Pregnancy
Safe Medications During Pregnancy: What You Can Take for Common Symptoms
Many common medicines are considered safe during pregnancy, but some aren't, and the right choice depends on the drug, the dose and how far along you are. In general, acetaminophen is preferred over ibuprofen for pain and fever, many allergy and heartburn medicines are considered low-risk, and NSAIDs like ibuprofen are avoided from 20 weeks on. Check with your OB/GYN, midwife or pharmacist before taking anything new, and never stop a prescription medicine on your own.
Almost everyone ends up standing in a pharmacy aisle at some point, pregnant, congested and squinting at a box of cold medicine. This guide is meant for that moment. Screenshot the table.
Why pregnancy changes the rules
Some drugs cross the placenta and can affect the baby's development. The risk depends on:
- Timing: organs form mainly in the first trimester; other risks, like effects on the baby's kidneys or heart, show up later
- Dose and how long you take it
- Your health: untreated conditions such as fever, depression, asthma or seizures can themselves harm a pregnancy
So the goal isn't to avoid all medicine. It's the right medicine, at the lowest effective dose, for as long as you need it. Your provider will tell you the dose that's right for you.
The pharmacy-aisle cheat sheet
This is general information about options OB/GYNs commonly discuss. It's not a substitute for advice about your pregnancy.
| Symptom | Options often considered | Usually avoided or used only with medical advice |
|---|---|---|
| Pain, headache, fever | Acetaminophen | Ibuprofen, naproxen, aspirin at pain-relief doses (unless prescribed) |
| Allergies | Loratadine, cetirizine, diphenhydramine; nasal steroid sprays; saline | Oral decongestants, especially in the first trimester |
| Cold and congestion | Saline spray or rinse, humidifier, warm fluids | Pseudoephedrine and phenylephrine (first trimester, high blood pressure); multi-symptom combos |
| Cough | Honey, warm fluids; some cough suppressants with provider approval | Products containing alcohol; multi-symptom combos |
| Heartburn | Calcium carbonate antacids, famotidine; omeprazole if advised | Antacids with sodium bicarbonate; bismuth subsalicylate (Pepto-Bismol) |
| Constipation | Fiber supplements, docusate, polyethylene glycol | Stimulant laxatives used regularly without advice; castor oil |
| Nausea | Vitamin B6, with or without doxylamine | Herbal remedies not reviewed by your provider |
| Diarrhea | Fluids and electrolytes; loperamide short-term if advised | Bismuth subsalicylate |
| Sleep | Sleep habits first; diphenhydramine or doxylamine occasionally if advised | Prescription sleep drugs without discussion |
The trap most people fall into: multi-symptom "cold and flu" or "nighttime" products. They often bundle a decongestant, a pain reliever and an antihistamine, sometimes with alcohol. Read the active ingredients on the back and pick single-ingredient products instead. Pharmacists are great at this; ask at the counter.
"Can I take Tylenol?"
Acetaminophen is the medicine ACOG recommends for pain and fever during pregnancy when medicine is needed. Untreated high fever in early pregnancy carries its own risks, so treating a fever matters.
You may have seen the 2025 headlines. In September 2025, the FDA began a process to update acetaminophen labeling to mention a possible association between prenatal use and neurodevelopmental conditions such as autism and ADHD, and advised clinicians to consider minimizing use for routine low-grade fevers. The FDA also noted that acetaminophen remains the safest over-the-counter option for pain and fever in pregnancy, since alternatives such as aspirin and ibuprofen have known risks to the fetus. ACOG and other medical groups have stated that the research does not show acetaminophen causes these conditions, and they continue to advise using it when needed, at the lowest effective dose for the shortest time.
Many patients tell us they felt guilty for taking it before they saw the news. Using it as advised for a real fever or pain is reasonable. Ask your provider how much and how often is right for you.
"What about Advil or Aleve?"
Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin at pain-relief doses. The FDA recommends avoiding NSAIDs from 20 weeks of pregnancy onward unless your doctor specifically advises them, because they can affect the baby's kidneys and lower amniotic fluid. In the third trimester, they can also affect a blood vessel in the baby's heart. Many providers advise avoiding them throughout pregnancy unless needed.
A common worry: "I took a couple of Advil before I knew I was pregnant." Tell your provider, but an occasional dose early on is something they hear about all the time.
Low-dose aspirin is different. Some people are prescribed it to lower the risk of preeclampsia. Take it only if your provider recommends it, and don't substitute regular-strength aspirin. See our preeclampsia guide.
