Can a pregnant patient take Benadryl (Diphenhydramine)?

From the Guidelines

Pregnant patients can take Benadryl (diphenhydramine) when necessary, but with caution, due to some concerns over a potential association with cleft palate, as suggested by a case-control study 1. When considering the use of Benadryl during pregnancy, it's essential to weigh the benefits against the potential risks. The available human data for first-trimester use of antihistamines, including diphenhydramine, are generally reassuring, with no significant increase in congenital malformations 1. However, the concern over a possible link to cleft palate cannot be ignored. Some key points to consider when using Benadryl during pregnancy include:

• The standard adult dose of 25-50 mg every 4-6 hours as needed can be used, not exceeding 300 mg in 24 hours.
• It's recommended to use Benadryl for short periods rather than continuously throughout pregnancy.
• Pregnant patients should consult with a healthcare provider before taking any medication, including Benadryl.
• Non-medication approaches for managing allergies, such as avoiding triggers and using saline nasal sprays, should be tried first.
• Potential side effects of Benadryl, including dry mouth, dizziness, and constipation, may compound similar pregnancy symptoms. It's crucial to note that while Benadryl is classified as FDA Pregnancy Category B, indicating that animal studies haven't shown risk to the fetus, the medication should still be used judiciously and under medical guidance 1.

From the FDA Drug Label

If pregnant or breast-feeding, ask a healthcare professional before use

• The drug label advises pregnant patients to ask a healthcare professional before use.
• The label does not provide a clear answer to whether a pregnant patient can take Benadryl (Diphenhydramine).
• Therefore, a conservative clinical decision would be to consult a healthcare professional before taking Benadryl during pregnancy, as the label suggests 2.

From the Research

Medication Use During Pregnancy

• The use of over-the-counter (OTC) medications during pregnancy is common, despite the lack of randomized controlled trials to guide their use 3.
• Most OTC medications taken during pregnancy are for allergy, respiratory, gastrointestinal, or skin conditions, as well as for general analgesia 3.
• There is no specific mention of Benadryl (Diphenhydramine) in the provided studies, but it is an antihistamine commonly used to treat allergy symptoms.

Safety of Specific Medications

• Acetaminophen is generally considered safe during any trimester of pregnancy 3, 4.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally not recommended in pregnancy, especially during organogenesis and in the third trimester 3, 5.
• Histamine H2 blockers and proton pump inhibitors have not demonstrated significant fetal effects 3.

Precautions and Recommendations

• All OTC medication use should be discussed with patients, and the effects of the symptoms should be balanced with the risks and benefits of each medication 3.
• Pregnant women should be cautious when taking any medication, and alternatives should be considered when possible 4, 5.
• More research is needed to understand the risks and benefits of medication use in pregnancy, particularly as prevalence is rising 6.