OTC Medication Use in Pregnancy and Breastfeeding

Seema H. Ledan, PharmD

Disclosures

US Pharmacist. 2019;44(9):16-19. 

In This Article

Commonly Treated Conditions

Pain and Headache

Studies show that pain is the most treated condition during pregnancy and postpregnancy.[3] However, with the wide variety of OTC options for pain, only a few are recommended.

Acetaminophen (Tylenol) has demonstrated efficacy and safety at all stages of pregnancy when used at recommended therapeutic doses and for short-term use.[15–17,21,22] Adverse pregnancy outcomes or abnormalities are not commonly seen with the use of acetaminophen. However, recent data have shown potential risks with prenatal acetaminophen use, such as asthma, lower performance intelligence quotient, neurodevelopmental problems, poorer attention, and behavioral problems in childhood.[22] Yet, acetaminophen is still a safer option for pain or fever in pregnancy and should be used only when needed at recommended doses.[22] In addition, it has been deemed safe for use in lactating women, with the amount in breast milk actually less than the dose typically given to an infant for fever or pain.[14,23]

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin are not recommended during the last 3 months of pregnancy due to an increase in blood flow and bleeding complications in the mother and baby during pregnancy and at delivery.[15–17,21] However, ibuprofen is actually one of the preferred choices for pain/fever in breastfeeding mothers because of its low levels in breast milk and short half-life.[1] Aspirin and naproxen are not preferred for breastfeeding due to longer half-lives and reported serious adverse reactions. It is important to note that combination acetaminophen/aspirin/caffeine (Excedrin) for headache may not be considered safe due to effects that aspirin and caffeine have on the growing fetus as well as the infant.

Nausea and Vomiting

Nausea and vomiting are the most common gastrointestinal complications in pregnant women. This may affect quality of life not only in the beginning of the pregnancy; in some women, the condition may impact much of their term. Multiple treatment options are available and may be considered safe during certain trimesters of pregnancy, and the majority of options are prescription medications. Common OTC products that are recommended and proven to be safe are vitamin B6 and ginger root.[24] The American College of Obstetricians and Gynecologists and the American Family Physician recommend a combination of vitamin B6 (10–25 mg every 8 hours) and doxylamine (Unisom) (12.5–25 mg every 8 hours) to help reduce nausea and vomiting in the first trimester.[25,26] This combination therapy may help decrease nausea and vomiting by 70%.

Constipation

Due to physiological and anatomic changes in the gastrointestinal tract, constipation may occur in up to 38% of pregnant women, making it the second most common gastrointestinal disturbance.[27] Fluids, dietary fiber, and exercise can help relieve constipation; however, alternatives such as probiotics or laxatives may be needed to achieve additional relief. Many laxatives are considered safe during pregnancy, with their own characteristics that may deter long-term use or monitoring for side effects.[27,28] Osmotic laxatives such as polyethylene glycol may cause flatulence and bloating but may be considered one of the preferred agents during pregnancy.

Stimulant laxatives such as senna may cause abdominal cramps and are limited to short-term use. Overuse of senna may cause the bowels to not function properly and may create dependency on the stimulant; routine use is not recommended and is limited to a last-line option for no more than 1 week.[29] Lubricants such as mineral oil should be avoided due to hemorrhage and absorption reduction of fat-soluble vitamins with long-term use. For breastfeeding mothers, laxatives that are not absorbed from the gastrointestinal tract, such as docusate, senna, and psyllium, cannot enter the breast milk and are preferred for short-term use.[14,28]

Cough and Cold

Mild upper-respiratory illnesses and the common cold are caused by viruses that are self-limiting; therefore, OTC medications are heavily relied on for symptoms and quality-of-life improvement.[30] Many of the OTC medications contain only a few ingredients; however, these products may not be the safest options in breastfeeding mothers. Table 2 provides a summary of the pregnancy and lactation recommendations for these products.

Yeast Infections

With changes in hormone levels and the increase in glycogen in vaginal secretions, yeast infections are common in pregnancy, especially in the second trimester. Topical azoles such as miconazole (Monistat) are the therapy of choice due to safety data collected in humans.[31] Therapy is recommended for 7 days, and shorter treatment duration does not show success.[31] Probiotics, such as lactobacillus and bifidobacterium, may also be used to treat yeast vaginosis, and they have not been reported to cause adverse fetal outcomes.[32] It is crucial to combat these infections, as they can pass to the baby's mouth if left untreated during delivery, causing thrush in newborns.

If a yeast infection does occur while breastfeeding, topical azoles and probiotics (i.e., lactobacillus) are deemed safe and recommended; transfer to breast milk is unlikely.[14,32]

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