What cold medications are safe to use during pregnancy?

Safe Cold Medications During Pregnancy

For pregnant women experiencing cold symptoms, acetaminophen (paracetamol) for fever/pain and saline nasal sprays for congestion are the safest first-line treatment options. 1

First-Line Safe Options

• Acetaminophen (paracetamol) is the most widely used medicine during pregnancy, with 40-65% of pregnant women using it at some point during pregnancy 2
• Saline nasal sprays are safe and effective for nasal congestion throughout pregnancy 1
• Short-acting beta-agonists (SABAs) such as albuterol can be safely used if needed for respiratory symptoms during pregnancy 1
• Inhaled corticosteroids like budesonide and beclomethasone have the most safety data for respiratory symptoms during pregnancy 1

Acetaminophen Considerations

• Acetaminophen crosses the placenta relatively easily and has been reported in umbilical cord blood after maternal administration 2
• The FDA label for acetaminophen advises to "ask a health professional before use" if pregnant or breastfeeding 3
• While generally considered safe, recent observational studies suggest a potential association between prenatal acetaminophen use and adverse neurological outcomes in childhood 2
• As a precaution, acetaminophen should be used at the lowest effective dose for the shortest possible time 4

Medications to Avoid or Use with Caution

• NSAIDs (ibuprofen, diclofenac) should be used with caution in early pregnancy and avoided completely after 28 weeks gestation 1
• NSAIDs can cause oligohydramnios or narrowing/occlusion of the fetal ductus arteriosus in late pregnancy 2
• If NSAIDs are necessary in early pregnancy, nonselective NSAIDs with a short half-life (e.g., ibuprofen) at the lowest effective dose for a short time (7-10 days) are preferred 2

Special Considerations

• Untreated severe symptoms, particularly high fever or respiratory distress, can potentially pose more risk to both mother and fetus than judicious use of appropriate medications 1
• For pregnant women with pre-existing conditions like asthma, diabetes, or hypertension, medication choices should be discussed with their healthcare provider 1
• Prednisone and prednisolone are not associated with an increased rate of major birth defects and can be considered during pregnancy if needed to control active disease, but should be tapered to ≤5 mg/day when possible 2

Treatment Algorithm for Cold Symptoms in Pregnancy

1. For fever and pain: Acetaminophen at the lowest effective dose for the shortest duration 4
2. For nasal congestion: Saline nasal sprays as first-line therapy 1
3. For respiratory symptoms: Short-acting beta-agonists like albuterol if needed 1
4. For persistent cough or congestion: Inhaled corticosteroids like budesonide or beclomethasone have the most safety data 1
5. Avoid NSAIDs after 28 weeks gestation; use with caution in early pregnancy 2