What allergy medication is safe to take when pregnant

The most common GI problems that happen during pregnancy include nausea, vomiting, acid reflux, diarrhea, and constipation. Drug therapy may be required when lifestyle modifications cannot provide adequate relief of symptoms.

While nausea and vomiting are common indicators of early pregnancy, an extreme manifestation of the condition is termed hyperemesis gravidarum.

What allergy medication is safe to take when pregnant

Severe hyperemesis gravidarum complications—including weight loss >5% of initial body weight, electrolyte imbalance, and dehydration— are the second most common reason for prenatal hospitalization.20 A variety of medications with diverse mechanisms of action that own been used to treat nausea and vomiting of pregnancy are listed in TABLE 3.20-22

Acid reflux is another common problem estimated to happen in 30% to 50% of every pregnancies.23 Due to the pressure on the uterus, acid reflux during pregnancy is less likely to reply to lifestyle modifications such as elevation of the head when sleeping, eating little frequent meals, or avoiding eating within 3 hours of bedtime.24 OTC antacids are considered the agents of first choice with the exception of magnesium trisilicate (Gaviscon) and sodium bicarbonate (Neut), which should be avoided during pregnancy.

Long-term use of high-dose magnesium trisilicate has been associated with increased risk of fetal nephrolithiasis, hypotonia, and respiratory distress; sodium bicarbonate has been associated with metabolic acidosis and fluid overload.23 A variety of agents that own been used to treat acid reflex during pregnancy are listed in TABLE 3.20-22

Diarrhea and constipation are also frequent problems associated with pregnancy. TABLE 3 lists agents used to treat these conditions.20-22 Castor oil and mineral oil should be avoided for the treatment of constipation. Alosetron (Lotronex) is only indicated for irritable bowel syndrome (IBS)–associated diarrhea.

Bismuth subsalicylate (Pepto-Bismol, Kaopectate) should be avoided in pregnancy because the salicylate moiety can lead to increased perinatal mortality.21



Pain

Acetaminophen is the most commonly used OTC analgesic in pregnancy, with at least 65.5% of women taking it at some point during pregnancy and 54.2% taking it during the first trimester.12 The use of single-ingredient acetamino-phen products during pregnancy has not been associated with increased risk of a wide range of birth defects.13-15 Due to its antipyretic effects, single-ingredient acetaminophen products own been associated with a decreased risk of some birth defects arising from febrile infection during pregnancy.14

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible during pregnancy.

A recent study found that although the use of NSAIDs in early pregnancy does not appear to be a major risk factor for birth defects, there were a few moderate associations between NSAIDs and specific birth defects.16 Another major concern is the increased risk of miscarriage that has been associated with the use of nonaspirin NSAIDs during pregnancy.17 The use of NSAIDs during pregnancy is also associated with premature closure of the ductus arteriosus, fetal renal toxicity, and inhibition of labor.4,15,18 Although there are limited reproductive studies involving the use of narcotic analgesics in human pregnancies, these drugs own been used in therapeutic doses for numerous years by pregnant women without a link to an elevated risk of birth defects.15,19 The use of opioids should be reserved for pain that is not managed with acetaminophen and, when possible, the lowest effective dose should be used.15


Cough, Freezing, and Allergy

It is extremely common for women to experience cough, freezing, or allergy symptoms during pregnancy.

The use of multiple OTC medications to treat these symptoms increases from the first to the third trimester. According to one study, 92.6% of the obstetric population interviewed self-medicated with OTC medications.2 The common freezing is typically caused by numerous viruses and, therefore, is generally self-limiting. Pregnant women should be advised to first attempt nonpharmacologic treatments such as a saline nasal spray, the use of a humidifier, and increased hydration.9,10 The most commonly used cough, freezing, and allergy products include antihistamines, decongestants, antitussives, and expectorants (TABLE 2).1


It appears that the older sedating antihistamines, also known as first-generation agents, are safe in pregnancy.

The recommended first-line agent is chlorpheniramine (Chlor-Trimeton), which is Category B. According to the Collaborative Perinatal Project, chlorpheniramine use during pregnancy was not associated with an increased risk of malformations.7 Diphenhydramine (Benadryl) is also an option in patients who need symptomatic relief from allergy or freezing symptoms. It is also Category B and was not associated with an increased risk of malformations; however, it can cross the placenta and has been reported to own possible oxytocin-like effects at high doses when used during labor.9

The newer nonsedating or second-generation antihistamines, such as loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec), own not been extensively studied.

