Safe Medications for Upper Respiratory Viral Illness During Pregnancy

First-Line Safe Medications

• Saline nasal rinses are effective and safe for managing nasal congestion during pregnancy 1

Safe Intranasal Medications

• Intranasal corticosteroids such as budesonide, fluticasone, and mometasone are considered safe for controlling nasal symptoms during pregnancy 1, 2
• These medications should be used at the lowest effective dose for the shortest duration necessary 2

Medications to Avoid

• Phenylephrine should be avoided during pregnancy, especially in the first trimester, due to potential fetal risks including congenital malformations 1
• First-generation antihistamines with sedative properties should generally be avoided during pregnancy 1, 2
• Oral decongestants should not be used, particularly during the first trimester, due to potential association with congenital malformations 1, 3

Special Considerations for Influenza

• Antiviral medications for influenza should be reserved for cases where benefits outweigh risks 4, 5
• Oseltamivir may cause nausea and vomiting but limited data show few women discontinue treatment due to these side effects 4, 5
• Zanamivir should be used with caution in pregnant women with underlying respiratory conditions such as asthma 4, 5

Important Clinical Considerations

• The first trimester carries the highest risk for medication-induced teratogenicity, so non-urgent treatments should be carefully evaluated during this period 2
• Untreated severe respiratory conditions can pose risks to maternal and fetal health, highlighting the need for appropriate management 1