When you’re pregnant, even a simple headache or stuffy nose can feel overwhelming. You don’t want to risk your baby’s health, but you also don’t want to suffer. The good news? Many common medications are safe during pregnancy - if you know which ones and how to use them correctly.
What’s Actually Safe? The Evidence-Based List
Not all over-the-counter drugs are created equal when you’re expecting. Some are fine. Others can be risky - especially after the first trimester. The key is sticking to medications backed by real data, not myths or old advice.
For allergies, cetirizine (Zyrtec) and loratadine (Claritin) are consistently recommended by top medical groups like the American College of Obstetricians and Gynecologists (ACOG) and MotherToBaby. Both are non-drowsy, and studies tracking over 35,000 pregnancies show no increased risk of birth defects. Stick to the standard dose: 10mg once daily. Avoid anything with decongestants like pseudoephedrine unless your provider says it’s okay.
For congestion, saline nasal sprays are the gold standard. They work without chemicals, and you can use them as often as needed. If you need something stronger, guaifenesin (Mucinex) is safe in plain form - just skip the multi-symptom versions that hide decongestants or antihistamines. And never use nasal sprays like Afrin for more than three days in a row. They can cause rebound congestion, making your nose even more blocked.
Pain Relief: What Works, What Doesn’t
Acetaminophen (Tylenol) is the only pain reliever widely approved for use throughout pregnancy. It’s been studied in hundreds of thousands of pregnancies and remains the top choice for headaches, muscle aches, and fever. But here’s the catch: don’t go overboard.
Most guidelines, including those from the University of Michigan and Woman’s Hospital Baton Rouge, say not to exceed 3,000mg in 24 hours. That’s six regular-strength 500mg tablets. Tylenol PM? Avoid it. It combines acetaminophen with diphenhydramine (an antihistamine), which can cause drowsiness and isn’t meant for daily use during pregnancy.
Now, what to avoid: ibuprofen (Advil), naproxen (Aleve), and aspirin. These are NSAIDs. They’re fine in early pregnancy, but after 20 weeks, they can affect your baby’s kidneys and reduce amniotic fluid. ACOG and the FDA both warn against them in the third trimester. Even a single dose can be risky if you’re past 28 weeks.
Heartburn and Digestion: Simple Fixes That Work
Heartburn is nearly universal in pregnancy - especially in the second and third trimesters. The good news? You have safe, effective options.
Calcium carbonate (Tums) is the most recommended antacid. It’s safe, fast-acting, and doubles as a calcium supplement. Use it as needed, but don’t go over 2,400mg of elemental calcium per day - too much can cause constipation or kidney stones.
If Tums aren’t enough, famotidine (Pepcid) is a proven acid reducer. Most providers say 20mg twice daily is safe. It doesn’t cross the placenta in large amounts, and long-term use hasn’t shown harm in studies.
For constipation, polyethylene glycol (Miralax) is the top pick. It’s not absorbed by your body - it just draws water into your bowels. The standard dose is 17g (one capful) mixed in water once a day. Avoid stimulant laxatives like senna or bisacodyl unless prescribed. They can trigger contractions.
Nausea and Morning Sickness: A Proven Combo
If you’re vomiting multiple times a day, you’re not alone. But you don’t have to suffer. The most effective, FDA-approved treatment for nausea in pregnancy is a combination of vitamin B6 and doxylamine.
Take 25mg of vitamin B6 three times a day, plus 25mg of doxylamine (Unisom SleepTabs) at night or as needed. This exact combo is what’s in Diclegis, the prescription version. But you can get the same result with over-the-counter pills - and save money. Studies show this combo reduces nausea by 70% or more. Some women report going from 10 vomits a day to just one or two.
Don’t try ginger pills or herbal remedies without talking to your provider. While ginger tea is generally safe, supplements aren’t regulated. Some contain unlisted ingredients that could be harmful.
What About Antidepressants and Other Prescriptions?
Many pregnant people take medications for mental health, epilepsy, asthma, or high blood pressure. Stopping them can be more dangerous than continuing them.
For depression and anxiety, sertraline (Zoloft) and citalopram (Celexa) are the most studied and safest SSRIs during pregnancy. ACOG says if you were on them before pregnancy, you should usually continue - the risk of untreated depression outweighs the small potential risks to the baby.
But here’s the catch: the FDA updated its warning in October 2023 about sertraline use in late pregnancy. A small number of newborns develop temporary symptoms like jitteriness or trouble feeding - called neonatal adaptation syndrome. It’s not dangerous, and it goes away in days. Your provider will monitor your baby after birth.
For asthma, inhaled corticosteroids like budesonide are safe and recommended. For high blood pressure, labetalol and nifedipine are first-line. Never stop these medications without talking to your OB. Your health matters just as much as your baby’s.
Red Flags: What to Avoid Completely
Some medications are outright dangerous during pregnancy. These include:
- Isotretinoin (Accutane) - causes severe birth defects
- ACE inhibitors (Lisinopril, Enalapril) - can damage fetal kidneys
- Methotrexate - used for autoimmune diseases and cancer, highly toxic to embryos
- Warfarin - increases risk of bleeding and brain defects
- Fluconazole (high-dose) - linked to rare birth defects
Also avoid any medication with “DXM” (dextromethorphan) in high doses. While low doses (up to 120mg in 24 hours) are generally okay, more than that can affect fetal development. And never take codeine or hydrocodone unless absolutely necessary - they’re opioids and can cause withdrawal in newborns.