Cetirizine may be alternative to chlorpheniramine in the second or third trimester if a first-generation antihistamine is not tolerated.9,10

istration of both inhaled and oral decongestants occurs during pregnancy. Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are the most common oral OTC decongestants used, with 25% of pregnant women using pseudoephedrine as their oral decongestant of choice.11 However, its use should be avoided during the first trimester due to associated risk of defects from vascular disruption known as gastroschisis. Inhaled decongestants such as oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine) are both Category C and appear to be safe for use.

The primary cough remedy used during pregnancy is dextromethorphan (Delsym).

Numerous studies propose that there is no association between dextromethorphan use and an increased risk of birth defects.9,10 However, numerous of the OTC products containing dextromethorphan also contain alcohol and should be avoided during pregnancy.

Guaifenesin (Mucinex) is the expectorant typically found in most OTC freezing medications. Its use appears to be safe during pregnancy, with the exception of the first trimester.9


Do the Benefits Outweigh the Risks?

Drug use during pregnancy continues to remain a major concern due to the unknown effects on mom and fetus.

Physicians are faced with hard situations as they own extremely little information to assist them decide whether the potential benefits to the mom outweigh the risks to the unborn fetus. To assist guide physicians in their selection and interpretation of the risks associated with the drug, the FDA introduced a drug classification system in 1979 (TABLE 1).4-7 Most information provided in this classification is derived from animal studies and uncontrolled studies in humans such as postmarketing surveillance reports. To date, extremely few well-controlled studies own been conducted in pregnant women, most likely due to ethical considerations.

Two significant limitations of the classification include5-7:

  1. All new FDA-approved medications are classified as Category C
  2. There are no FDA regulations requiring further studies or seeking more data; therefore, changes in the classification are rare.

    What allergy medication is safe to take when pregnant

    In addition, the classification is often not changed when new data become available.

Approximately 20 to 30 of the most commonly used drugs are identified as teratogens, with 7% of the more than 1,000 medications listed in the Physicians’ Desk Reference classified as Category X.7 Some of the commonly used drugs with proven teratogenic effects in humans are warfarin, isotretinoin, valproic acid, and tetracycline antibiotics.

The timing of fetal exposure to a drug is critical to the likelihood of an adverse effect occurring. Most of the major body structures are formed during the first trimester, and exposure during this time could lead to structural teratogenic effects.8 Some drugs own diverse FDA categorizations based on the trimester of pregnancy.

As pharmacists, we frolic a vital role in educating and counseling pregnant women on the risks associated with a drug.

Informing a pregnant lady of the risks and possible fetal defects can reduce the number of complications. Furthermore, it is our responsibility to ensure that other health care professionals are familiar with the current literature available on the safety of drugs istered during pregnancy. This article will present a concise discussion of common medications used to treat pregnancy-associated conditions, including cough, freezing, and allergies; pain; and gastrointestinal (GI) disorders; as well as provide an update on the current immunization recommendations for pregnancy.


Conclusion

Most women will take medications at some point during pregnancy.

It is significant to consider the risks and benefits of drug therapy to both mom and fetus. The decision to treat should be based on a number of factors, including the safety profile of the drugs in question, symptom severity, and potential for quality-of-life improvement.

REFERENCES

1. Black RA, Hill DA. Over-the-counter medications in pregnancy. Am Fam Physician. 2003;67:2517-2524.
2. Glover DD, Amonkar M, Rybeck BF, Tracy TS. Prescription, over-the-counter, and herbal medicine use in a rural, obstetric population. Am J Obstet Gynecol. 2003;188:1039-1045.
3. Andrade SE, Gurwitz JH, Davis RL, et al. Prescription drug use in pregnancy.

Am J Obstet Gynecol. 2004;191:398-407.
4. Gunatilake R, Patil AS. Drugs in pregnancy. Merck Manual Online for Health Care Professionals. January 2013. www.merckmanuals.com/professional/gynecology_and_obstetrics/drugs_in_pregnancy/drugs_in_pregnancy.html?qt=drugspregnancy&alt=sh. Accessed May 15, 2013.
5. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998;338:1128-1137.

