No medication, prescription or over-the-counter, should be assumed safe in pregnancy without checking first, but many common medications do have a well-established safety record and are used regularly throughout pregnancy when needed. This guide covers general categories to help you understand the landscape and ask better questions, it is not a substitute for confirming any specific medication with your OB-GYN, midwife, or pharmacist.

How Medication Safety in Pregnancy Is Evaluated

In 2015, the FDA replaced the old letter-based pregnancy categories (A, B, C, D, X) with the Pregnancy and Lactation Labeling Rule (PLLR), which requires drug labels to describe actual risk information in narrative form rather than a single letter grade. This change reflects how much medication safety in pregnancy depends on the specific drug, dose, timing, and individual health picture, rather than a simple category. Your provider and pharmacist use current label information, published research, and your medical history together to make a recommendation.

Commonly Used Over-the-Counter Medications

Acetaminophen (Tylenol): Generally the preferred pain reliever and fever reducer throughout pregnancy when needed, at the lowest effective dose for the shortest time.

Certain antihistamines: Loratadine (Claritin) and cetirizine (Zyrtec) are commonly used for allergy symptoms and are generally considered reasonable options; diphenhydramine (Benadryl) is also commonly used short-term.

Antacids: Calcium carbonate (Tums) and similar antacids are commonly used for heartburn, which is very common in pregnancy.

Stool softeners: Docusate is considered a safe first-line option for pregnancy-related constipation.

Medications Generally Avoided or Used with Caution

NSAIDs (ibuprofen, naproxen): Generally avoided starting around 20 weeks and not recommended in the third trimester because of risks to fetal kidney function and, later, the fetal heart. Occasional early first trimester use is sometimes considered acceptable, but check with your provider.

Aspirin at full pain-relief doses: Generally avoided; low-dose aspirin may be specifically prescribed for certain pregnancy indications, which is different from using it for pain.

Certain acne medications: Isotretinoin (Accutane) is strictly contraindicated in pregnancy due to a well-documented risk of severe birth defects and requires pregnancy prevention measures before, during, and after use.

ACE inhibitors and ARBs: Blood pressure medications in these classes are generally avoided in pregnancy; your provider will switch you to a pregnancy-appropriate alternative if you take one of these and become pregnant.

Certain antibiotics: Some tetracyclines and fluoroquinolones are generally avoided, while many others, including penicillins and cephalosporins, are considered safe and used routinely.

Warfarin: This blood thinner is generally avoided, especially in the first trimester, and providers typically switch patients to a different anticoagulant during pregnancy.

Prescription Medications for Chronic Conditions

If you take a regular prescription medication for a chronic condition (depression, anxiety, epilepsy, thyroid disease, asthma, diabetes, high blood pressure), do not stop it on your own upon finding out you're pregnant. For many chronic conditions, an untreated illness poses more risk to the pregnancy than a well-chosen medication. Talk with your prescriber as soon as possible about whether your current medication and dose are appropriate for pregnancy, or whether an adjustment makes sense.

What to Ask Your Doctor or Pharmacist

• Is this medication, at this dose, appropriate for my stage of pregnancy?
• Is there a preferred alternative with more pregnancy safety data?
• Does this interact with my prenatal vitamin or other medications I take?
• What symptoms should prompt me to stop and call?

When to Seek Medical Care

Bottom Line

Many medications are well-studied and safely used throughout pregnancy, but the right choice depends on the specific drug, your stage of pregnancy, and your health history. The safest approach is always to check with your provider or pharmacist before starting, stopping, or changing any medication, rather than relying on general lists alone.