OTC Medication Use in Pregnancy

Introduction

Given the potential for teratogenic effects of certain drugs, this article explores the safe use of over-the-counter medications during pregnancy.

  • Products containing alcohol should be avoided.



Pain

The use of paracetamol (acetaminophen) in recommended doses during pregnancy has not be associated with an increased risk of miscarriage or still birth.

  • Nonetheless, paracetamol should be used at the lowest effective dose for the shortest duration of time to effectively treat the mother and protect the health of the foetus (inconclusive data on adverse events such as wheezing and asthma in early childhood, adverse effects on male reproductive development and ADHD or autism spectrum disorders)
  • An increase in foetal death or spontaneous abortion may been seen following maternal overdose if treatment is delayed.

In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks' gestation because of the risk of

  • Miscarriage in early pregnancy; however, evidence of this effect is conflicting.
  • Oligohydramnios via effects on foetal renal function when an NSAID is used after 20 weeks' gestation.
  • Premature closure of the ductus arteriosus, and delayed labour and birth, when an NSAID is used after 30 weeks' gestation.
  • Peripartum haemorrhage, especially with complicated deliveries, due to effects on maternal platelet function.

However, there continues to be a role for NSAID use during pregnancy in some circumstances (e.g. ankylosing spondylitis, rheumatoid arthritis).



Cough

Dextromethorphan at standard OTC doses for antitussive is generally considered safe.

Mucolytics agents, such as bromhexine and guaifenesin, are generally safe to use.

  • Limited clinical experience with acetylcysteine has not resulted in adverse effects to the foetus. The use of acetylcysteine for acetaminophen overdose during pregnancy is justified.

There is insufficient reliable data for Hedera helix (English ivy) leaf extract syrup (Prospan).



Cold

Antihistamine is generally safe to use during pregnancy.

  • Although there is more experience with older sedating antihistamine, less sedating antihistamines such as loratadine and cetirizine may be considered due to reduced sedating and anticholinergic effects.
  • Promethazine should be avoided when close to delivery, since platelet aggregation may be inhibited in newborns following maternal use of promethazine within 2 weeks of delivery.

Systemic sympathomimetics such as phenylephrine and pseudoephedrine is best avoided in pregnancy (particularly first trimester) because mild foetal malformations have been reported.

There is no adequate study on topical sympathomimetics such as oxymetazoline and xylometazoline, hence use is not recommended.



Heartburn

Most antacids marketed are combination products containing two, three or even four constituents and are safe to use in usual doses for the treatment of heartburn or gastroesophageal reflux in pregnant women.

  • Magnesium trisilicates are not recommended.
  • Products containing alginates (e.g. the Gaviscon range) can be given during pregnancy and breastfeeding.
  • Simethicone is physiologically inert and not absorbed systemically following oral administration.

H2 antagonist

  • Cimetidine, ranitidine (preferred) and famotidine are safe to use.

Proton pump inhibitors

  • Based on available data, proton pump inhibitors may be used when clinically indicated.
  • Omeprazole appears safe to use (more human data).



Constipation

Medications for constipation may be used when diet and lifestyle modifications are ineffective.

Lactulose is safe to use since it is poorly absorbed following oral administration.

  • Similarly, polyethylene glycol (PEG or macrogol) has minimal systemic absorption and would be unlikely to cause foetal malformations.

Stimulants (e.g. bisacodyl, senna) should be avoided except for occasional doses.

  • The use should be limited due to increased risk of adverse events such as electrolyte abnormalities.



Diarrhoea

Oral rehydration and dietary changes is recommended for acute diarrhoea in pregnant women.

  • Oral rehydration salt is safe to use.

Activated charcoal is safe to use since it is not absorbed systemically following oral administration.

Information related to loperamide use in pregnancy is limited and conflicting.

  • Only if symptoms are disabling, one or two doses of loperamide may be used.



Summary

The true need for any medication during pregnancy should be carefully evaluated, as judicious use is essential to protect the developing foetus.



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