What allergy medication is safe to take when pregnant

6. Invasive cancer incidence—United States, 2009. MMWR Morb Mortal Wkly Rep. 2013;62:113-118.
7. Hansen WF, Peacock AE, Yankowitz J. Safe prescribing practices in pregnancy and lactation. J Midwifery Womens Health. 2002;47:409-421.
8. Rakusan K. Drugs in pregnancy: implications for a cardiologist. Exp Clin Cardiol. 2010;15:e100-e103.
9. Cough and freezing medicine use in pregnancy. Pharm/Prescr Ltr. 2006;22:221112.
10. Erebara A, Bozzo P, Einarson A, Koren G.

Treating the common freezing during pregnancy. Can Fam Physician. 2008;54:687-689.
11. Cabbage LA, Neal JL. Over-the-counter medications and pregnancy: an integrative review.

What allergy medication is safe to take when pregnant

Nurse Pract. 2011;36:22-28.
12. Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol.

What allergy medication is safe to take when pregnant

2005;193:771-777.
13. Rebordosa C, Kogevinas M, Bech BH, et al. Use of acetaminophen during pregnancy and risk of adverse pregnancy outcomes. Int J Epidemiol. 2009;38:706-714.
14. Feldkamp ML, Meyer RE, Krikov S, Botto LD. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study. Obstet Gynecol. 2010;115:109-115.
15. Analgesics in pregnancy and lactation. Pharm/Prescr Ltr. February 2012.

PL Detail-Document #280211. http://twileshare.com/uploads/Analgesics.pdf. Accessed May 15, 2013.
16. Hernandez RK, Werler MM, Romitti P, et al. Nonsteroidal anti-inflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol. 2012;206:228.e1-228.e8.
17. Nakhai-Pour HR, Broy P, Sheey O, Bérard A.

What allergy medication is safe to take when pregnant

Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. 2011;183:1713-1720.
18. Koren G, Florescu A, Costei AM, et al. Nonsteroidal anti-inflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: a meta-analysis. Ann Pharmacother. 2006;40:824-829.
19. Babb M, Koren G, Einarson A. Treating pain in pregnancy. Motherisk.

2010. www.motherisk.org/prof/updatesDetail.jsp?content_id=922. Accessed May 15, 2013.
20. King TL, Murphy PA. Evidence-based approaches to managing nausea and vomiting in early pregnancy. J Midwifery Womens Health. 2009;54:430-444.
21. Gastrointestinal drug use in pregnancy. Pharm/Prescr Ltr. 2006;22:221210.
22. Anderka M, Mitchell AA, Louik C, et al. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol. 2012;94:22-30.
23.

What allergy medication is safe to take when pregnant

Mahadevan U, Kane S. American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006;131:283-311.
24. Mahadevan U, Kane S. American Gastroenterological Association Institute medical position statement on the use of gastrointestinal medications in pregnancy. Gastroenterology. 2006;131:278-282.
25. Guidelines for vaccinating pregnant women. Vaccines & immunizations. CDC. www.cdc.gov/vaccines/pubs/preg-guide.htm.

Accessed May 22, 2013.
26. Healy CM, Rench MA, Baker CJ. Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants. Clin Infect Dis. 2013;56:539-544.
27. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, Inc; 2013.

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Read More On: WOMEN'S HEALTH

Always check with your Women’s Care physician if you own questions about taking medications during pregnancy. Listed under are a few recommendations for over-the-counter options that you may take while pregnant.

Find a Women’s Care Physician

Allergy Medications

Benadryl

Claritin

Loratadine

Sudafed PE

Tylenol Allergy Multi Symptom
Zyrtec

Allergy Eye Drops

Medicated Allergy Eye drops not recommended during pregnancy; may use Saline only

Nasal Spray

Medicated Nose Sprays not recommended during pregnancy; may use Saline

Cold & Flu

TheraFlu Flu & Sore Throat

Cough & Cold

Robitussin DM

Cough & Cold: Freezing Rubs

Halls Menthol Cough Suppressant / Oral Anesthetic

Vicks VapoRub Cough Suppressant / Topical Analgesic

Cough & Cold: Freezing Drops

Halls Menthol-Cough Suppressant / Oral Anesthetic Plus Medicine

Ricola Cough Suppressant Throat Drops

Vicks Menthol Cough Suppressant / Oral Anesthetic Drops

Cough & Cold: Sore Throat Relief

Cepacol Dual Relief Sore Throat Spray

Cepacol Sugar Free Additional Strength Sore Throat Lozenges with Pain Numbing Relief