Why You Should Never Guess
One of the biggest mistakes? Assuming “natural” means safe. Herbal teas, essential oils, and supplements aren’t regulated. Some - like black cohosh, pennyroyal, or high-dose vitamin A - can cause miscarriage or birth defects.
Even “harmless” things like melatonin are now under review. ACOG’s November 2023 update says melatonin at 1-3mg may be acceptable for sleep, but long-term effects aren’t known. Don’t self-prescribe.
And don’t rely on internet forums. Reddit and Facebook groups are full of well-meaning advice - but also misinformation. One woman reported using Sudafed after her first trimester, only to find her pharmacy refused to sell it without extra paperwork. Another took Advil for a headache at 32 weeks and later found out it could have affected her baby’s heart.
Every pregnancy is different. Your weight, medical history, and trimester all matter. A medication that’s safe for one person might not be for another.
How to Use This List
Here’s how to make this information work for you:
- Keep a list of all medications you take - including vitamins, herbs, and supplements.
- Before taking anything new, even a cough drop, check with your OB or midwife.
- Know your active ingredients. Claritin = loratadine. Zyrtec = cetirizine. Tums = calcium carbonate.
- Use the lowest effective dose for the shortest time.
- Track any side effects. If something feels off, call your provider.
If you’re unsure, call MotherToBaby at 1-866-626-6847. They’re a free, confidential service staffed by specialists who answer questions about pregnancy and medications. They’ve handled over 12,000 calls in 2022 alone.
What’s Changing? The Future of Pregnancy Medication Safety
Right now, we’re in a transition. The old A, B, C, D, X pregnancy safety categories were scrapped in 2015 because they were too simplistic. Now, drug labels give detailed summaries of risks, benefits, and data - but many drugs still lack solid evidence.
Only 12% of clinical trials include pregnant people. That means for most medications, we’re guessing based on animal studies or small case reports. The NIH’s PregSource project and the PREVENT initiative are pushing to fix this. By 2027, we might see mandatory inclusion of pregnant women in late-stage drug trials - which could finally give us the answers we need.
In the meantime, stick to what’s known: acetaminophen, cetirizine, famotidine, Miralax, vitamin B6 + doxylamine. Avoid the rest unless your provider says otherwise. And always, always ask questions.
Is Tylenol really safe during pregnancy?
Yes, acetaminophen (Tylenol) is the safest pain reliever for use during pregnancy. It’s been studied in hundreds of thousands of pregnancies and is recommended by ACOG and the CDC. But don’t exceed 3,000mg per day, and avoid Tylenol PM because it contains diphenhydramine, which isn’t meant for regular use in pregnancy.
Can I take allergy medicine while pregnant?
Yes. Cetirizine (Zyrtec) and loratadine (Claritin) are both safe at standard doses (10mg daily). Avoid combination products with decongestants like pseudoephedrine unless your provider approves them. Saline nasal sprays are the safest option for congestion.
Is it safe to take ibuprofen during pregnancy?
No - not after 20 weeks. Ibuprofen and other NSAIDs can cause serious problems for your baby’s kidneys and reduce amniotic fluid. Even occasional use in the third trimester can be risky. Use acetaminophen instead for pain or fever.
What can I take for nausea besides Zofran?
The most effective, FDA-approved option is vitamin B6 (25mg) plus doxylamine (Unisom SleepTabs, 25mg). This combo works as well as Zofran for most women and is available over the counter. Take B6 three times a day and doxylamine at night or as needed. Many women see a 70% drop in nausea within days.
Are herbal supplements safe during pregnancy?
No - not without talking to your provider. Herbal products aren’t regulated, and many contain ingredients that can cause miscarriage or birth defects. Avoid black cohosh, pennyroyal, high-dose vitamin A, and untested teas. Even ginger supplements can vary in strength. Stick to ginger tea if you want to try it.
Can I keep taking my antidepressant if I’m pregnant?
Often yes. If you’re on sertraline (Zoloft) or citalopram (Celexa), stopping can be more dangerous than continuing. Untreated depression raises risks for preterm birth, low birth weight, and postpartum complications. Talk to your provider before making any changes. Never stop cold turkey.
What should I do if I took a risky medication before knowing I was pregnant?
Don’t panic. Most medications don’t cause harm if taken in the first few weeks - before the baby’s organs start forming. Call MotherToBaby (1-866-626-6847) or your OB. They’ll help you assess the risk based on the drug, dose, and timing. Most exposures turn out to be low risk.
Next Steps: What to Do Today
Start by reviewing every medication you take - prescriptions, vitamins, supplements, and OTC drugs. Write them down. Then call your OB or midwife and ask: “Which of these are safe to keep taking?” Don’t wait until your next appointment.
If you’re not sure about something, use the FDA’s free Medicines in Pregnancy app. Or call MotherToBaby. They’re there to help - no judgment, no cost.
Pregnancy isn’t the time to guess. It’s the time to be informed, cautious, and proactive. You’re not just protecting your baby - you’re protecting yourself, too.