10 Over-the-Counter Drugs to Avoid During Pregnancy
Transcription
10 Over-the-Counter Drugs to Avoid During Pregnancy
10 over-thecounter drugs to avoid during pregnancy These surprising, safer alternatives may be a better choice 1 September 2014 We were surprised to discover research suggesting that pregnant women may be more likely to turn to over-the-counter (OTC) drugs to treat coughs and colds or aches and pains than they might otherwise. Women may believe these drugs are safer to use, while pregnant, than prescription medications. In fact, many of the OTCs are not good choices for pregnant women. Yet we found little reliable, clear information available about which ones are safe for a pregnant woman to take and which she should avoid. The enclosed report, “10 over-the-counter drugs to avoid during pregnancy,” is our answer to consumers’ need for better information about these everyday medications. The recommendations are based on our assessments of data from the Organization of Teratology Information Specialists, a nonprofit organization that provides evidence-based information on medications and exposures to other potential toxins during pregnancy and while breast feeding. Consumer Reports’ Best Buy Drugs consumer education program, from which this report was developed, is housed in the Consumer Reports Health Ratings Center. The program aims to help consumers understand the safety, effectiveness, and cost of medications. We do not accept funding from any industry, including pharmaceutical companies, and our staff (including writers and editors) does not have any relationships with industry. Because of our independence, consumers can be confident that they are receiving unbiased advice, based on the best available evidence. We hope you will find the article informative and share it with others who may find it useful. We also look forward to hearing your feedback via email at [email protected]. Doris Peter, PhD Director, Consumer Reports Health Ratings Center Consumer Reports Headquarters 101 Truman Avenue Yonkers, New York 10703-1057 914-378-2000 2 10 over-the-counter drugs to avoid during pregnancy These surprising, safer alternatives may be a better choice Mothers-to-be get headaches and upset stomachs just like everyone else. So it’s not surprising that most pregnant women have used over-the-counter medications. In fact, some data suggest that, overall, women are actually more likely to use certain medications—including cough and cold drugs and acetaminophen (Tylenol, generic)—after they become pregnant. to pose risks to the developing fetus at different stages of pregnancy. “There’s a misperception that if a drug is available overthe-counter, that it’s approved by the Food and Drug Administration, so it must be safe for everyone, including pregnant women,” Allan Mitchell, M.D. professor of pediatrics and epidemiology at the Boston University School of Public Health and Medicine, said. “Even doctors can fall for this idea.” But some OTC drugs have been shown Even then, you should use alternatives judiciously, and only as advised by your health care provider. Experts refer to safer medications because for 98 percent of prescription and OTC drugs, there simply isn’t enough data to say for sure that a drug is entirely safe to take during pregnancy. Due to ethical concerns, most FDA-approved medicines have not been tested in pregnant women. To help you and your doctor make more informed choices about which medications to take, we’ve identified 10 common ingredients used in OTC drugs that are risky for pregnant women, as well as safer alternatives. 3 For example, acetaminophen has long been considered a safer way for pregnant women to reduce fever and alleviate pain than nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen (Advil and generic), and naproxen (Aleve and generic.) But children whose mothers use the pain reliever during pregnancy may be at higher risk for asthma, behavior problems, and attention deficit disorder, according to preliminary research. Tension Headache, is indeed, free of aspirin, but still contains caffeine. “For women who use acetaminophen only occasionally, the risk appears to be quite small,” Mitchell said. But frequent use—more than three times a month throughout pregnancy—is cause for more concern, according to Mitchell. So, while it’s reasonable to treat a fever or the occasional severe headache with medication, women who find themselves needing to take a pain reliever several days in a row or more than once every few weeks should consult their providers to help find and address the underlying cause of their symptoms. An Internet search will turn up lots of websites with advice on “safe medications to use during pregnancy.” But the advice is inconsistent and recommendations are often based on a lack of data, rather than evidence for safe use according to a study of Web-based information published in 2013. Bottom line: If you are pregnant or may become pregnant, you should be extremely cautious about anything you take, including OTC and prescription medications, and all vitamins, supplements, and herbals. Tips to consider before taking an OTC drug Try nondrug measures. For complaints commonly handled by OTC products, nondrug measures can help alleviate symptoms without the risk. For example, stress busters such as massage, meditation, relaxation exercises, or even a walk around the block, can