Cepacol Maximum Strength Sore Throat Lozenges

First Aid: Anti-Itch Cream

Aveeno Athletic Naturals Anti-Itch Concentrated Lotion

Aveeno Calamine & Pramoxine HCl Anti-Itch Cream with Natural Colloidal Oatmeal Steroid Free

Benadryl Original or Additional Strength Itch Stopping Cream or Gel

Calamine Lotion

Cortaid Anti-Itch Cream, Maximum Strength1% Hydrocortisone

Cortizone-10 Maximum Strength Anti-Itch Cream

Eucerin Calming Itch Relief Treatment

Gold Bond Medicated Body Lotion Additional Strength or Anti-Itch Cream

Lanacane Maximum Strength Anti-Itch Cream

Sarna Anti-itch Lotion

Lice Treatment

NIX

Pain Relief

*Long-term chronic use is not advised.

Tylenol Regular or Additional Strength

Tylenol Additional Strength PM Pain Reliever /Sleep Aid

Tylenol PM Additional Strength Pain Reliever /Nighttime Sleep Aid

Hemorrhoid Care

Anusol

Preparation H

Medicated Wipes with Aloe

Hemorrhoidal Cream with Maximum Strength Pain Relief

Hemorrhoidal Ointment

Hemorrhoidal Suppositories

Tucks Witch Hazel Hemorrhoidal Medicated Pads

Stomach Remedies: Antacids

Gaviscon

Antacid with Calcium, Chewable Tablets

Extra Strength Antacid, Chewable Tablets

Extra Strength Liquid Antacid

Maalox Maximum Strength Multi-Symptom Antacid/Antigas, Chewable Tablets or Liquid

Mylanta Antacid / Anti-Gas

– Regular Strength

– Maximum Strength

– Ultimate Strength Pepcid AC Original Strength Acid Reducer 10 mg, Tablets

Rolaids

– Additional Strength

Multi-Symptom Antacid & Anti-Gas

Plus Additional Strength Antacid & Anti-Gas

Tagamet 200mg

Tums

– Regular Strength

E-X 750 Additional Strength

E-X 750 Additional Strength

Ultra 1000 Maximum Strength

Zantac 75mg

Stomach Remedies: Anti-Diarrheal

* Call before taking to assess medical condition.

Imodium A-D Anti-Diarrheal

Imodium A-D Advanced Anti-Diarrheal /Anti-Gas Caplets

Maalox Anti-Diarrheal Caplets

Stomach Remedies: Fiber Supplements

Citrucel Methylcellulose Fiber Therapy for Regularity

Fiber Choice Fiber Supplement

Metamucil Fiber Laxative

Stomach Remedies: Gas Relief

Gas-X Additional Strength Anti-gas

Gas-X Additional Strength Anti-gas Plus Antacid with Maalox

Mylanta Regular or Maximum Strength Gas Simethicone /Anti-Gas Phazyme Ultra Strength Gas Relief

Rolaids Multi-Symptom Antacid & Anti-gas

Stomach Remedies: Nausea/Vomiting

* Contact us if you are unable to hold any food or liquids below for 24 hours.

Emetrol Nausea Relief

Vitamin B6 100mg

Sea-Band Wristbands

Stomach Remedies: Stool Softeners

Colace Stool Softener 50 mg

Colace Stool Softener 100 mg

Vaginal Yeast Infections

Monistat 7 Cream

Monistat 7 Suppositories

Medications that are safe to take for freezing symptoms during pregnancy:

  • Acetaminophen (Tylenol)
  • Cough drops
  • Dextromethorphan (Robitussin)
  • Sore throat sprays or lozenges
  • Vaporizers or saline nose drops/sprays
  • Mentholated rubs
  • Sudafed PE or products containing Phenylephrine HCL- avoid using during the first 14 weeks of pregnancy
  • Vitamin C

*Call your doctor if you experience a severe headache unrelieved by Tylenol or persistent vomiting or diarrhea greater than 24 hours.

