It may feel safe to reach for over-the-counter (OTC) medicines, but there are several ingredients in the pharmacy aisles you (and baby) should avoid. Here are some common OTC medicines you should avoid during pregnancy, and treatment options you can consider instead.

Reminder: Always check with your doctor or ob/gyn before taking any medications. Avoid self-medicating during pregnancy.

If you have pain:

Avoid: aspirin, ibuprofen, naproxen

Aspirin, ibuprofen, and naproxen (among others) all belong to a family of pain relievers called non-steroidal anti-inflammatory drugs, or NSAIDs. Studies2 have found NSAID use in later trimesters to be associated with an increased risk of miscarriage. NSAID-use is generally least risky during the first trimester. The FDA3 also recently warned about a link between kidney issues in unborn babies and NSAID use during pregnancy.

In certain cases, your doctor may still recommend low-dose aspirin or other NSAIDs during your pregnancy. While NSAIDs can be used safely under doctor supervision, it’s recommended to avoid these active ingredients when looking for pain relief options at the pharmacy.

Common brand name items that contain these ingredients include:

  • Aspirin: Bayer® Aspirin, Alka-Seltzer®, Ecotrin®

  • Ibuprofen: Motrin®, Advil®

  • Naproxen: Aleve®, Naprelan®

Replace with: ice/heat packs, acetaminophen, lidocaine cream

Both ice and heat can be valuable sources of pain relief during pregnancy. Ice or heat packs should be applied for at most 20 minutes at a time and removed for at least 40 minutes before another is re-applied.

Acetaminophen is generally considered to be safe to use during pregnancy. However, newer studies4 have shown developmental risks associated with acetaminophen. These risks appear to be related to timing of exposure, duration, and dose. Because of these findings, it’s recommended to check with your doctor prior to using acetaminophen and use the drug sparingly. It’s important to remember not to take any more than 3,000 milligrams of acetaminophen (from all sources) in 24 hours.

If you’re experiencing strong pain and are looking for a topical treatment, ask your doctor if lidocaine cream is a safe option for you. Lidocaine is a local anesthetic that can help relieve pain by numbing the area to which it’s applied.

Common brand name items that contain these ingredients include:

If you have diarrhea:

Avoid: bismuth subsalicylate

Bismuth subsalicylate is commonly used to treat diarrhea, heartburn, and upset stomach. What many don’t know is this stomach relief option contains salicylate,5 a type of drug also found in aspirin.

Similar to other salicylates, bismuth subsalicylate should be avoided in the second and third trimesters due to increased risk for both the mother and fetus.

Common brand name items that contain bismuth subsalicylate include: Kaopectate®, Pepto-Bismol®, Kapectolin®

Replace with: loperamide

Loperamide is another common treatment option for diarrhea and is considered safe for pregnant women.

Common brand name items that contain loperamide include: Imodium®, Diamode®, Kaodene A-D®

If you have nasal or chest congestion:

Avoid: guaifenesin and guaifenesin-containing products

Little evidence is available to support safe, regular use of guaifenesin, among other cold medicines, in pregnancy. Several studies involving pregnant women taking guaifenesin have failed to report any increased risk of major malformations. However, the FDA hasn’t declared the ingredient as safe for use without doctor supervision.

Common brand name items that contain guaifenesin include: Cabinet Mucus Relief, Mucinex®, Tylenol Cold & Flu®

Replace with: saline drops/nasal spray, nasal irrigation, humidifier, steam

When it comes to congestion, home remedies are always preferred. If congestion is causing you misery, try some of these natural options:

  • Use a nasal spray, like Afrin®.

  • Rinse out your nasal cavity with a neti pot.

  • Invest in a humidifier. A humidifier can help to break up mucus,6 making it easier for you to cough it up.

  • Try catching some steam from a hot shower,7 a hot cup of tea, or a vaporizer. Steam can help moisten the air and loosen up congestion. Avoid steam that is too hot, as that can quickly cause burns.

If you have allergies:

Avoid: pseudoephedrine or phenylephrine-containing allergy products

Both pseudoephedrine and phenylephrine are commonly used for symptoms of congestion that come with allergy. Each ingredient can be taken alone or in combination with an allergy pill.

If your congestion can't be help with allergy medicine alone, pseudoephedrine can be an option in some pregnancies (second and third trimesters), under doctor supervision.

Common brand name items that contain these ingredients include:

Replace with loratadine, cetirizine, chlorpheniramine, diphenhydramine, intranasal steroid sprays, home remedies

The American College of Obstetricians and Gynecologists (ACOG) and The American College of Allergy, Asthma and Immunology (ACAAI)8 recommended chlorpheniramine as the antihistamine of choice for pregnant women. Because chlorpheniramine and diphenhydramine are older allergy medicines and have been studied more in the pregnant population, medical professionals tend to recommend them as first-line treatment options. Unfortunately, older antihistamines do tend to cause drowsiness.

Although not many studies have been done, newer over-the-counter allergy options are thought to be safe for use in pregnancy. Loratadine and cetirizine9 are two non-drowsy options doctors commonly recomend.

Common brand name items that contain these ingredients include:

  • Loratadine: Claritin®

  • Cetirizine: Zyrtec®

  • Diphenhydramine: Benadryl®, Unisom®, Dimetapp®

  • Chlorpheniramine: Aller-Chlor®, Chlo-Amine®, Chlor-Trimeton®

  • Intranasal steroid sprays: Flonase®, Nasacort®

If you have morning sickness or nausea:

Home remedies: pyridoxine (vitamin B6), ginger

The theme of treating issues during pregnancy is to start natural and seek medicine when necessary. One of the most common treatment options for morning sickness is vitamin B6, or pyridoxine. Studies10 have shown that this vitamin is a safe and effective therapy for nausea and vomiting in pregnancy.

Ginger has also been shown to provide relief11 from nausea in pregnancy, without risk for side effects or adverse events. Ginger can, however, affect your blood’s ability to clot. If you have pre-existing medical conditions, ask your doctor if ginger supplements are safe for you.

Medicine options: dimenhydrinate, meclizine, diphenhydramine

If morning sickness or nausea are big concerns during pregnancy, you’re in luck! Most over-the-counter medicine options are fair game.

Generally, dimenhydrinate, meclizine, and diphenhydramine are safe to during pregnancy. While these are effective options, they may cause excessive drowsiness. Always check with your doctor to see if these products are right for you.

Common brand name items that contain these ingredients include:

  • Dimenhydrinate: Dramamine® Original Formula

  • Meclizine: Dramamine® All Day Less Drowsy

  • Diphenhydramine: Benadryl®