Is ebastine (antihistamine) safe to use during the last trimester of pregnancy?

Ebastine Use During Last Trimester of Pregnancy

Ebastine should be avoided during the last trimester of pregnancy due to insufficient safety data and the availability of better-studied alternatives with established safety profiles. 1

Safety Concerns with Ebastine in Pregnancy

Ebastine is a second-generation, non-sedating antihistamine that has been used for allergic rhinitis and chronic idiopathic urticaria 2, 3. However, there are several important considerations regarding its use during pregnancy, especially in the third trimester:

• There is insufficient safety data specifically for ebastine use during pregnancy 1
• None of the antihistamines available today have been categorized as completely safe during pregnancy 4
• The British Journal of Dermatology guidelines recommend avoiding all antihistamines during pregnancy when possible 1

Preferred Antihistamines During Pregnancy

If antihistamine therapy is necessary during pregnancy, including the third trimester, the following options are preferred based on safety data:

1. First choice: Chlorphenamine (chlorpheniramine) - has the longest safety record in pregnancy 1
2. Second choices: Loratadine or cetirizine - FDA Pregnancy Category B drugs with no evidence of harm to the fetus, although well-controlled human studies are limited 1

Important Considerations for Antihistamine Use in Late Pregnancy

• Use the lowest effective dose for the shortest duration possible 1
• Be aware that first-generation antihistamines like chlorphenamine have sedating properties 1
• Avoid oral decongestants completely during pregnancy, especially when combined with antihistamines 5
• NSAIDs should be discontinued after gestational week 28 (end of second trimester) due to risks of premature closure of the ductus arteriosus 5

Management Algorithm for Allergic Symptoms in Third Trimester

1. First approach: Try non-pharmacological methods (allergen avoidance, saline nasal rinses)
2. If medication necessary: Use chlorphenamine at lowest effective dose
3. If first-generation antihistamines not tolerated: Consider loratadine or cetirizine
4. Avoid: Ebastine, bilastine, and other newer antihistamines with limited pregnancy safety data

Monitoring and Follow-up

• Monitor for sedation with first-generation antihistamines
• Discontinue treatment as soon as symptoms are controlled
• Consider intranasal corticosteroids as an alternative for allergic rhinitis, as they have a better safety profile during pregnancy 5

Remember that while treating allergic symptoms is important for maternal comfort, medication choices during the third trimester should prioritize fetal safety, particularly when approaching delivery.