What cough medicines are safe to take during pregnancy?

Safe Cough Medicines During Pregnancy

Dextromethorphan and guaifenesin are the safest cough medicines to use during pregnancy, while avoiding medications containing alcohol, codeine, and certain antihistamines.

First-Line Cough Medications in Pregnancy

Guaifenesin (Expectorant)

• FDA classifies guaifenesin as a medication where pregnant women should consult a healthcare professional before use 1
• Generally considered safe for use during pregnancy when used as directed
• Helps thin and loosen mucus in the airways, making coughs more productive
• Available in many over-the-counter formulations
• Should be used at the lowest effective dose for the shortest duration needed

Dextromethorphan (Cough Suppressant)

• Considered relatively safe during pregnancy
• Works by suppressing the cough reflex in the brain
• Useful for dry, non-productive coughs
• Should be used at recommended doses and for short durations

Medications to Avoid During Pregnancy

Codeine and Other Opioid-Based Cough Suppressants

• Should be avoided during pregnancy due to potential risks to the fetus
• Can cause respiratory depression in newborns, especially if used near term
• Risk of maternal dependence with prolonged use

Antihistamine Combinations

• Many combination cough medicines contain antihistamines
• Some antihistamines have limited safety data in pregnancy
• First-generation antihistamines may cause sedation and anticholinergic effects

Alcohol-Containing Formulations

• Many cough syrups contain alcohol
• Alcohol should be avoided during pregnancy
• Check ingredient lists carefully

Non-Pharmacological Approaches

Hydration

• Increased fluid intake helps thin mucus secretions
• Warm liquids can soothe irritated airways

Humidification

• Using a humidifier can add moisture to the air
• Helps relieve congestion and cough

Honey

• May help soothe cough (for women without gestational diabetes)
• Should not be given to infants under 12 months, but is safe for pregnant women

Special Considerations

Asthma-Related Cough

• Inhaled medications for asthma have been used for many years without documented adverse effects on the fetus 2
• Undertreated asthma resulting in severe exacerbation with maternal hypoxia can have adverse effects on the fetus 2
• Salbutamol (albuterol) is classified as compatible for use during pregnancy and is the preferred short-acting beta-agonist 3
• Budesonide is the preferred inhaled corticosteroid during pregnancy due to extensive safety data 3

Infection-Related Cough

• If cough is due to bacterial infection requiring antibiotics:
  • Beta-lactam and macrolide antibiotics are generally considered safe in pregnancy 4
  • TMP-SMZ (trimethoprim-sulfamethoxazole) should not be administered to pregnant women due to potential risk for kernicterus among infants 2

When to Seek Medical Attention

• Cough lasting more than 7 days
• Cough accompanied by fever, rash, or persistent headache
• Shortness of breath or wheezing
• Coughing up blood or discolored sputum
• Symptoms of dehydration

Pitfalls and Caveats

• Many over-the-counter cough medicines contain multiple ingredients - always check labels carefully
• Avoid self-medicating with combination products that may contain unsafe ingredients
• Untreated severe respiratory conditions pose greater risks to mother and fetus than medication side effects 3
• Monthly evaluations of respiratory status are essential if chronic respiratory conditions exist 3
• Failing to recognize risks of uncontrolled respiratory disease can lead to adverse outcomes for both mother and fetus 3

Remember that the benefits of treating significant symptoms often outweigh the theoretical risks of medication use during pregnancy. Always consult with a healthcare provider before taking any medication during pregnancy.