What cold medications are safe to use during the 3rd trimester of pregnancy?

Safe Cold Medications in Third Trimester Pregnancy

Acetaminophen (paracetamol) is the safest option for treating cold symptoms during the third trimester of pregnancy, and should be used at the lowest effective dose for the shortest possible time. 1, 2

First-Line Recommendation: Acetaminophen

• Acetaminophen is considered safe throughout all trimesters of pregnancy, including the third trimester, and is used by approximately 65% of pregnant women 1
• Use the lowest effective dose for the shortest duration to minimize any theoretical risks 3, 4
• Acetaminophen remains the safest analgesic and antipyretic option when medication is medically indicated during pregnancy 4
• There is no safer alternative for pain relief and fever reduction in pregnancy 4

Medications to AVOID in Third Trimester

NSAIDs (Ibuprofen, Naproxen, Others)

• All NSAIDs must be discontinued after gestational week 28 (some sources recommend stopping by week 32) 5
• Third trimester NSAID use causes premature closure of the fetal ductus arteriosus 5, 6
• Additional serious fetal risks include oligohydramnios (reduced amniotic fluid) and pulmonary hypertension in the newborn 5
• While NSAIDs can be used briefly (7-10 days) in the first and second trimesters, they are contraindicated in the third trimester 5, 6

Decongestants and Antihistamines

• Short-term use of cold medications is generally considered safe outside of the first trimester, though specific safety data for the third trimester is limited 1
• Most over-the-counter cold remedies contain multiple ingredients and show no increased risk with short-term use 2

Supportive Medications from Cancer Guidelines

While the following evidence comes from oncology supportive care guidelines, it provides relevant safety data:

• Antiemetics (ondansetron, metoclopramide) may be safely used beyond the first trimester 7
• Opioids have been administered in pregnant women beyond the first trimester without major adverse effects, though there is some risk of fetal respiratory depression near delivery 7

Practical Approach for Cold Symptoms

For Fever and Body Aches:

• Use acetaminophen as first-line treatment 1, 4
• Avoid all NSAIDs completely in the third trimester 5

For Congestion and Cough:

• Short-term use of over-the-counter cold medications appears safe, but read labels carefully to avoid NSAIDs 2
• Consult with a pharmacist to ensure products don't contain contraindicated ingredients 2

For Nausea (if present):

• Ginger is considered safe and effective for treating nausea in pregnancy 1

Critical Caveats

• Balance symptom severity against medication risks: Only use medication when medically indicated 3, 4
• Avoid prolonged use: All medications should be used for the shortest time necessary 5, 3
• Check all ingredients: Many cold medications contain NSAIDs or multiple active ingredients that may not be safe 2
• If NSAIDs were inadvertently used in the third trimester, immediate discontinuation and fetal assessment for ductal constriction and oligohydramnios is necessary 6