A Guide to Safe Over-the-Counter Medications During Pregnancy

I’ve never been the type to tough it out when I have an annoying ailment. If I have a headache, I take a pain reliever; if it’s allergy season, I pop an antihistamine. That all changed when I was pregnant: For nine months, some of my go-to medicines were totally off-limits, while others were only allowed as a last resort. To make sure I was following the rules, I read ingredient labels, scoured reliable online sources and called my provider when I needed advice. Skipping the meds wasn’t realistic for me—or for many other expectant moms.

“I tried to avoid taking anything unless I really needed it, but a bad headache and horrible allergies made it hard to function at work,” says Bethany L., a mom of three in Indiana.

Interested in finding safe medications during pregnancy? We talked to experts, researched more than two dozen active ingredients and put together a comprehensive guide. Here’s what you can take, what you should skip and when you should call your provider instead of heading to the pharmacy.

Key Takeaways

• There are no universal guidelines: The rules are different for taking OTC medications during pregnancy because not all medications are safe for baby, and some even affect you differently while you’re expecting.

• It’s usually best to treat common ailments like pain, nausea, cold symptoms and upset stomach with non-medicated alternatives first, then move to safe medications during pregnancy as needed under your provider’s supervision.

• No medication is 100 percent safe during pregnancy, but many OTC drugs have a long history demonstrating their safety. Tylenol, antacids, Unisom and antihistamines are usually okay to use during pregnancy.

• Learn to check ingredient labels to make sure the formulation you’re using is safe, and always check with your provider before taking any OTC medication for the first time in pregnancy.

Rules for Taking OTC Medicine While Pregnant

There are a few important things to know when it comes to safe medications during pregnancy.

• Medicine may affect you differently during pregnancy. Taking medications—whether they’re prescription, OTC, herbal or homeopathic—can be tricky during pregnancy. “Many over-the-counter medications are safe to use in pregnancy, but there are a few surprising drugs that can lead to problems for baby,” explains Dr. Ashley Roman, MD, MPH, an ob-gyn and chair of the department of obstetrics, gynecology and reproductive sciences at Rutgers Robert Wood Johnson Medical School. “Always speak with your doctor prior to taking any medication and always follow the dosage instructions on the package.” Plus, some usually unconcerning symptoms, like headaches, can point to serious pregnancy-related complications in certain cases, Dr. Roman adds, so it’s always best to let your doctor know about any symptoms.
• Multiple medications may interact. When it comes to pregnancy-safe medications, certain OTC options are generally okay to use as long as you follow the dosage instructions for adults, but that could change if you’re taking multiple medications. “Even medications that are considered safe in pregnancy can become dangerous when they interact with others,” says Dr. Roman. “If you’re not sure, always check in with your ob-gyn.” The dosage for a certain OTC medication may also change depending on other medications you’re already taking.
• There are liability concerns. While you may not go to your ob-gyn for every ache and pain during pregnancy, they’ll likely be the ones counseling you on what prescription and OTC medications to take, says Dr. Daniel F. Roshan, MD, FACOG, a maternal-fetal medicine specialist and founder of Rosh Maternal & Fetal Medicine in New York City. “Other doctors usually avoid giving any medications to pregnant patients in order to avoid liability,” he explains.

It’s also worth noting that pregnant women are often not included in studies due to concerns over potential harm to baby. As a result, there’s a lack of data that makes it hard to know exactly what risks might be associated with OTC medications during pregnancy, says Dr. Cynthia Flynn, MD, an ob-gyn in Daytona Beach, Florida. “Any over-the-counter or prescription drug can potentially pose a risk,” she adds, especially based on how often you take the medication. The rule of thumb? Always check in with your doctor before taking anything, even if it’s on the list of safe medications for pregnancy.

At-a-Glance: Pregnancy Medication Safety

Wondering which OTC medications are safe for pregnancy? Check out this chart. (But always check with your doctor first.)

Pain, Headaches and Fever

Aches and pains are unfortunately all too common during pregnancy—and a fever while pregnant needs to be treated immediately. Here’s what to try.

• What to try first for aches: If you get a headache during pregnancy, there are a few things you can try to relieve your pain before reaching for an OTC medication. Hydrating and lying down in a dark room with an ice pack or warm compress can help. You can also gently massage your head or neck, or practice some simple stretches.

Acetaminophen (Tylenol)

• Verdict: First-line choice across all trimesters for pain and fever.

• Why it’s used: Medicine that uses acetaminophen as the main ingredient, like Tylenol, is generally seen as safest for treating general aches and pains, including headaches, as well as fever, Dr. Roman says. However, you want to be cautious about what type of Tylenol you take; make sure it only contains acetaminophen and not other potentially unsafe ingredients. Also be mindful of the dosage.

