Safe Cough Medicines During Pregnancy

First-Line Safe Options

Saline nasal rinses are the safest and most effective treatment for nasal congestion, with zero systemic absorption and no fetal risk 1
The American College of Obstetricians and Gynecologists recommends acetaminophen as the preferred medication for pain and fever control during pregnancy, to be used at the lowest effective dose for the shortest possible time 1

Albuterol is the preferred treatment for asthma-related cough, with extensive safety data from pregnant women, and is classified as Category A by the Australian TGA, indicating compatibility during pregnancy 2, 1
Ipratropium bromide is the only recommended inhaled anticholinergic in pregnancy, and can be safely combined with albuterol in nebulizer treatment 1, 2
Budesonide nasal spray is safe for persistent congestion, with minimal systemic absorption, and is preferred over oral decongestants 1

Pseudoephedrine and phenylephrine should be avoided, especially in the first trimester, due to the risk of fetal gastroschisis and maternal hypertension 1
Diphenhydramine and chlorpheniramine should be avoided due to sedative and anticholinergic effects 1
Ibuprofen, naproxen, and aspirin are contraindicated, especially after 32 weeks gestation, due to the risk of fetal complications including premature closure of ductus arteriosus 1
TMP-SMZ is contraindicated in pregnant women due to the risk of kernicterus 3, 4
Clarithromycin is FDA Pregnancy Category C, with animal studies showing adverse fetal effects 5, 3

Inadequately controlled respiratory symptoms pose greater risk to the fetus than appropriate medication use, and maternal hypoxia from severe symptoms is more dangerous than the medications themselves 1
Uncontrolled respiratory conditions can increase the risk of perinatal mortality, preeclampsia, and low birth weight 2
Never withhold necessary respiratory medications due to pregnancy concerns, and evaluate for asthma, bacterial infection, or other serious causes if symptoms persist 1

If pertussis or bacterial infection is suspected, erythromycin is FDA Pregnancy Category B and can be used, as recommended by the Centers for Disease Control and Prevention, based on guidelines from MMWR Recommendations and Reports 6
Clarithromycin is Category C with animal studies showing adverse effects and should be avoided, according to the MMWR Recommendations and Reports 6