Cold and Flu Medications While Pregnant: What to Avoid and What’s Safe

When you're pregnant and fighting a cold or the flu, every decision feels heavier. You don’t just think about yourself-you think about the baby. That’s why reaching for that bottle of Advil or NyQuil might feel like a normal move, but it could be risky. The good news? There are safe ways to feel better without putting your baby in danger. The key is knowing what to avoid-and what you can actually use.

What’s Safe: The Go-To Medications

Acetaminophen (Tylenol) is your best friend during pregnancy for fever, headaches, or body aches. It’s been studied in more than 50,000 pregnancies, including over 200 cases where it was taken in the first trimester. No increased risk of birth defects was found. It’s the only pain reliever and fever reducer that doctors consistently recommend across all trimesters. Stick to the lowest effective dose, and don’t use it longer than needed.

For coughs, dextromethorphan (found in Robitussin DM) is considered safe for short-term use. A 2007 study tracked 300 women who took it in their first trimester and 580 who used it anytime during pregnancy. No link to birth defects emerged. Just make sure it’s plain dextromethorphan-no added alcohol, antihistamines, or decongestants.

Guaifenesin (plain Mucinex) helps loosen mucus and clear your chest. It’s also considered safe during pregnancy. Again, avoid the multi-symptom versions. Stick to the single-ingredient product.

For runny noses or allergies, second-generation antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are preferred. They’re less likely to cause drowsiness and have solid safety data. Unlike older antihistamines like diphenhydramine (Benadryl), they don’t cross the placenta as easily and aren’t linked to birth defects.

Topical remedies like Vicks Vapor Rub and menthol cough drops are safe too. They work locally, so very little gets into your bloodstream. Saline nasal sprays and humidifiers are also excellent, drug-free options to ease congestion without any risk.

What to Avoid: The Dangerous Ones

Stay away from all NSAIDs-ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. These can affect fetal development, especially in the third trimester. They may reduce amniotic fluid, delay labor, or cause heart problems in the baby. Even occasional use isn’t worth the risk unless a doctor specifically says otherwise.

Decongestants are tricky. Phenylephrine (found in Sudafed PE and many cold medicines) is not safe during pregnancy. It can restrict blood flow to the placenta. Pseudoephedrine (Sudafed) is even more controversial. Some sources say it’s okay in limited doses after the first trimester. Others, including major health systems like VCU Health, say avoid it entirely. Given the conflicting advice, it’s safest to skip it unless your OB says otherwise.

Combination cold and flu meds are the biggest trap. Products like DayQuil, NyQuil, and Mucinex FastMax mix multiple ingredients-some safe, some not. NyQuil and DayQuil also contain alcohol (10-15% in liquid forms), which is a known risk during pregnancy. Even the caplets without alcohol often include antihistamines or decongestants you shouldn’t take. Skip them entirely.

Codeine is off-limits. The FDA warns it can cause serious breathing problems in newborns, even at low doses. It’s been linked to stillbirth and neonatal withdrawal. Don’t use it for coughs or pain.

Herbal supplements? Don’t risk it. The FDA doesn’t regulate them, so you have no idea what’s actually in the bottle. Things like echinacea, elderberry, or zinc lozenges might sound natural and harmless, but there’s no solid proof they’re safe for your baby. Some herbs can trigger contractions or affect hormone levels. Better to stick with proven, tested options.

What About the Flu? Antivirals Are Okay

If you think you have the flu-fever, chills, body aches, fatigue-don’t wait. The flu is more dangerous during pregnancy. You’re at higher risk for pneumonia, hospitalization, and even ICU admission. The good news? Antiviral meds like oseltamivir (Tamiflu) are safe and recommended.

Studies show no increased risk of birth defects with Tamiflu use during pregnancy. The American College of Obstetricians and Gynecologists says treatment should start within 48 hours of symptoms, but even after that, it’s still beneficial. Don’t wait for a positive test. If you’ve been exposed or have flu-like symptoms, talk to your doctor right away.

Zanamivir (Relenza) is another option, though it’s inhaled and might not be ideal if you have asthma. Baloxavir (Xofluza) is not recommended-there’s just not enough safety data yet.

And yes, get the flu shot. The CDC recommends it for all pregnant women during flu season (October to May), no matter the trimester. It protects you and gives your baby antibodies for the first few months after birth. The Abrysvo vaccine is also recommended for RSV prevention between 32 and 36 weeks.

Non-Medication Strategies That Actually Work

Before you reach for anything, try these proven, zero-risk methods:

• Drink plenty of fluids-water, broth, herbal teas. Dehydration makes symptoms worse.
• Rest as much as you can. Your body needs energy to fight infection.
• Use a saline nasal spray or neti pot to clear congestion.
• Run a humidifier in your bedroom at night. Moist air helps loosen mucus.
• Saltwater gargles for sore throats. Simple, safe, and effective.
• Elevate your head with an extra pillow to help with breathing at night.

These aren’t just "home remedies"-they’re the first line of defense recommended by obstetricians and pharmacists alike. They don’t just ease symptoms; they support your body’s natural healing process.

When to Call Your Doctor

You don’t need to panic over every sniffle, but some signs mean you should call right away:

• Fever over 101°F (38.3°C) that doesn’t come down with acetaminophen
• Difficulty breathing or shortness of breath
• Chest pain or pressure
• Severe headache or confusion
• Decreased fetal movement
• Signs of dehydration-dizziness, dark urine, not peeing for 8+ hours

If you’re unsure whether a medication is safe, don’t guess. Call your OB, midwife, or a pharmacist who specializes in pregnancy. The InfantRisk Center offers a free hotline for questions about medications in pregnancy. They’re a trusted resource used by doctors nationwide.

Bottom Line: Safer Choices, Fewer Risks

Pregnancy doesn’t mean you have to suffer through a cold or flu. You just need to be smarter about what you take. Stick to acetaminophen for pain and fever. Use plain dextromethorphan or guaifenesin for cough and congestion. Avoid anything with multiple ingredients, alcohol, or decongestants. Skip herbal supplements and NSAIDs entirely.

The biggest mistake? Waiting too long to treat the flu. Untreated flu poses a far greater threat to your baby than Tamiflu ever could. Get help early. Get vaccinated. And when in doubt, ask your provider. Your health-and your baby’s-is worth the extra step.