“In both of my pregnancies, I had terrible headaches during the first trimester,” says Alexa R., a mom of a toddler currently expecting her second child in California. “I’d try a cold compress in a dark room, but ultimately ended up needing OTC pain relief and took Tylenol, knowing my ob-gyn flagged it as safe.”

NSAIDs (Ibuprofen/Advil/Motrin, Naproxen/Aleve)

• Verdict: Avoid.

• Why it’s restricted: Nonsteroidal anti-inflammatory drugs, better known as NSAIDs, include ibuprofen (Advil and Motrin), naproxen (Aleve) and aspirin. NSAIDs are best avoided in pregnancy unless your provider recommends them. Some studies have linked them to a higher risk of miscarriage in early pregnancy, and from 20 weeks on, the US Food and Drug Administration (FDA) warns they can affect baby’s kidneys and lower amniotic fluid. Aspirin is a special case. Providers sometimes prescribe low-dose aspirin during pregnancy for certain conditions, such as to help lower the risk of preeclampsia, but don’t take it unless your provider recommends it (see below).

“Certain medications, including nonsteroidal anti-inflammatory drugs such as ibuprofen, can negatively affect the blood flow between Mom and baby, causing miscarriages, delayed onset of labor and other dangerous fetal effects,” explains Dr. Sherry Ross, MD, FACOG, a board-certified ob-gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. They may also be associated with congenital heart defects when taken during the first trimester, Dr. Roman adds, and have been linked to other heart abnormalities and low amniotic fluid levels when used in the third trimester.

Low-dose aspirin vs. high-dose OTC aspirin

• Verdict: Whether you can take aspirin depends on the dose.

• What to know: Low-dose (81 milligrams) is considered safe when prescribed by a healthcare provider and is sometimes recommended for those with a risk of preeclampsia. But high-dose OTC aspirin (325 milligrams or more) should be avoided.

Acetaminophen, aspirin and caffeine (Excedrin)

• Verdict: Avoid.

• Why it’s restricted: While acetaminophen is safe to take during pregnancy, aspirin is only okay in low doses and caffeine should be limited to less than 200 milligrams per day. It’s best not to take a combination medication like Excedrin, which can make it hard to keep track of your daily intake of OTC drugs.

Nausea, Morning Sickness and Motion Sickness

While there are plenty of at-home remedies for pregnancy nausea, if you’re still struggling make sure to ask your doctor about medication.

• What to try first: Even if you’re having one of those unicorn pregnancies that doesn’t cause any morning sickness, there’s still a chance you’ll feel nauseated by something during those nine months. Home remedies for nausea include ginger, peppermint tea, seasickness bands, eating small, carb-heavy snacks like crackers or pretzels and choosing bland foods.

Vitamin B6 (pyridoxine) and doxylamine succinate (Unisom)

• Verdict: Safe.

• Why it’s used: Pyridoxine, which is a form of vitamin B6, is often recommended to help with morning sickness symptoms, says Dr. Ross. It’s even more effective when you combine it with doxylamine succinate (Unisom), she adds.

Emetrol

• Verdict: Safe.

• Why it’s used: Dr. Michelle Gebhardt, MD, chair of obstetrics and gynecology at The Permanente Medical Group (Kaiser Permanente) in Northern California, says liquid Emetrol is another option for treating nausea. It contains glucose, fructose and phosphoric acid as its main ingredients, and works by soothing the stomach.

Bismuth subsalicylate (Pepto-Bismol)

• Verdict: Avoid.

• Why it’s restricted: In your pre-pregnancy life, Pepto-Bismol may have been your go-to nausea remedy, but now that you’re expecting, it’s best to steer clear. The main ingredient in Pepto-Bismol is bismuth subsalicylate, and according to the American Academy of Family Physicians (AAFP), while bismuth on its own is generally safe, it may be harmful when combined with salicylate.

Meclizine (Dramamine Less Drowsy)

• Verdict: Yes.

• What to know: Meclizine isn’t usually the first medication providers recommend for nausea and vomiting in pregnancy, says Dr. Susan Wilson, MD, an ob-gyn at Redlands Community Hospital in Redlands, California, but it’s safe to take: Studies done on women taking meclizine in pregnancy haven’t shown an increased risk of birth defects or abnormalities.

Coughs, Colds and Sinus Congestion

Unfortunately, pregnancy makes us more susceptible to all kinds of bugs—here’s how to relieve symptoms.

