Feeling crummy while you’re pregnant is tough—and picking meds can feel even tougher. While no medicine is 100% risk-free, going without treatment can sometimes be riskier for you and your baby. The key is simple: use the safest effective option, at the lowest dose, for the shortest time, and always loop in your OB-GYN.

Quick Rules Before You Take Anything

  • Talk to your OB-GYN or pharmacist first (even for OTC meds).

  • Use single-ingredient products so you know exactly what you’re taking.

  • Avoid combo cold/flu “multi-symptom” packs unless a clinician okays them.

  • First trimester = be extra conservative.

  • Read labels for hidden ingredients (e.g., decongestants, salicylates).

Allergies: Options That Are Commonly Considered Safe

  • Loratadine

  • Cetirizine

  • Chlorpheniramine

  • Fexofenadine

  • Fluticasone propionate (nasal spray)

  • Budesonide (nasal spray)

Try first: saline nasal rinses, HEPA filters, shower after outdoor exposure.

Headaches & General Pain

  • Preferred: Acetaminophen (any trimester)

  • Use with clinician guidance: Sumatriptan (avoid combo tabs with naproxen)

  • Avoid: NSAIDs (ibuprofen/naproxen) in 1st & 3rd trimesters; if used at all, it’s typically limited to the 2nd trimester only and only if acetaminophen fails—confirm with your OB.

Non-drug tips: hydrate, rest, cold/warm compress, light neck/shoulder massage, relaxation breathing.

Cold & Flu Symptoms

  • Acetaminophen (fever, aches)

  • Chlorpheniramine or diphenhydramine (runny nose; may cause drowsiness)

  • Loratadine or cetirizine (allergy-type congestion)

  • Topical menthol rubs

Caution: Many cold meds are only considered when used short-term. Be extra careful in the 1st trimester and avoid decongestants unless approved.

Comfort care: rest, humidifier, warm fluids, honey-lemon, saline gargles.

Heartburn (Very Common in 3rd Trimester)

  • First-line: Antacids with aluminum, calcium, or magnesium

  • If not enough: Sucralfate; H2 blockers (e.g., cimetidine, ranitidine*)

  • Next step: PPIs (e.g., omeprazole, esomeprazole) when H2s/antacids fail

*Ranitidine has been withdrawn in some markets; your clinician will recommend current alternatives.

Avoid: Sodium bicarbonate and bismuth subsalicylate; excess calcium (>1,000 mg elemental/day) without guidance; vonoprazan.

Lifestyle help: small meals, stay upright after eating, elevate head of bed 10–15 cm, ginger tea (if approved).

Diarrhea

  • Start with: oral rehydration + bland diet (e.g., BRAT)

  • May be used (case-by-case): kaolin or pectin preparations; loperamide at the lowest effective dose for severe cases (short-term, clinician-guided)

Avoid: diphenoxylate-atropine, bismuth subsalicylate.

Constipation

  • First-line: fluids + fiber (25–30 g/day) + movement

  • Med options: bulk-forming laxatives (psyllium, calcium polycarbophil, methylcellulose); polyethylene glycol

Avoid: mineral oil; stimulant laxatives (bisacodyl, senna) unless specifically advised; castor oil; bismuth-containing products.

Yeast Infections

  • Preferred in pregnancy: vaginal azoles (miconazole, clotrimazole) or nystatin creams/suppositories

Avoid: oral fluconazole.

Nausea & Vomiting (NVP)

  • First-line: Pyridoxine (vitamin B6)

  • Add-ons/alternatives (clinician-guided): doxylamine, diphenhydramine, meclizine, chlorpheniramine

  • Reserve: ondansetron when others fail

Non-drug tips: small frequent bland meals, ginger, BRATT diet (bananas, rice, applesauce, toast, tea).

Medications Commonly Advised to Avoid

  • Decongestants: phenylephrine, pseudoephedrine (especially 1st trimester)

  • Mucolytics: guaifenesin (avoid in 1st trimester unless advised)

  • Pain: routine NSAIDs (ibuprofen, naproxen, diclofenac)—avoid 1st & 3rd trimesters

  • Migraine: ergotamine

  • GI: bismuth subsalicylate; sodium bicarbonate; castor oil

  • Infections (yeast): oral fluconazole

  • High-risk prescription categories: systemic retinoids, valproic acid, high-dose vitamin A (>25,000 IU retinol/day), tetracyclines (incl. doxycycline, minocycline), thalidomide

If you’re already on a long-term prescription, do not stop abruptly—contact your prescriber to discuss pregnancy-safe switches.

Natural Remedies That Often Help

  • Allergies: saline rinses, HEPA filters, shower after outdoors

  • Headache: hydration, compresses, brief nap, gentle stretching

  • Cold/Flu: rest, humidifier, warm soups, salt-water gargles

  • Heartburn: elevate head of bed, chew gum, sit upright post-meal

  • Diarrhea: oral rehydration, BRAT diet

  • Constipation: fiber, prune juice, walking

  • Yeast: breathable underwear; yogurt with live cultures (adjunct, not treatment)

When to Call Your OB-GYN Now

  • Fever, persistent vomiting, severe headache, vision changes

  • Vaginal bleeding or fluid leakage

  • Painful urination, severe abdominal pain

  • Decreased fetal movement (after 28 weeks)

  • You took a medicine you’re unsure about

FAQ

Are OTC meds automatically safe in pregnancy?
No. “OTC” doesn’t mean “pregnancy-safe.” Always check first.

Can I use multi-symptom cold packs?
Prefer single-ingredient products to avoid unintended exposures.

What about herbal supplements?
Many lack safety data in pregnancy. Treat them like medicines—ask your clinician first.