WebMD Ask the Pharmacist

Pregnancy Health Tips: Ask the Pharmacist

May 11, 2010. Pharmacist Heather Free, PharmD, answers questions about pregnancy and medication safety for you and your unborn baby.

Question:

I'm wondering what kind of medicine I can take for headaches and migraines while I’m pregnant?

Answer:

First, I would want to know more about the type of headaches you are experiencing to know the best treatment to recommend. The safest over-the-counter medication that you can take during pregnancy that treats minor to moderate headaches is Tylenol and its generics (acetaminophen). I would try the Tylenol to see if that works.
If you need something stronger, partner with your ob-gyn or your pharmacist to find out what is safe. If you are diagnosed with suffering from migraines, they can be a bit more complicated to treat during pregnancy.

Question:

I am 4 weeks pregnant and because of the high pollen my throat is very sore. My tonsils feel swollen but I have no fever or anything other symptoms of a cold. What can I take to soothe my throat?

Answer:

Keep your throat moist and drink plenty of fluids, specifically those that will not dehydrate you (less or no caffeine). If you have regular issues with allergies, partner with your pharmacist and physician to make sure it is right for you, concerning the timing or current trimester of your pregnancy.

Question:

My doctor gave me Lorcet for a hernia. I am 33 weeks pregnant. Is that OK?

Answer:

Lorcet is a combination of hydrocodone and acetaminophen. It is listed as a pregnancy risk category C, which means we do not have enough studies to determine the risk. Therefore, it is not recommended unless the benefits outweigh the risks. It really depends on the situation for the individual.

Question:

My cousin is 11 weeks pregnant and she has a urinary tract infection. Her doctor put her on an antibiotic for the remainder of her pregnancy. Is this safe?

Answer:

There are plenty of antibiotics that are safe for your cousin to take while pregnant that can help treat a urinary tract infection. The doctor will take into consideration many factors, such as the term of the pregnancy, the type of infection, the age and health of the patient, possible harm to the fetus, and prior experiences with using certain medications during pregnancy. Without knowing the exact antibiotic and bacteria that is causing the infection I would not be able to give you an exact recommendation. However, in order to prevent harm to the fetus, your cousin should be as forthcoming as possible about her pregnancy if it isn’t her ob-gyn prescribing her the medicine.

Question:

Can the drugs Singulair, Advair, and Proventil inhalers be used in pregnancy?

Answer:

Asthma is a very serious condition and you should be seen by a pulmonary specialist to determine how severe your asthma risk is and to know the appropriate treatment options. Every patient is different and their asthma is different. We need to see what works best for you to prevent doing harm to you and/or your unborn child.

For treating asthma during pregnancy, the keys are knowing the severity of your asthma, weighing the risks vs. benefits of certain medications, working with your health care providers, and educating yourself with credible information to help you make the right decisions for you and your unborn child.

Question:

I would like to know if taking my prenatal vitamin and a daily supplement is too much. Should I be taking ONLY my prenatal vitamin?

Answer:

If your ob-gyn has not recommended that you take the extra supplements, I would not take the products. Your ob-gyn has access to many lab results and is there to monitor your pregnancy. He/she knows best. Make sure you are honest and let him/her know about every medication, herb, supplement, and over-the-counter product. They should know about any drug you are taking in order to provide better care for you and your baby. Your doctor can work with you to help make supplement decisions that will not harm you or your baby.

Question:

What are the side effects of taking sulfa-based drugs like Bactrim DS during pregnancy?

Answer:

Work with your health care provider and ob-gyn when this medication is prescribed to determine if it is the correct medication for the treatment you’re seeking and to know whether or not it could be dangerous for your fetus. You should gain comfort before taking this mediation by asking as many questions as you can and by gathering information to help you decide whether or not it is right for you.

Question:

We are planning for a baby and wanted to find out if there are any medications that will increase our chances for a twin birth.

Answer:

Work with your ob-gyn to see what your options are for fertility. I do not recommend taking fertility medications just to have twins. Every medication has side effects. If you are unable to get pregnant naturally, then fertility treatment options are available. Again, you need to work closely with your health care provider, especially your ob-gyn, to see what the best options are for you and your partner.

Question:

My daughter-in-law is 3 months pregnant and her doctor just prescribed her metronidazole for an infection. I was reading the prescription information and it says do not take if you are 3 months pregnant. After taking the pill she became immediately sick and vomited. That is what prompted me to read the prescription information. What should we do?