• What to try first: The AAFP notes that most OTC cold medicines are considered safe for short-term use in pregnancy as long as it’s outside of the first trimester, but if you want to skip medication altogether, there are some ways to ease viral symptoms. Stay hydrated and soothe your throat at the same time with warm teas, broths and soups and make sure to get plenty of rest. Saline nasal sprays can help clear mucus without medication while steam or a humidifier can relieve coughs.

Plain guaifenesin (Mucinex, Robitussin)

• Verdict: Avoid in the first trimester; acceptable in the second and third trimesters.

• Why it’s restricted early: Guaifenesin is an expectorant that loosens up thick mucus and is commonly found in medicines like Mucinex and Robitussin. There is some weak evidence that first-trimester use of guaifenesin may be linked to certain birth defects, so it’s best to avoid it until you reach the second trimester.

Dextromethorphan (Delsym, Robitussin DM)

• Verdict: Generally safe in moderation across all trimesters.

• Why it’s used: Dextromethorphan is a cough suppressant found in many cough syrups that’s generally considered safe to use at any point during pregnancy. Just be sure that any cough medication you take doesn’t contain alcohol as an inactive ingredient.

“I had a horrible head cold—cough, sore throat, runny nose, couldn’t talk without coughing—while on a work trip,” says Megan M., a mom of two in Maryland. “I took alcohol-free cough medication that both my ob-gyn and the pharmacist approved. I was nervous to take so much medicine, but needed to do something to be able to work.”

Oral decongestants (pseudoephedrine/Sudafed, phenylephrine)

• Verdict: Avoid in the first trimester; use with caution in the second and third trimesters under doctor direction.

• Why it’s restricted: Previous studies have suggested that exposure to certain decongestants, such as pseudoephedrine and phenylephrine, in early pregnancy may increase the risk of birth defects involving baby’s abdominal wall, Dr. Roman says. “Also, decongestants (such as phenylephrine) may affect blood flow to the placenta and should generally be avoided throughout pregnancy,” she adds.

Because of what we know, many experts advise against using Sudafed, and other cold or allergy medications using pseudoephedrine as the main ingredient, wherever possible during pregnancy. If you absolutely need a decongestant, talk to your healthcare provider: They may let you use it cautiously after the first trimester or might recommend you avoid it completely.

Steroid nasal sprays (Flonase, Rhinocort, Nasonex)

• Verdict: Generally yes, but it depends on the active ingredient.

• Why it’s used: For the most part, using a steroid nasal spray for congestion during pregnancy is significantly safer than using Sudafed. That said, some of the active ingredients in nasal sprays are better studied than others. For example, Dr. Wilson says budesonide (Rhinocort) has the most safety data and is the preferred first-line choice.

Sprays that contain other steroids (like fluticasone/Flonase and mometasone/Nasonex) have less human safety data, but are still considered acceptable in pregnancy, Dr. Wilson adds, with the exception of triamcinolone (Nasacort): It’s been associated with birth defects in some human studies.

Allergies and Hay Fever

If you suffer from allergies, they might get worse during pregnancy—or they might get better. Either way, you deserve relief.

• What to try first: Allergies are hard to treat without OTC antihistamines, so it’s a good thing the American College of Obstetrics and Gynecology (ACOG) and Centers for Disease Control and Prevention (CDC) report that most of these allergy-treating drugs are generally safe to use during pregnancy. But there are a few ways to lessen allergy symptoms without medication, too, including using saline nasal sprays to flush out allergens and drinking extra water to keep mucus thin. You can also make some changes to your environment: keep windows closed or run your air conditioning, use an air purifier and change your clothes after spending time outdoors.

First-generation antihistamines (diphenhydramine/Benadryl)

• Verdict: Safe across all trimesters.

• Why it’s used: First-generation antihistamines containing chlorpheniramine, dexchlorpheniramine and diphenhydramine (Benadryl) are all considered safe to use during pregnancy, but they may cause symptoms like drowsiness more often than second-generation antihistamines (see below).

Leesa L., an expectant mom and pediatrician from California, says Benadryl and Claritin were the only medications that helped get rid of her acute hives. Even as a healthcare provider herself, she worried about the safety of OTC meds: “I knew what was and wasn’t safe, but I did tell my ob-gyn know what I was taking,” she says.

Second-generation antihistamines (loratadine/Claritin, cetirizine/Zyrtec)

• Verdict: First-line choice for non-drowsy, daily allergy management.

• Why it’s used: These medications have been shown to be safe and less likely to cause drowsiness than older antihistamines, so experts usually recommend them first during pregnancy if allergies are a concern.

