Are Claritin (loratadine) and Flonase (fluticasone) safe to use during pregnancy?

Safety of Claritin (Loratadine) and Flonase (Fluticasone) During Pregnancy

Both Claritin (loratadine) and Flonase (fluticasone) are generally considered safe to use during pregnancy when medically necessary, with loratadine being FDA Pregnancy Category B and intranasal fluticasone having established safety data. 1

Antihistamines in Pregnancy

Loratadine (Claritin)

• Loratadine is classified as FDA Pregnancy Category B, indicating no evidence of harm to the fetus during pregnancy, though well-controlled studies in humans are limited 1
• Considered one of the preferred second-generation antihistamines during pregnancy due to its established safety profile 1, 2
• No epidemiological studies have shown an association between loratadine and congenital malformations 1
• Often recommended over first-generation antihistamines which can cause sedation 3

First vs. Second Generation Antihistamines

• First-generation antihistamines (like chlorpheniramine) have a longer history of use during pregnancy, but second-generation options like loratadine and cetirizine are now often preferred due to better side effect profiles 3, 4
• Diphenhydramine (a first-generation antihistamine) has been associated with development of cleft palate in some reports 1

Intranasal Corticosteroids in Pregnancy

Fluticasone (Flonase)

• Intranasal fluticasone is considered safe to use during pregnancy at recommended therapeutic doses 1, 5
• Expert panels recommend modern nasal corticosteroids including fluticasone for CRS (chronic rhinosinusitis) maintenance during pregnancy 1
• A placebo-controlled randomized study of fluticasone propionate nasal spray in 53 pregnant women showed no detectable influence on maternal cortisol levels or fetal growth 1
• No significant association with congenital organ malformations has been linked to intranasal use of fluticasone propionate or fluticasone furoate 5

Safety Considerations for Intranasal Steroids

• Intranasal corticosteroids have minimal systemic absorption compared to oral corticosteroids 1
• Budesonide has the most safety data among intranasal corticosteroids during pregnancy, but fluticasone is also considered safe 2, 5
• The benefits of treating maternal rhinitis symptoms generally outweigh the potential risks of these medications 1

General Considerations for Medication Use in Pregnancy

Risk-Benefit Assessment

• The potential benefits of treating allergic rhinitis during pregnancy should be weighed against the potential risks 5
• Untreated severe allergic symptoms can potentially affect maternal and fetal well-being through sleep disruption, reduced appetite, and increased stress 3
• Many pregnant women have heightened concerns about medication use, often avoiding even over-the-counter medicines due to safety concerns 6

Treatment Approach for Allergic Rhinitis in Pregnancy

• First-line approach should be allergen avoidance when possible 3
• Intranasal cromolyn sodium is considered first-line therapy with an excellent safety profile 3
• Second-line options include antihistamines like loratadine and intranasal corticosteroids like fluticasone 3, 4
• Oral decongestants should be avoided, particularly during the first trimester, due to reports of an association with congenital malformations 1

Summary

For pregnant women requiring treatment for allergic rhinitis:

• Loratadine (Claritin) is a preferred antihistamine option with FDA Category B rating 1
• Fluticasone (Flonase) intranasal spray is considered safe at recommended doses 1, 5
• Always use the lowest effective dose for the shortest duration necessary 1
• Consult with healthcare providers before initiating or continuing any medication during pregnancy 1