Prescriptions known to be risky
Some prescription drugs are known to cause birth defects or other harm and are usually switched before or as soon as pregnancy is confirmed. Examples:
- Isotretinoin (for acne)
- Valproate and some other seizure medicines
- Warfarin (a blood thinner)
- ACE inhibitors and ARBs (blood pressure medicines like lisinopril and losartan)
- Methotrexate
- Some tetracycline antibiotics, such as doxycycline, especially after the first trimester
Taking one of these? Contact your prescriber right away. Don't stop without guidance, since some need to be tapered or replaced.
Antidepressants and other ongoing medicines
Many people need to keep taking medicine for depression, anxiety, asthma, thyroid disease, high blood pressure or diabetes during pregnancy. Untreated illness can be risky for both you and the baby. Your OB/GYN, prescriber and sometimes a maternal-fetal medicine specialist can help you weigh options and switch medicines when needed.
Stopping an antidepressant cold turkey after a positive test is one of the most common things people do on their own, and it can backfire. Call first.
Vaccines during pregnancy
Several vaccines are recommended during pregnancy to protect you and your newborn:
- Flu shot during flu season, at any point in pregnancy
- Tdap between 27 and 36 weeks, in every pregnancy
- RSV vaccine between 32 and 36 weeks during RSV season, as one option to protect the baby
- COVID-19 vaccine: ACOG continues to recommend it in pregnancy; ask your provider about current guidance
Live vaccines, such as MMR and chickenpox, are not given during pregnancy.
Herbs and supplements
"Natural" doesn't mean safe in pregnancy. Herbal supplements aren't tested or regulated like medicines, and products vary in strength and purity. Take the prenatal vitamin your provider recommends, and ask before adding anything else, including teas marketed for pregnancy.
Stock your cabinet before you need it
Getting to a 24-hour pharmacy at 2 a.m. is easier in Manhattan than in much of Suffolk or Dutchess County. Early in pregnancy, ask your provider to approve a short list, then keep it at home:
- Acetaminophen
- Saline nasal spray
- An approved antacid
- A fiber supplement or stool softener
- A thermometer
Reliable places to ask
- Your OB/GYN, midwife or pharmacist can review your full medication list.
- MotherToBaby offers free, evidence-based fact sheets and a hotline about medicines and other exposures in pregnancy and breastfeeding.
- Bring every bottle, including vitamins and supplements, to your first prenatal appointment, or take photos of the labels.
Need a prenatal provider in New York? Search the directory.
When to call your provider
Call your provider if:
- You took a medicine and later found out it may not be safe in pregnancy
- You have a fever of 100.4°F (38°C) or higher
- A headache doesn't improve with rest and acetaminophen, or comes with vision changes or swelling
- Over-the-counter remedies aren't controlling your symptoms
- You're thinking about stopping or changing a prescription medicine
- You have side effects from any medicine
Frequently asked questions
Can I take Tylenol while pregnant?
Acetaminophen (Tylenol) remains the pain and fever reliever ACOG recommends during pregnancy when medicine is needed, used at the lowest effective dose for the shortest time. In 2025 the FDA began a labeling update about a possible association with neurodevelopmental conditions; ACOG says the evidence does not show acetaminophen causes these conditions. Talk to your provider about your situation.
Can I take ibuprofen while pregnant?
Ibuprofen, naproxen and similar NSAIDs are generally avoided, especially from 20 weeks of pregnancy onward, because they can affect the baby's kidneys and amniotic fluid, and later the baby's heart. Ask your provider before taking any NSAID.
What cold medicine is safe during pregnancy?
Many people can use saline spray, honey for cough, and some single-ingredient products. Oral decongestants like pseudoephedrine are usually avoided in the first trimester and in people with high blood pressure. Check with your provider before using combination products.
Should I stop my prescription medicine when I find out I'm pregnant?
Not without talking to your clinician first. Stopping some medicines suddenly, such as those for seizures, depression, asthma or blood pressure, can be more dangerous than continuing them.
Sources
- ACOG — Medicines During Pregnancy guidance and FAQs
- ACOG — Response to HHS announcement on acetaminophen use in pregnancy (2025)
- FDA — Notice to Physicians on acetaminophen use in pregnancy (2025)
- FDA — Avoid use of NSAIDs in pregnancy at 20 weeks or later (Drug Safety Communication)
- CDC — Treating for Two: Medicine and Pregnancy
- MotherToBaby (Organization of Teratology Information Specialists) — Fact Sheets
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.