“I was concerned about [needing to stop taking] my allergy pills because Arizona has a lot of dust in the air, and my sinuses got worse during pregnancy,” says Lisa M., a mom of one in Arizona. “I was a little worried about taking them, but I was told it was totally safe [and] trusted my doctor! I don’t know what I would’ve done if I couldn’t have taken them.”

Heartburn, Acid Reflux and Indigestion

Pregnancy can make you more vulnerable to issues like heartburn due to baby putting pressure on your digestive system.

• What to try first: Changing hormones and a growing uterus can cause plenty of GI upset during pregnancy, but a few dietary and lifestyle changes can make it easier to manage heartburn, reflux and indigestion. In addition to eating smaller meals, adding more dairy to your diet, sipping herbal tea and chewing gum help by coating your stomach and neutralizing stomach acid. You can also eat more slowly, sit upright during and after meals and avoid carbonated beverages and spicy, fatty or greasy foods.

Calcium-based antacids (Tums, Rolaids)

• Verdict: First-line choice across all trimesters.

• Why it’s used: Heartburn during pregnancy is common, but antacids such as Tums and Rolaids are usually safe to use and can help with symptoms, Dr. Roman says.

Magnesium-based antacids (Mylanta, Maalox, Milk of Magnesia)

• Verdict: Safe.

• Why it’s used: Antacids containing magnesium hydroxide, like Mylanta, Maalox and Milk of Magnesia, are also considered generally safe to use during pregnancy, even if they also contain aluminum hydroxide. Just avoid formulas that contain sodium bicarbonate, magnesium trisilicate or aspirin.

H2 blockers (famotidine/Pepcid AC, Zantac 360)

• Verdict: First-line choice across all trimesters.

• Why it’s used: The active ingredient in most histamine-2 (H2) blockers sold as OTC treatments for heartburn is famotidine, which Dr. Wilson says is considered safe for use during pregnancy.

Ranitidine (Zantac)

• Verdict: Safe as long as it’s the new formula.

• Why it’s restricted: The original form of Zantac, which used ranitidine as its main ingredient, was banned by the FDA in 2019 when it detected low levels of a cancer-causing contaminant in samples of the drug, says Dr. Roman. After that, manufacturers pulled the drug off shelves and worked on a reformulation of the active ingredient, which Dr. Wilson says was approved by the FDA in 2025 and is considered safe for use during pregnancy.

The bottom line? If you plan to use the original Zantac containing ranitidine, make sure it’s not an old package—opt for one manufactured after November 2025.

PPIs (omeprazole/Prilosec, esomeprazole/Nexium)

• Verdict: Second-line choice if antacids fail; check with doctor first.

• Why it’s used: Proton pump inhibitors (PPIs) are generally considered safe in pregnancy, says Tania Lopez, CNM, a certified nurse-midwife at Pediatrix Medical Group in Texas, but they’re often the last option providers recommend. We know more about the safety of conservative treatments like dietary changes, calcium carbonate antacids (like Tums) and H2 blockers, so it’s best to see if any of those treatments work for you before stepping up to a PPI. That said, if you have severe symptoms that don’t respond to conservative treatments, talk to your provider about a PPI.

Constipation, Gas and Diarrhea

Constipation and other digestive issues are common concerns during pregnancy. Here’s how to deal.

• What to try first: Just like with heartburn, hormones and your enlarged uterus can make regular bowel movements a thing of the past. The easiest way to avoid constipation is to eat lots of fiber every day, drink plenty of water and get regular exercise. If you’re having diarrhea while pregnant, switch to a bland diet and stay hydrated; choose an electrolyte drink, if you need it, to replace lost fluids.

Stool softeners and fiber (docusate/Colace, psyllium/Metamucil)

• Verdict: Safe.

• Why it’s used: When lifestyle changes aren’t enough, most ob-gyns will recommend fiber supplements like Metamucil and Citrucel or stool softeners with docusate (a mild laxative), like Colace. All of these are considered safe for pregnancy, Dr. Ross says.

Simethicone (Gas-X)

• Verdict: Safe.

• Why it’s used: Simethicone is a gas-reducing medication that stays in your digestive tract rather than entering your bloodstream, so it’s considered safe to use by pregnant women.

Anti-diarrheals (loperamide/Imodium)

• Verdict: Consult your doctor before use; generally avoid in the first trimester.

• Why it’s restricted: According to Lopez, Imodium is safe to use in pregnancy for a short period of time. But if you have diarrhea for more than two days, if your symptoms are severe, or you have more than 8 to 10 episodes in a single day, you should call your provider: They may want to monitor you and get you rehydrated, says Lopez.