Answer:

In general, metronidazole is very harsh on the stomach and can cause nausea, vomiting and upset stomach. It is recommended to take with food and to avoid alcohol, which has a drug-drug interaction (will cause vomiting). If you daughter is pregnant, I would not take this medication and would seek advice from your doctor as to why or if another medication can be prescribed.  

Have your daughter-in-law contact her ob-gyn to see if he/she feels safe with her taking this medication. Also ask your ob-gyn if they have a list of medications that they believe are safe to take during pregnancy.

Question:

Are there any side effects that will harm my baby if I took Plan B but became pregnant anyway?

Answer:

There is always a risk when any medication is ingested. However, Plan B is like taking a pack of birth control pills. There have been cases where women have become pregnant while taking birth control pills during the first month of pregnancy and there wasn’t any harm to the fetus.

Question:

Where is the safest place to inject heparin when you are pregnant?

Answer:

Heparin is given as a subcutaneous injection. There are three areas recommended for administration of a subcutaneous injection: the upper arm, the abdomen, or the thigh.

For the upper arm you want to uncover the arm to the shoulder to see the whole arm. Have the person getting the shot stand with hand on hip. Stand next to and a little behind the person. Find the area in the middle part of the arm, halfway between the elbow and shoulder. Gently grasp the skin at the back of the arm between your thumb and first 2 fingers. You should have 1-2 inches of skin.

For the abdomen you want to uncover the abdomen to see the whole area. Find the waist area. You may give a shot bounded by these landmarks: below the waist, to just above the hip bone, and from where the body curves at the side to about 2 inches from the middle of the abdomen. Avoid the belly button. Use the natural line in the middle of the body as a marker.

Lastly, for the thigh you want to uncover the entire leg. Find the area between the knee and hip. The middle of the thigh, from mid-front to mid-side, on the outside part of the thigh is a safe site. Gently grasp the area to make sure you can pinch 1 to 2 inches of skin.

I would avoid the stomach area for injection since you are pregnant. You will need a partner to give the injections since the locations available for administration are difficult to reach on your own.

Question:

I am in the first trimester of pregnancy and I am having a hard time sleeping. I've quit smoking and feel a little overwhelmed. Is there anything I can do or take to help me sleep better?

Answer:

Congratulations on quitting smoking! It is a very difficult behavior to modify, but a healthy choice, not only for your baby but for yourself and others surrounding you. I hope that you can continue to stop smoking even after the baby is born. The anxiety associated with quitting smoking along with the addition of hormones from pregnancy can be overwhelming. Work with you physician to see if there is anything to take the edge off. Keep in mind that many withdrawal symptoms associated with quitting smoking subside 2-4 weeks after the last cigarette.

Find a "buddy" that you can use when the cravings arise, so you can find a way to distract yourself. Do something to replace the old behavior with a new behavior. Just be cautious of replacing it with eating/snacking. This can cause weight gain, which sometimes drives people back to smoking. The first month is the most difficult, but with motivation, willpower and support from others you will get through it. So hang in there!

Question:

I have genital herpes and I am pregnant. I would like to start taking lysine to help control breakouts. I am concerned that it will harm the baby or prevent me from breastfeeding. Is this true?

Answer:

If you are having flare-ups I would work with your ob-gyn to find the correct medication to bring you relief without harming your baby.  

Again, this is a condition that you need to consult with your ob-gyn about. The doctor has plenty of experience with medications that have been used during pregnancy, weighing the risk vs. benefits, and he/she will be able to give you the best care while pregnant.

Question:

I am pregnant and I have a yeast infection. I don’t know what medication is safe to take. My doctor was supposed to call in a medication for me today and never did. So I am out of luck until Monday. I just remembered I already have a yeast infection medication called fluconazole and wanted to know if it is safe to take while pregnant?

Answer:

I would not self-treat with a prescription medication without seeking advice from your ob-gyn.

Question:

Hi, I am 7 months pregnant and before I got pregnant my doctor prescribed Cymbalta. I stopped taking the Cymbalta due to my pregnancy, but my condition has worsened and I would like to start taking it again. Would this be dangerous to take while pregnant?

Answer:

I would not start this prescription medication back up on your own. It is really important to consult with your ob-gyn and the prescriber for the Cymbalta. This is why it is critical to partner with both health care providers to determine the best medication for you, so as not to hurt your unborn child.

Question:

Could I take the Plan B one step pill 2 times in one week safely?

