There is a wide choice of cough preparations on the market. How safe are these for
use in pregnancy?
For coughs, there are two main groups of preparations: the cough suppressants and
Cough suppressants are marketed with a claim that they will reduce the frequency
and intensity of coughing. Their effect is modest at best and they may help the person
to sleep better. Most of them are based on opioids, especially codeine and sedatives
such as diphenhydramine.
Cough medicines containing codeine will tend to cause constipation. Constipation
is a common problem in pregnancy and if the pregnant woman is already having this
trouble, then she should think hard before taking such preparations. They are likely
to make the problem worse without really giving her much benefit.
Those cough suppressants based on sedatives will cause drowsiness and may not be
ideal for a pregnant woman who is working, looking after small children or needs
to drive. Their effectiveness, again, is modest at best.
Expectorants are cough preparations which are marketed with the claim that they promote
the expulsion of the sputum and secretions produced in the respiratory tract. They
are supposed to relieve the symptoms by making one cough less and breathe easier.
The reality is that they make little or no difference, and scientific evidence of
their effectiveness is lacking. Simple linctus (the most common type) is a citric
acid solution (i.e. orange or lemon!).
Some of them are marketed in combination with painkillers (such as paracetamol) and-
decongestants (see below). Their value, over and above the placebo effect, is dubious.
All these preparations have no direct adverse effect on the pregnancy. Any preparation
containing iodine should be avoided. Always read the label.
What about medicines for colds in pregnancy?
The nasal decongestants on the market are mostly made of an active ingredient in
the form of pseudoephedrine or similar. Many also contain an antihistamine. Their
effectiveness is really unproven and this is probably the biggest gravy-train in
the retail trade today. The benefit from most is largely through the placebo effect:
You believe it will do something, your mind and body responds to the expectation
and you feel better.
Those preparations containing pseudoephedrine and similar drugs need to be used with
caution if the mother is hypertensive or has a heart disease. They may also interfere
with diabetes control. There is, however, no direct adverse effect on the pregnancy
Preparations containing antihistamines such as chlorpheniramine (Piriton®) will
tend to make the mother drowsy.
Hay-fever and allergic rhinitis in Pregnancy
Many people suffer from 'Seasonal allergic rhinitis' also called hay-fever, or even
simple recurrent allergic rhinitis. Is medication for this safe to use in pregnancy?
Nasal allergies of all types are mostly treated with antihistamines. Some of these,
especially the newer 'non-sedating' ones, are clearly considered unsafe to use in
pregnancy. It is therefore important for a pregnant woman intending to use any of
these preparations to check with her doctor and the enclosed literature about their
status vis-a-vis pregnancy.
Some of the antihistamines contra-indicated for use in pregnancy include Fexofenadine
(Telfast®), Loratadine (Clarityn®), Mizolastine (Mizollen®) and Astemizole (Hismanal®).
The contra-indication is based on unavailability of proof of safety in pregnancy
rather than any documented adverse effect.
The older generation antihistamine chlorpheniramine (Piriton®) is considered safe
to use in pregnancy
Steroidal preparations are also used in allergic rhinitis. These include beclomethasone
(Beconase®, Qvar®), budesonide (Rhinocort Aqua®, Pulmicort®), fluticasone (Seretide®)
etc. These are safe to use.
Eczema in Pregnancy
What about eczema and its treatment in pregnancy?
This fairly common condition can continue after conception. Treatments to control
the lesions commonly consist of an emmolient, a steroidal skin preparation, occasionally
oral medication or a combination of any of these.
Emmolients are meant to soothe and rehydrate the skin. There are many such preparation
with many different proprietary names. Common ones include E45®, Oilatum®, Neutrogena®,
Vaseline®, aqueous cream, white soft paraffin etc. There is no evidence of adverse
effect from their use during pregnancy. Steroidal skin (topical) preparations, when
used as recommended, are also regarded as safe to use during pregnancy.
Last update: February 16, 2013
Loratadine and similar newer anti-histamines may be unsafe in pregnancy