You should also call your provider before taking Imodium if you’re in the first trimester; we don’t have a lot of safety data for it, and it may come with a small risk of birth defects.

Stimulant laxatives (sennosides like Ex-Lax and Senokot)

• Verdict: Consult your doctor before use; generally avoid in the first trimester.

• Why it’s restricted: Laxatives, mineral oils and rectal suppositories can actually stimulate labor, so these should only be used after speaking with your provider, Dr. Roman says. “Stimulant laxatives, such as Ex-Lax and Senokot, are the hardest on your intestines and should be used with caution during pregnancy.”

Sleep Aids

Pregnancy insomnia is no joke—but many sleeping pills are off-limits. Thankfully, there are plenty of other options to help you sleep better.

• What to try first: It’s no secret that getting a good night’s sleep during pregnancy is a challenge, but if you’re truly dealing with pregnancy insomnia, that’s a different story. Before trying any OTC medication, consider implementing some lifestyle changes to help you get more rest. Exercise daily and avoid drinking a lot of fluids (especially caffeine) before bedtime. Address any ongoing pregnancy complaints—like heartburn—that could keep you awake at night. And make sure you practice good sleep hygiene: Follow a consistent sleep schedule, turn off your devices at least 30 minutes before going to bed, keep your room dark and cool and use a pregnancy pillow for extra comfort.

Diphenhydramine (ZzzQuil)

• Verdict: Safe for short-term use.

• What to know: The active ingredient in ZzzQuil, diphenhydramine, is also the active ingredient in Benadryl, which is considered safe for use in pregnancy. So why is only short-term use recommended? “As with all medication use in pregnancy, the recommendation is to use the least amount for the shortest amount of time, and only when absolutely needed,” explains Dr. Wilson. “Taking higher than recommended doses, or taking doses regularly close to delivery, may cause a newborn to be more drowsy or irritable than normal.”

Doxylamine succinate (Unisom)

• Verdict: Safe for short-term use.

• What to know: We know Unisom is safe for pregnancy, nurse-midwife Lopez says, because it’s been tested as an early pregnancy treatment for morning sickness when combined with B6. But there are different ingredients in different types of Unisom, she adds, and while both ingredients—doxylamine and diphenhydramine—are safe for pregnancy, you may find one more or less effective than the other.

Melatonin and herbal sleep supplements

• Verdict: Avoid unless you have permission from your provider.

• Why it’s restricted: “Natural” doesn’t always mean “safe,” and herbal sleep supplements like melatonin aren’t regulated by the FDA. That means no one is checking to make sure they contain the right ingredients in the right amounts. While some studies suggest melatonin during pregnancy could be safe, there’s too little evidence to know for certain. Unless your provider determines that the benefits of melatonin outweigh the risks for you, avoid sleep supplements completely.

Red Flag Symptoms: When to Call Your Doctor Immediately

You might be used to reaching for OTC medications to treat common ailments in your normal life, but the rules are different for pregnancy. Sometimes even common symptoms are a red flag during pregnancy, requiring a call to your provider, not a trip to the pharmacy.

In general, the CDC recommends calling your provider right away if you’re pregnant and have any of the following symptoms:

• Sudden, severe headache
• Fainting or dizziness
• Vision changes
• Fever
• Swelling in your hands or feet
• Difficulty breathing or chest pain
• Fast heartbeat
• Severe vomiting or unable to keep any food or liquids down
• Sharp cramping
• Vaginal bleeding or leaking fluid
• Severe swelling, pain or tenderness in one leg

To Sum It Up

Figuring out what OTC medications are safe to take during pregnancy can be challenging, especially if you’re not feeling well and looking for quick, reliable relief of your symptoms. Two things can make it easier to choose a safe medication for pregnancy: reviewing the ingredients and checking with your provider.

How We Developed This Article

Many pregnant women wonder whether their standby meds for issues like headaches and colds are safe for pregnancy. To learn more about OTC medications during pregnancy, we asked six ob-gyns and a nurse-midwife about the safety of dozens of active ingredients available without a prescription. We also consulted several medical and academic sources, including the American Academy of Family Physicians and the Centers for Disease Control and Prevention. Finally, we scoured the web looking for moms who took OTC medications for common ailments during pregnancy.

After editing, this article was vetted through fact-check and reviewed by our ob-gyn medical adviser. Learn more about how we ensure the accuracy of our content through our editorial and medical review process.

About the author: Sarah Bradley is a freelance contributor for The Bump who combines her love of writing with her parenting experience. She had headaches, morning sickness and allergies during all three of her pregnancies, so she understands how confusing and stressful it can be to make decisions about taking OTC medications while pregnant.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.