Medications Safe During Pregnancy: A Complete Patient List

When you're pregnant, even a simple headache or stuffy nose can feel like a crisis. You want to feel better-but you also don’t want to risk your baby’s health. The truth is, most common medications are safe during pregnancy, but not all. And the ones that are safe? They come with rules. Dosage limits. Trimester restrictions. Brand vs. generic confusion. Skip the Google search. This list is built from the latest guidelines from the American College of Obstetricians and Gynecologists (ACOG), the CDC, and top U.S. maternity hospitals, updated through 2024.

What’s Actually Safe? The Core List

Let’s cut through the noise. Here are the medications most doctors agree are safe when used correctly. These aren’t guesses. They’re backed by over 100,000 documented exposures tracked by the MotherToBaby registry.

• Allergy Relief: Cetirizine (Zyrtec) at 10mg once daily. Loratadine (Claritin) at 10mg once daily. Fexofenadine (Allegra) at 180mg once daily. All are non-drowsy and have been used safely in thousands of pregnancies.
• Cold & Congestion: Guaifenesin (Mucinex) for chest congestion-plain formula only. Dextromethorphan (Robitussin DM) up to 120mg in 24 hours. Saline nasal spray-no restrictions. Avoid multi-symptom formulas. They often hide decongestants.
• Pain Relief: Acetaminophen (Tylenol) is the gold standard. Maximum 3,000mg per day. That’s six 500mg tablets. Don’t go over. Avoid ibuprofen (Advil), naproxen (Aleve), and aspirin after 20 weeks. They can affect fetal kidney development.
• Heartburn & Indigestion: Calcium carbonate (Tums) as needed. Famotidine (Pepcid) up to 20mg twice daily. Both are well-studied and safe.
• Constipation: Polyethylene glycol (Miralax) at 17g daily. It doesn’t get absorbed into the bloodstream, so it doesn’t reach the baby.
• Nausea & Morning Sickness: Vitamin B6 (25mg) three times daily + doxylamine succinate (Unisom) 25mg up to three times daily. This combo is the active ingredient in Diclegis, the only FDA-approved medication for morning sickness.

What to Avoid-And Why

Some meds seem harmless. But they’re not. Here’s what to skip:

• NSAIDs after 20 weeks: Ibuprofen, naproxen, celecoxib. These can cause low amniotic fluid and heart problems in the baby. Even a single dose in the third trimester can be risky.
• Pseudoephedrine (Sudafed): It’s tricky. Some doctors say it’s okay after the first trimester. Others say no. The problem? It can reduce blood flow to the placenta. If you must use it, check with your provider first. In some states, you need to show ID and sign a log to buy it.
• Decongestant nasal sprays (Afrin, Neo-Synephrine): Use no more than 3 days. After that, you get rebound congestion-worse than before.
• Herbal remedies: Just because it’s “natural” doesn’t mean it’s safe. Chamomile, ginger tea in large amounts, black cohosh, and dong quai can trigger contractions or affect hormones.
• Aspirin: Except for low-dose (81mg) prescribed for preeclampsia prevention. Never take regular-strength aspirin.

Brand Names vs. Generic Ingredients

Confusion kills. You’re not buying a brand-you’re buying an ingredient. Here’s how to decode labels:

• Claritin = loratadine
• Zyrtec = cetirizine
• Allegra = fexofenadine
• Tylenol = acetaminophen
• Advil = ibuprofen
• Pepcid = famotidine
• Miralax = polyethylene glycol

Watch out for combo products. Claritin-D? That’s loratadine + pseudoephedrine. Avoid it. Robitussin? Just the plain cough syrup. Not the “Max Strength” version. That one has dextromethorphan + guaifenesin + phenylephrine. The phenylephrine? Skip it.

Dosage Matters More Than You Think

It’s not just “take one.” It’s “take one, and never more than this.”

• Acetaminophen: Max 3,000mg per day. That’s six 500mg pills. Tylenol PM? Each pill has 500mg acetaminophen + 25mg diphenhydramine. Don’t take more than six in 24 hours.
• Dextromethorphan: Max 120mg in 24 hours. That’s four 30mg doses.
• Famotidine: Max 40mg per day. Two 20mg tablets.
• Vitamin B6: Stick to 25mg per dose. Higher doses (over 200mg/day) can cause nerve damage.

Overdosing on acetaminophen is the #1 cause of acute liver failure in the U.S. It’s easy to do if you’re taking multiple products. Check every label. Even cold and flu meds often contain acetaminophen.

When to Call Your Doctor

Some symptoms need more than an OTC fix. Call your provider if:

• Your fever stays above 100.4°F for more than 24 hours
• You’re vomiting so much you can’t keep fluids down
• You have chest pain, trouble breathing, or swelling in your face or hands
• You’re taking any prescription medication-even if it’s been fine for years
• You’re unsure about a supplement, herbal tea, or “natural” remedy

Don’t assume your doctor knows what you’re taking. Many women don’t mention OTC meds because they think they’re “harmless.” But 41% of pregnant people stop necessary medications out of fear-like antidepressants-when research shows sertraline (Zoloft) and citalopram (Celexa) are among the safest options for depression during pregnancy.

The Bigger Picture: Why This Is So Confusing

Here’s the hard truth: for 73% of prescription drugs approved between 2000 and 2010, there’s still not enough data on how they affect babies. Why? Because pregnant people are rarely included in clinical trials. The FDA changed its labeling rules in 2015 to replace the old A-B-C-D-X categories with plain-language summaries. But many providers still rely on outdated charts.

And then there’s the access problem. One woman in Texas told her doctor Sudafed was okay after the first trimester. Her pharmacist refused to sell it without extra paperwork. She went three days with a bad sinus infection because no one gave her a clear answer.

Another study found that 58% of pregnant patients think herbal remedies are automatically safe. They’re not. Ginger tea is fine in small amounts. But concentrated ginger pills? That’s a different story.

What’s changing? Good things. The NIH’s PregSource project has collected over 18,700 real-world reports from pregnant people. The FDA just updated warnings for sertraline in late pregnancy. And universities are now using AI to build personalized risk models based on genetics and medical history.

But until then? Stick to the list. Use the lowest dose for the shortest time. And always talk to your provider before starting or stopping anything.

Real Stories, Real Results

One woman on BabyCenter said the B6 and Unisom combo cut her vomiting from 10 times a day to 1 or 2. Another said Zyrtec let her sleep through the night for the first time in months. But then there’s the woman who took ibuprofen for a headache at 32 weeks because “it worked better than Tylenol.” Her baby had low amniotic fluid. She had to deliver early.

There’s no one-size-fits-all. But there is a safe path. It’s not about avoiding all meds. It’s about choosing the right ones, the right way.

Next Steps: What to Do Today

Don’t wait until you’re sick. Here’s what to do now:

1. Check your medicine cabinet. Toss any expired or unnecessary OTC meds-especially multi-symptom cold pills.
2. Write down every medication you take daily, including vitamins, supplements, and herbal products.
3. Bring that list to your next prenatal visit. Ask: “Which of these are safe? Which should I stop?”
4. Download the FDA’s “Medicines in Pregnancy” app. It’s free, updated regularly, and doesn’t require an account.
5. Keep a small notebook. Note when you take a medication, why, and how you felt. It helps your provider spot patterns.

Pregnancy isn’t the time to wing it. But it’s also not the time to suffer in silence. With the right information, you can stay healthy-without putting your baby at risk.