How to prevent the spread of influenza and freezing viruses:

*Call your doctor if you experience a severe headache unrelieved by Tylenol or persistent vomiting or diarrhea greater than 24 hours.

How to prevent the spread of influenza and freezing viruses:

  • Avoid touching eyes, nose or mouth, which may increase the chance of infection.
  • Cover your mouth and nose with a tissue when sneezing or coughing.
  • Wash your hands frequently, especially after shaking hands or touching anything dirty.

    Scrub with soap and boiling water for at least 30 seconds.

  • Stay home from work and school when you are sick.
  • Avoid sharing food, eating utensils, drinking glasses, pens and pencils, towels and other personal items.
  • Don’t reuse or share bottles of water.

How does this medication work?

What allergy medication is safe to take when pregnant

What will it do for me?

This combination product contains two medications: senna and docusate sodium. Senna belongs to the class of medications called stimulant laxatives. Docusate sodium belongs to the family of medications known as stool softeners. Senna works by increasing the muscle activity in the digestive system, causing waste material to be eliminated as stool. Docusate sodium works by increasing the quantity of water in the stool, making stools softer and easier to pass.

This combination medication is used to treat occasional constipation due to hard stools. Specifically, it is recommended for women who own recently given birth; people for whom hard, dry stools should be avoided (e.g., people with hemorrhoids or anal fissures); and people for whom stool straining should be avoided (e.g., people with heart disease).

This combination generally produces a stool between 6 and 12 hours after taking the medication.

This medication may be available under multiple brand names and/or in several diverse forms. Any specific brand name of this medication may not be available in every of the forms or approved for every of the conditions discussed here. As well, some forms of this medication may not be used for every of the conditions discussed here.

Your doctor may own suggested this medication for conditions other than those listed in these drug information articles. If you own not discussed this with your doctor or are not certain why you are taking this medication, speak to your doctor.

Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they own the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How does this medication work? What will it do for me?

This combination product contains two medications: senna and docusate sodium. Senna belongs to the class of medications called stimulant laxatives.

Docusate sodium belongs to the family of medications known as stool softeners. Senna works by increasing the muscle activity in the digestive system, causing waste material to be eliminated as stool. Docusate sodium works by increasing the quantity of water in the stool, making stools softer and easier to pass.

This combination medication is used to treat occasional constipation due to hard stools. Specifically, it is recommended for women who own recently given birth; people for whom hard, dry stools should be avoided (e.g., people with hemorrhoids or anal fissures); and people for whom stool straining should be avoided (e.g., people with heart disease).

This combination generally produces a stool between 6 and 12 hours after taking the medication.

This medication may be available under multiple brand names and/or in several diverse forms. Any specific brand name of this medication may not be available in every of the forms or approved for every of the conditions discussed here. As well, some forms of this medication may not be used for every of the conditions discussed here.

Your doctor may own suggested this medication for conditions other than those listed in these drug information articles. If you own not discussed this with your doctor or are not certain why you are taking this medication, speak to your doctor.

Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they own the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.


Immunizations

Women who are considering pregnancy or those already pregnant should be advised on the importance of receiving vaccines. Informing these patients of the benefits of receiving certain vaccinations can significantly reduce the occurrence of preventable diseases.

With the numerous vaccines available, and pharmacists at the front lines as immunizers, it is significant to discuss the agents utilized for specific groups of patients. The following are a few of the current recommendations for vaccine use during pregnancy.

The most current update to the immunization schedule was the recommendation to ister tetanus, diphtheria, and acellular pertussis (Tdap) vaccine with each pregnancy during the 27th to 36th week of gestation. This is diverse from prior recommendations that were dependent upon previous vaccination history.

Waiting until the second trimester is reasonable to minimize concerns about possible adverse reactions.25 Healy et al concluded that the infants of mothers immunized either before their pregnancy, or in early gestation, displayed insufficient antibodies to aid in baby protection from disease.26 Furthermore, the antibodies that were transferred were lost within a 6-week period, which could possibly put the baby at risk of infection.26

Influenza vaccination should be recommended for every pregnant women for prevention of seasonal influenza and can be istered in any trimester.

It is most beneficial when given as early as available in the flu season.27 The immunizations contraindicated during pregnancy are live vaccinations, which include influenza (LAIV); measles, mumps, and rubella (MMR); varicella; and zoster.25


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