What are safe medications for upper respiratory viral illness during pregnancy?

Safe Medications for Upper Respiratory Viral Illness During Pregnancy

Acetaminophen and saline nasal rinses are the safest first-line treatments for upper respiratory viral illness during pregnancy, while intranasal corticosteroids can be used for persistent nasal symptoms. 1, 2

First-Line Safe Medications

• Acetaminophen is safe for pain and fever control during pregnancy, though patients should consult a healthcare professional before use 2
• Saline nasal rinses are effective and safe for managing nasal congestion during pregnancy 1
• Dextromethorphan may be used for cough after consulting a healthcare professional 3

Safe Intranasal Medications

• Intranasal corticosteroids such as budesonide, fluticasone, and mometasone are considered safe for controlling nasal symptoms during pregnancy 1, 4
• These medications should be used at the lowest effective dose for the shortest duration necessary 4

Medications to Avoid

• Phenylephrine should be avoided during pregnancy, especially in the first trimester, due to potential fetal risks including congenital malformations 1
• First-generation antihistamines with sedative properties should generally be avoided during pregnancy 1, 4
• Oral decongestants should not be used, particularly during the first trimester, due to potential association with congenital malformations 1, 5

Special Considerations for Influenza

• All women who are pregnant or planning pregnancy should receive the influenza vaccine 6
• For pregnant women who develop influenza, supportive care is the primary treatment 6
• Antiviral medications for influenza should be reserved for cases where benefits outweigh risks 6, 7
• Oseltamivir may cause nausea and vomiting but limited data show few women discontinue treatment due to these side effects 7
• Zanamivir should be used with caution in pregnant women with underlying respiratory conditions such as asthma 7

Important Clinical Considerations

• The first trimester carries the highest risk for medication-induced teratogenicity, so non-urgent treatments should be carefully evaluated during this period 4
• Untreated severe respiratory conditions can pose risks to maternal and fetal health, highlighting the need for appropriate management 1
• Viral respiratory infections during pregnancy are associated with increased risk of preterm delivery and lower birth weight 8
• Pregnant women with asthma have more common colds during pregnancy and experience more severe symptoms than pregnant women without asthma 9

Management Algorithm

1. Start with non-pharmacological approaches:

   • Rest, adequate hydration, and humidity 10
   • Saline nasal rinses for nasal congestion 1

2. For symptomatic relief:

   • Acetaminophen for fever and pain 2
   • Dextromethorphan for cough if benefits outweigh risks 3

3. For persistent nasal symptoms:

   • Intranasal corticosteroids (budesonide, fluticasone, or mometasone) 1, 4

4. For suspected influenza:

   • Consider antiviral treatment if benefits outweigh risks 6, 7
   • Monitor closely for complications 11

5. Seek medical attention for:

   • Difficulty breathing or shortness of breath 11
   • High fever unresponsive to acetaminophen 10
   • Decreased fetal movement 11