Is it safe to take cough syrup, specifically dextromethorphan, during pregnancy?

Dextromethorphan is Safe for Cough During Pregnancy

Dextromethorphan can be used safely during pregnancy for short-term symptomatic relief of cough, with no evidence of increased risk for birth defects or adverse pregnancy outcomes. 1, 2

Recommended Treatment Approach

First-Line Options (Start Here)

• Non-pharmacological remedies should be tried first: honey and lemon mixtures, adequate hydration, humidified air, and menthol inhalation 1, 2
• These simple measures are effective for acute viral cough and carry zero medication risk 1

When Pharmacological Treatment is Needed

• Dextromethorphan is appropriate for short-term use when non-pharmacological approaches are insufficient 1, 2
• Use the lowest effective dose for the shortest duration necessary 1
• The FDA label advises asking a health professional before use during pregnancy, but does not contraindicate it 3

Safety Evidence for Dextromethorphan

Human Studies Show No Teratogenic Risk

• A controlled study of 184 pregnant women (128 used dextromethorphan in first trimester) found major malformation rates of 2.3% versus 2.8% in controls—within the expected baseline rate of 1-3% 4
• Large epidemiologic case-control analysis found no relationship between dextromethorphan exposure and neural tube defects, congenital heart defects, or other birth defects 5
• Dextromethorphan has been on the market for many years without ever being implicated as a human teratogen 6

Widespread Use During Pregnancy

• Dextromethorphan is among the most commonly used over-the-counter medications during pregnancy, with usage increasing from 1976 to 2004 7
• Evidence-based information suggests no increased risk with short-term use 8

Special Considerations by Trimester

• First trimester: Exercise particular caution during organogenesis, but dextromethorphan remains acceptable when benefits justify use 2, 9
• Second and third trimesters: No special restrictions beyond general guidance 1

Contraindications and Precautions

Absolute Contraindications

• Current use of MAO inhibitors or within 2 weeks of stopping MAOI therapy 3
• Allergy to sodium metabisulfite (contained in some formulations) 3

When to Avoid or Seek Medical Advice

• Chronic cough associated with smoking, asthma, or emphysema—these require specific treatment 3
• Productive cough with excessive phlegm—may need expectorant instead 3
• Cough lasting more than 7 days, or accompanied by fever, rash, or persistent headache 3

Alternative Medications Based on Cough Etiology

For Asthma-Related Cough

• Albuterol is the preferred medication due to extensive safety data and favorable risk-benefit profile 1, 2
• Inadequate asthma control poses greater fetal risk than medication use 1, 2

For Productive Cough

• Guaifenesin (expectorant) can help thin mucus when benefit justifies potential risk 2, 9

For Allergy-Related Cough

• Second-generation antihistamines (loratadine or cetirizine) are preferred 1, 2
• First-generation antihistamines with sedative properties can suppress nocturnal cough 1

Medications to Avoid

• Oral decongestants: Avoid especially in early pregnancy due to potential association with rare birth defects 1, 2
• Codeine or pholcodine: No greater efficacy than dextromethorphan but significantly worse adverse effect profile 1, 2
• Combination products: Use cautiously to avoid unnecessary medication exposure 1, 2

Common Pitfalls to Avoid

• Failing to identify underlying cause: Determine if cough is from asthma, allergies, viral infection, or gastroesophageal reflux 1
• Using combination products unnecessarily: Single-ingredient products are preferable when they suffice 2
• Prolonged use without reassessment: Aim for shortest effective duration 2
• Treating symptom rather than cause: Address the underlying condition (asthma control, allergy management, GERD treatment) rather than just suppressing cough 2, 9