Dextromethorphan Safety During Pregnancy
Dextromethorphan is considered safe to use during pregnancy as it has not been shown to increase the risk of birth defects above the baseline rate. 1
Safety Profile and Classification
- Dextromethorphan has been extensively used during pregnancy without evidence of increased teratogenic risk 1
- The FDA drug label for dextromethorphan recommends consulting a healthcare professional before use during pregnancy, but does not contraindicate its use 2
- A controlled study specifically examining dextromethorphan use during pregnancy found no increased risk of major malformations (2.3% in dextromethorphan users vs 2.8% in controls) 1
Evidence Supporting Safety
- A comprehensive controlled study following 184 women who used dextromethorphan during pregnancy found no increased risk of birth defects compared to matched controls 1
- Of the 128 women who used dextromethorphan during the first trimester (when teratogenic effects would be most concerning), only 2.3% had babies with major malformations, which is within the expected baseline rate of 1-3% 1
- Birth weights were comparable between dextromethorphan-exposed infants (3,381 ± 670g) and control infants (3,446 ± 571g) 1
Clinical Recommendations
- Dextromethorphan can be used for cough suppression during pregnancy when the maternal benefit outweighs any potential risk 2, 1
- Among over-the-counter medications used during pregnancy, dextromethorphan has shown an excellent safety profile 3
- Earlier concerns based on chicken embryo studies have been dismissed as this model is not appropriate for predicting human teratogenic potential 4
Important Considerations
- As with all medications during pregnancy, dextromethorphan should be used at the lowest effective dose for the shortest duration necessary 3
- The FDA drug label advises consulting a healthcare professional before use, which is standard guidance for most medications during pregnancy 2
- If cough persists beyond 7 days or is accompanied by fever, rash, or persistent headache, medical evaluation is recommended 2
Precautions
- Dextromethorphan should not be used concurrently with monoamine oxidase inhibitors (MAOIs) during pregnancy, as noted in the FDA warning 2
- Patients with sulfite allergies should be cautious as some dextromethorphan preparations contain sodium metabisulfite 2
- For chronic cough associated with conditions like asthma or emphysema, medical consultation is advised before using dextromethorphan 2