help with tension headaches. And rest, fluids, and chicken soup are a much safer way for pregnant women to deal with symptoms of a cold than antihistamines and decongestants. Consult your healthcare provider. Don’t take anything without first discussing it with your practitioner. “There are trade-offs with OTC products,” Mitchell said. “You have to balance your need to take something with any possible risks.” Avoid combination products. Multi-symptom cold and allergy medications typically contain ingredients from the “off-limits” list. For example, while Tylenol pain reliever (acetaminophen) is relatively safe for occasional use during pregnancy, Tylenol Sinus Congestion and Pain and Tylenol Cold Multi-Symptom liquid contain the decongestant phenylephrine, which is not. Read labels. Ingredients such as alcohol and caffeine turn up in surprising places. For example, Vick’s Nyquil Cold & Flu Liquid contains alcohol. And CVS Aspirin-Free Where to find reliable information on the web For up-to-date, reliable information, we recommend www.MotherToBaby.org, the consumer website of the Organization of Teratology Information Specialists, a nonprofit organization dedicated to providing evidence-based information on medications and exposures to other substances during pregnancy and while breastfeeding. You can also call toll-free at 1-866-626-6847 to talk to an information specialist free of charge. 4 10 OTC drugs to avoid when you’re pregnant Note: This chart does not list every drug that is unsafe to take during pregnancy. Always talk to your healthcare provider before taking any drug or supplement. Consumer Reports Recommendation Possible Alternative Drug Found In Aspirin Bayer; Excedrin Migraine Not recommended1 Tylenol (acetaminophen) Bismuth Subsalicylate Kaopectate; Pepto Bismol Before 20 weeks: Use with caution After 20 weeks: Not recommended Imodium (loperamide) Brompheniramine Dimetapp Cold and Allergy Before 36 weeks: Use with caution After 36 weeks (9th month): Not recommended Claritin (loratadine); Zyrtec (cetirizine) Caffeine Anacin Regular Strength; Excedrin Extra Strength; Excedrin Migraine Use with caution; To reduce risk of miscarriage, do not exceed 200 milligrams daily, including caffeine from coffee, tea, or soda. None Castor Oil ----- Do not take Unacceptable risk Increase physical activity, drink more fluids and eat fiber-rich foods. Consider psyllium- based fiber supplements. Chlorphen-iramine Chlor-Trimeton; Combination products: Advil Allergy & Congestion Relief; Alka-Seltzer Plus Cold Formula; Dristan Cold Before 36 weeks: Use with caution After 36 weeks (9th month): Not recommended Claritin (loratadine); Zyrtec (cetirizine) 5 Drug Found In Consumer Reports Recommendation Ibuprofen Advil, Motrin Weeks 14 - 26 (2nd trimester): Use with caution Before 14 weeks & after 27 weeks (1st and 3rd trimester): Not recommended Tylenol (acetaminophen) Naproxen Aleve Weeks 14 to 26 (2nd trimester): Use with caution Before 14 weeks & after 27 weeks (1st and 3rd trimester): Not recommended Tylenol (acetaminophen) Nicotine Cigarettes and all other forms of tobacco; Nicorette gum; Nicoderm CQ patches Not recommended; however the benefits of gum or patches to help stop smoking may exceed risks of smoking during pregnancy. None Phenylephrine and Pseudo-ephedrine Products containing Pseudo-ephedrine2: Advil Cold & Sinus; Claritin-D; Sudafed 12 Hour Before 14 weeks (1st trimester): Not recommended After 14 weeks (2nd and 3rd trimester): Use with caution Drink plenty of fluids, consider using steam to relieve congestion, avoid irritants like tobacco smoke Products containing Phenylephrine: Alka-Seltzer Plus Day; Sudafed PE Pressure + Pain; Tylenol Cold Multi-symptom; Vicks Dayquil Cold and Flu Relief Information from Briggs GG, Freeman RK, Yaffe SJ eds. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. 9th ed. Wolters. Possible Alternative 1. Low-dose aspirin (40 to 150 mg daily) may be prescribed for certain conditions associated with pregnancy such as gestational high blood pressure and pre-eclampsia. 2. Sold behind the counter without a prescription. 6 Consumer Reports James A. Guest, President, Consumer Reports Chris Meyer, Vice President, External Affairs Tara Montgomery, Senior Director, Consumer Reports Health John Santa, Medical Director, Health Ratings Center Doris Peter, Director, Health Ratings Center Kristina Mycek, Statistician Lisa Gill, Deputy Content Editor, Best Buy Drugs Steve Mitchell, Associate Editor, Best Buy Drugs Teresa Carr, Associate Editor, Best Buy Drugs Ginger Skinner, Associate Editor, Best Buy Drugs Kathleen Person, Project Manager Lisa Luca, Web Editorial Associate Health Impact Dominic Lorusso, Director, Health Partnerships Development Lesley Greene, Associate Director, Health Impact Programs David Ansley, Senior Analyst, Health Product Development Beccah Rothschild, Senior Outreach Leader, Health Partner Development Pamela Austin, Senior Marketing Associate Lane Rasberry, Wikipedian-in-Residence Claudia Citarella, Senior Administrative Assistant Health and Food Content Development Nancy Metcalf, Senior Editor Joel Keehn, Deputy Content Editor, Health and Food About this report This “What Hospitals Don’t Want You To Know About C-sections” report is published by Consumer Reports, the nation’s expert, independent, and nonprofit consumer organization. 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