Over-the-Counter Pain Relievers in Pregnancy: What's Safe to Take?
Medically reviewed by Lindsay Cook, PharmD
When you are pregnant and experiencing pain, you may be wondering which medications are safe to take.
Some medications, such as Tylenol (acetaminophen), are considered safe, while others, like nonsteroidal anti-inflammatory drugs (NSAIDs) can cause problems if taken during pregnancy. You may also have questions about topical forms of these medications, such as creams or patches.
Though you should always consult a healthcare provider for personalized medical advice, this article will discuss some general safety guidelines for taking over-the-counter (OTC) pain relievers during pregnancy.
Getty Images / Oscar Wong
What OTC Pain Relievers Can I Take While Pregnant?
Just because a medication is available over the counter does not mean it is safe for everyone.
When you are pregnant, you want to be sure the medication is safe for you and the fetus. For mild pain or fever, Tylenol is considered the preferred OTC pain reliever to take during pregnancy.
Tylenol (Acetaminophen)
Tylenol, which contains the active ingredient acetaminophen, is generally considered safe during pregnancy. Most healthcare providers recommend pregnant people take this OTC medication for pain or fever over other options.
Generally, they will recommend taking Tylenol at the lowest dose for the shortest period.
Tylenol refers to the single-ingredient product that only contains acetaminophen, not any combination products. It's important to note that acetaminophen can be found in many combination products that contain additional ingredients that may not be safe during pregnancy.
Although Tylenol is generally considered safe, you should still check with a healthcare provider before taking it to ensure that it is safe for you.
You may have heard that some studies suggest taking Tylenol is unsafe during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) has stated that studies have not established a connection between Tylenol and any problems with fetus development.
The ACOG recommends taking Tylenol during pregnancy only after checking with one's healthcare provider and taking it in moderation.
What OTC Pain Relievers Should I Avoid While Pregnant?
NSAIDs are a class of drugs that are taken to treat pain, fever, and inflammation. NSAIDs are available in both prescription and OTC forms. Examples of OTC NSAIDs include:
Advil, Motrin (ibuprofen)
Aleve (naproxen)
Aspirin
In 2020, the U.S. Food and Drug Administration (FDA) released a warning against taking NSAIDs at 20 weeks of pregnancy or later. This is because doing so may cause serious kidney problems in the fetus, which could lead to low levels of amniotic fluid. The amniotic fluid surrounds and protects the fetus during pregnancy.
Additionally, taking NSAIDs in the third trimester can cause problems that may lead to high blood pressure in the baby's lungs. Therefore, you should not take NSAIDs at 20 weeks of pregnancy or later unless directed to do so by your healthcare provider.
As for earlier in pregnancy, some studies have found possible associations between ibuprofen use and intestinal problems in the baby, but results are conflicting.
Other studies have shown that ibuprofen use in early pregnancy may cause miscarriage or heart problems, but these studies have not established the reason for ibuprofen use. This may be important because the illness itself could have caused a miscarriage or heart problems rather than the medication.
Because there is not enough data to know whether NSAIDs are safe during early pregnancy, you should always consult a healthcare provider. Tylenol (acetaminophen) may be a better option.
Like acetaminophen, NSAIDs can be found in combination drugs as well. Always check the label and ask your pharmacist for help selecting an appropriate OTC medication.
Low-Dose Aspirin in Pregnancy
Though regular-strength aspirin (325 milligrams (mg)) and extra-strength aspirin (500 mg) are included in the NSAID warnings above, some pregnant people take low-dose aspirin (usually 81 mg daily) to prevent blood clots or preeclampsia (dangerously high blood pressure and pregnancy complications).
This is not in the same category as taking higher doses for pain or fever. Low-dose aspirin is not expected to cause miscarriage, birth defects, or other pregnancy-related problems.
If you take low-dose aspirin, check with your healthcare provider regarding recommendations for use during pregnancy.
Can I Use Topical Pain Relievers During Pregnancy?
