough reflex sensitivity, but subjective measures do not support this finding 4.
• Inhaled corticosteroids are also considered safe to use during pregnancy, but caution must be taken with high doses 5.
• It is essential to consult a healthcare provider before taking any medication during pregnancy to discuss the potential risks and benefits.

Key Findings

• Dextromethorphan has been on the market for many years and has never been implicated as a human teratogen 2.
• The use of dextromethorphan during pregnancy does not increase the rates of major malformations above the expected baseline rate of 1% to 3% 3.
• Inhaled corticosteroids should be continued throughout pregnancy at low to moderate doses to control asthma symptoms and prevent exacerbations 5.

Medication Safety During Pregnancy

• All medications should be used with caution during pregnancy, and the safety of the mother and fetus should be considered paramount 6.
• Medications such as beta-lactam antibiotics, macrolides, and clindamycin are considered relatively safe to use during pregnancy, but the use of erythromycin and clarithromycin carries a certain risk 6.
• Non-selective NSAIDs, nasal decongestants, and intranasal corticosteroids can be used to relieve symptoms, but with caution and under the guidance of a healthcare provider 6.