What can a pregnant patient take for a cough?

Safe Cough Treatments During Pregnancy

Start with honey and lemon mixtures as first-line treatment, then use dextromethorphan if symptoms persist, as these are the safest and most effective options for cough during pregnancy. 1, 2

First-Line Non-Pharmacological Approach

• Honey and lemon mixtures are the simplest, cheapest, and often most effective treatment for cough in pregnancy, recommended as the initial approach before any medications. 1, 2
• Voluntary cough suppression techniques can reduce cough frequency through central modulation of the cough reflex. 1
• Adequate hydration and avoiding irritants (especially tobacco smoke) improve maternal well-being with less need for medications. 1
• Menthol inhalation provides quick but temporary relief when needed for acute symptom control. 1, 2

Pharmacological Options When Non-Pharmacological Measures Fail

Preferred Medication: Dextromethorphan

• Dextromethorphan is the preferred antitussive during pregnancy due to its established safety profile and effectiveness. 1, 2
• The effective dose is 30-60 mg, with maximum cough suppression at 60 mg. 1
• Use the lowest effective dose for the shortest duration necessary. 3
• The FDA label advises asking a health professional before use if pregnant or breastfeeding, but does not contraindicate its use. 4

Alternative for Productive Cough

• Guaifenesin can be considered for cough with excessive mucus, though the FDA label recommends consulting a health professional before use in pregnancy. 5

Medications to AVOID

• Codeine and pholcodine should NOT be used - they have no greater efficacy than dextromethorphan but carry a much greater adverse side effect profile. 6, 1
• First-generation sedating antihistamines should be avoided due to sedative and anticholinergic effects. 2
• Combination products containing multiple ingredients should be used cautiously to avoid unnecessary medication exposure. 3

Special Considerations for Asthma-Related Cough

• If cough is related to asthma or bronchospasm, albuterol is the preferred treatment with the most extensive safety data in pregnancy. 6, 3, 2
• Maintaining asthma control is safer for both mother and fetus than leaving symptoms untreated, as uncontrolled asthma increases risks of perinatal mortality, pre-eclampsia, preterm birth, and low-birth-weight infants. 6
• Budesonide is the preferred inhaled corticosteroid if controller medication is needed, with the most safety data during pregnancy. 6, 2

When to Escalate Care

• Re-evaluate if cough persists beyond 7 days or is accompanied by fever, shortness of breath, or other concerning symptoms. 1, 5, 4
• Consider underlying causes such as asthma (which may worsen in one-third of pregnant women), gastroesophageal reflux, or infection requiring specific treatment. 6, 1, 3
• Frequent symptom recurrence indicates inadequate control and warrants further evaluation. 3

Critical Safety Principle

It is safer to treat pregnant women with appropriate medications than to allow persistent respiratory symptoms that could compromise oxygen supply to the fetus. 6, 1, 2 Maternal hypoxia from uncontrolled symptoms poses greater risk than appropriate medication use. 2