Topical medications, such as creams or patches, are applied to an affected area to relieve pain.
However, these medicines are still absorbed into the bloodstream, although to a lesser extent than a medication taken by mouth. You should always check with a healthcare provider before using any medication during pregnancy.
Voltaren Arthritis Pain contains diclofenac sodium (an NSAID) and comes with the same NSAID warning about pregnancy. Do not use this product at 20 weeks of pregnancy or later. Before 20 weeks of pregnancy, consult a healthcare provider for medical advice.
Topical products that contain ingredients such as menthol, lidocaine, or capsaicin may be safe. Animal studies have not shown harm to the fetus, but studies in humans are limited. As always, consult a healthcare provider before using any of these products.
Is CBD Safe to Use During Pregnancy?
CBD, or cannabidiol, is a compound found in marijuana, but it does not cause a "high." It is sometimes used in oral and topical forms for pain relief.
Marijuana, or cannabis, also contains tetrahydrocannabinol (THC), which causes that "high" effect. Because using any type of CBD, THC, or marijuana during pregnancy (or while breastfeeding) comes with many potential serious risks, the U.S. Food and Drug Administration (FDA) strongly advises against it.
Why Opioids Should Not Be Taken During Pregnancy
Opioids are a class of drugs that includes:
Strong pain medications (narcotics) available by prescription, such as Percocet (oxycodone/acetaminophen) and OxyContin (oxycodone).
The synthetic opioid fentanyl, which is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl is available by prescription for severe pain, such as pain associated with cancer, for example. Fentanyl is also made illegally. It is often added to illegal drugs because it is so strong. This makes drugs cheaper, stronger, more dangerous, and more addictive.
The illegal drug heroin.
Opioids are responsible for most overdose deaths, often from illegally manufactured fentanyl, which may be added to other drugs and taken unknowingly.
Using opioids during pregnancy is dangerous for both the pregnant person and the fetus. It can lead to problems such as stillbirth, growth problems, preterm delivery, maternal death, or neonatal opioid withdrawal syndrome (wherein the newborn goes through drug withdrawal after becoming dependent on opioids during the pregnancy).
For people who are pregnant and have chronic (ongoing) pain, the ACOG recommends avoiding or minimizing opioid use, leaning toward other types of therapy like non-opioid medication and/or non-medicinal treatments like physical therapy.
For people who are pregnant and have acute severe pain (sudden and/or urgent pain) requiring an opioid pain medication, their healthcare provider will prescribe the lowest effective dose for the shortest time possible and monitor the individual closely.
Sometimes, individuals will require a short course of low-dose opioid medications after a cesarean (C-section) delivery.
Other Ways to Relieve Pain During Pregnancy
In addition to taking medication, your healthcare provider may approve some non-medicinal ways to relieve your pain. For example, if you have back pain, the ACOG recommends tips such as:
Wearing clothes that provide support. You can also try an abdominal support.
Wearing supportive shoes as well. Try walking shoes or athletic shoes with arch support. Avoid wearing high heels.
Resting one foot on a stool to reduce back strain, especially if you've been standing for a long time.
Sleeping on your side, especially later in pregnancy, with one or both knees bent. Try placing one pillow between your knees and another pillow under your stomach—or use a full-length body pillow.
Wrapping a heating pad in a towel and using it on the lowest setting. Set a timer to prevent burns from keeping the pad on for too long. You could also try cold compresses.
Trying gentle exercise, such as walking or yoga.
Summary
If you experience pain during pregnancy, there are some things you can do to relieve your symptoms. Generally, Tylenol (acetaminophen) is safe to take during pregnancy. Avoid other pain relievers, such as NSAIDs, which can carry risks if taken while pregnant.
Check with your healthcare provider first to ensure it is safe for you, considering your medical history and conditions. Your healthcare provider can also recommend other measures you can take based on your symptoms to make you more comfortable.
Read the original article on Verywell Health.