Answer:

First of all, Plan B is to prevent implantation of the fertilized egg into the uterine wall. In order for this to work effectively, it must be taken within 72 hours of the unprotected intercourse. If you are purchasing more than one pack of Plan B to use more than once per month, then you should consider using another form of contraception or consider taking birth control pills, which many pharmacies have on their discounted program lists.

Question:

Will a Z-Pak treat a swollen lymph node and can you take a Z-Pak while pregnant?

Answer:

It depends on what is causing the swollen lymph nodes. Many infections or viruses can cause the lymph nodes to start swelling. This infection must be properly diagnosed by your health care provider to make sure you are getting the correct medication.

Question:

Is the product MotionEaze safe for pregnant women?

Answer:

I would check with your ob-gyn to make sure it is all right to take this product.

Question:

I am 5 1/2 months pregnant and I take Xanax. I take approximately 1 to 1.5 milligrams a day. Should I be concerned about harming the fetus and what would be a good regimen for tapering off my dosage?

Answer:

The U.S. Food and Drug Administration (FDA) assigns a category system to classify the possible risks to a fetus when a specific medicine is taken during pregnancy. Xanax and its generic (alprazolam) have been assigned pregnancy category D, meaning this class of medication have shown clear evidence of risk to the fetus in studies. Pregnancy category D is a stronger warning class than pregnancy categories C or B classifications. A pregnancy category D medicine may still be given to a pregnant woman if the health care provider believes that the benefits to the woman outweigh the possible risks to the unborn child.

I would not just stop taking the medication if you are concerned that you may be causing harm to your baby. Work with your health care provider to decide whether you should be taking the medication. If you reach a decision to not take the medication any longer, work with your provider or pharmacist to taper (decrease gradually) the dose to take and to prevent withdrawal symptoms. Common withdrawal symptoms consist of, but are not limited to, nausea, vomiting, diarrhea, increased heart rate, palpitations, hallucinations, memory loss, confusion, panic attacks, seizures, dizziness, headaches, depression, and insomnia. It is important to work with your health care provider to make sure you are getting the best care possible.

Question:

Can I take an OTC medicine during pregnancy that contains phenylephrine?

Answer:

It is important to check with your ob-gyn to see what medication they recommend you taking during pregnancy. Depending on your situation, your doctor may feel that the benefits of taking this medication outweigh the risks.

Question:

I have a big headache and I'm pregnant. What over-the-counter medicine can I take that will be safe?

Answer:

Currently, the only safe over-the-counter medication for the treatment of headaches during pregnancy is Tylenol (acetaminophen). Make sure you are using a product that only contains Tylenol (acetaminophen) and not other ingredients. Remember to follow the directions according to the labeled product, or as your health care provider advices. If this medication is not working, consult your ob-gyn to find a medication that is effective, but still safe for your unborn baby.

Question:

Is it safe to take Benadryl when you are 7 months pregnant?

Answer:

Benadryl is listed as pregnancy category B and is safe to take. Make sure you are using a product that only contains Benadryl (diphenhydramine) and not any other ingredients. Remember to follow the directions according to the labeled product, or as your health care provider advises. If this medication is not working, consult your ob-gyn to find a medication that is effective but still safe for your unborn baby.

Question:

Are there any medications for postpartum depression that are safe to take while nursing? What are the risks and side effects for mom and baby?

Answer:

This is a complicated question. Depression is very individualized for people, despite pregnancy. There are also different types and causes of depression that can lead to different treatment regimens. Your physician and ob-gyn need to work together to better manage your symptoms and determine the benefits over the risks with the medication(s).

Question:

Is it safe to use Selsun Blue shampoo while pregnant?

Answer:

The medication in Selsun Blue is selenium sulfide. Before using selenium sulfide topical, you should consult your ob-gyn to make sure it is all right to use during pregnancy.

Question:

I’m 30 weeks pregnant and can never get any sleep. Can I take the Unisom to get some sleep?

Answer:

I stress the importance of communicating with your ob-gyn about all medications, herbs, vitamins, and over-the-counter medications that you have taken or that you are currently taking during your pregnancy.

It is important for you to inform you doctor, especially about long-term use and care during labor. If sleep is a huge issue, work with your doctor to find a consistent and safe way to help with your insomnia.

Thank you for joining us for WebMD Ask the Pharmacist. Be sure to come back on May 25 at 1 p.m. ET when we’ll be focusing on headaches and migraines. Sign up if you’d like an email reminder the day before our next premiere event.