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 how you feel-you think about your baby. That’s why knowing what cold and flu medications are safe-and which ones to avoid-isn't just helpful, it’s essential.

What’s Safe to Take During Pregnancy?

Acetaminophen (Tylenol) is the go-to for fever, headaches, and body aches. It’s been studied in more than 50,000 pregnancies, including over 200 cases where it was used in the first trimester. No link to birth defects was found. It’s safe in all three trimesters, as long as you stick to the recommended dose: no more than 3,000 mg per day unless your doctor says otherwise.

For coughs, dextromethorphan (found in Robitussin DM) is considered low-risk. A study of 300 women who took it in the first trimester showed no increase in birth defects. Just make sure you’re getting the plain version-no added alcohol, antihistamines, or decongestants.

Guaifenesin (plain Mucinex) helps loosen mucus and is also considered safe. Again, avoid combination products. If it says “FastMax,” “Severe,” or “Multi-Symptom,” put it back. Those often contain ingredients you shouldn’t take while pregnant.

For runny nose or allergies, second-generation antihistamines like loratadine (Claritin) and cetirizine (Zyrtec) are preferred. They don’t cause much drowsiness and have solid safety data. Nasal saline sprays and humidifiers are also great, drug-free options to clear congestion without any risk.

Topical remedies like Vicks Vapor Rub and menthol cough drops are safe to use. They don’t enter your bloodstream in significant amounts, so they won’t reach your baby. Just avoid swallowing large amounts of cough drops-some contain high sugar or artificial sweeteners.

What You Should Avoid at All Costs

NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are not safe during pregnancy-especially after 20 weeks. These drugs can cause serious issues like reduced amniotic fluid, premature closure of a fetal heart vessel, and even kidney problems in the baby. Even occasional use after the first trimester carries risk.

Decongestants are tricky. Phenylephrine (found in Sudafed PE and many cold formulas) is linked to a small but real increase in birth defects, especially in the first trimester. VCU Health and Catholic Health both warn against it. Pseudoephedrine (Sudafed) is more controversial-some providers say it’s okay in moderation after the first trimester, but others say avoid it entirely. Because the data isn’t clear-cut, most OB-GYNs recommend skipping it unless absolutely necessary.

Combination products are the biggest trap. DayQuil, NyQuil, Mucinex FastMax, and similar multi-symptom cold remedies often mix acetaminophen with dextromethorphan, antihistamines, and decongestants. That means you might be taking something unsafe even if you think you’re being careful. NyQuil and DayQuil also contain alcohol-up to 15% in liquid versions. Even small amounts can cross the placenta. Caplets without alcohol may be less risky, but why take the chance when safer options exist?

Codeine and other opioid-based cough syrups are off-limits. The FDA issued a strong warning in 2021: codeine can cause life-threatening breathing problems in newborns, especially if taken near delivery. It’s not worth the risk.

Herbal supplements and “natural” remedies? Avoid them. The FDA doesn’t regulate them, and there’s little to no research on how they affect fetal development. Echinacea, elderberry, zinc lozenges, and garlic supplements may seem harmless, but you simply don’t know what’s in them or how they interact with your pregnancy.

What About the Flu? Should You Take Antivirals?

Yes. If you have the flu while pregnant, the risks of not treating it are much higher than the risks of taking antivirals. Pregnant women are more likely to get seriously ill-hospitalization, pneumonia, even ICU admission are real dangers. The American College of Obstetricians and Gynecologists says treating flu with antivirals is likely more beneficial than risky for your baby.

Oseltamivir (Tamiflu) is the first choice. Studies show no increased risk of birth defects. It works best if taken within 48 hours of symptoms, but even after that, it can still reduce severity and duration. Zanamivir (Inavir) is a second option, inhaled and also considered safe. Baloxavir (Xofluza) is not recommended-there’s simply not enough safety data.

Don’t wait for a positive flu test to start treatment. If you have symptoms like fever, body aches, fatigue, and cough during flu season, talk to your provider right away. They’ll likely start you on Tamiflu based on symptoms alone.

Vaccines Are Your Best Defense

The best way to avoid getting sick is to prevent it. The CDC recommends the flu shot for all pregnant women during flu season (October to May), no matter what trimester you’re in. It’s safe, effective, and protects both you and your baby for months after birth.

There’s also the Abrysvo vaccine for RSV. If you’re between 32 and 36 weeks pregnant, getting this shot helps protect your newborn from severe respiratory illness in the first few months of life. It’s a newer vaccine, but data from 2023 shows it’s safe and highly effective.

Both vaccines use inactivated viruses-no live components. You can’t get the flu or RSV from them. Side effects are mild: sore arm, low fever, fatigue. These are signs your immune system is working, not signs of harm.

Non-Medication Strategies That Actually Work

Before you reach for a bottle, try these first:

• Drink plenty of fluids-water, broth, herbal teas (avoid caffeine-heavy ones).
• Rest as much as you can. Your body needs energy to fight infection.
• Use a saline nasal spray or neti pot to clear congestion. Sterile saline is safe and effective.
• Run a humidifier in your bedroom. Moist air helps soothe irritated airways.
• Saltwater gargles for sore throat. Just mix half a teaspoon of salt in warm water.
• Elevate your head with an extra pillow at night to reduce postnasal drip.

These methods don’t cure your cold, but they make it more bearable-and they don’t carry any risk.

When to Call Your Doctor

You don’t need to panic over every sniffle. But call your provider if you have:

• Fever over 101°F that doesn’t come down with acetaminophen
• Difficulty breathing or shortness of breath
• Chest pain or pressure
• Severe headache or confusion
• Decreased fetal movement
• Symptoms lasting more than 10 days

These could signal something more serious like pneumonia, a sinus infection, or even preterm labor triggered by illness. Don’t wait to see if it gets better.

Final Rule: Less Is More

The golden rule for cold and flu meds during pregnancy? Use the lowest dose for the shortest time possible. Even safe medications aren’t meant to be taken daily for weeks. If you’re feeling better after three days, stop taking the medicine. Let your body heal.

Always check with your OB-GYN or midwife before taking anything-prescription, over-the-counter, or supplement. What’s safe for one person might not be right for you, depending on your health history, allergies, or pregnancy complications.

Remember: Untreated flu is dangerous. Overmedicating is risky. The goal isn’t to avoid all medicine-it’s to choose wisely. When in doubt, stick with acetaminophen, rest, fluids, and your provider’s advice. Your baby is counting on you to make smart choices.