What over-the-counter and prescription drugs are not safe to take during pregnancy?

he Food and Drug Administration (FDA) has a system to rate drugs in terms of their safety during pregnancy. This system rates both over-the-counter (OTC) drugs you can buy in a drug or discount store, and drugs your health care provider prescribes. But most medicines have not been studied in pregnant women to see if they cause damage to the growing fetus. Always talk with your health care provider if you have questions or concerns.

The FDA system ranks drugs as:

  • Category A – drugs that have been tested for safety during pregnancy and have been found to be safe. This includes drugs such as folic acid, vitamin B6, and thyroid medicine in moderation, or in prescribed doses.

  • Category B – drugs that have been used a lot during pregnancy and do not appear to cause major birth defects or other problems. This includes drugs such as some antibiotics, acetaminophen (Tylenol), aspartame (artificial sweetener),famotidine (Pepcid), prednisone (cortisone), insulin (for diabetes), and ibuprofin (Advil, Motrin) before the third trimester. Pregnant women should not take ibuprofen during the last three months of pregnancy.

  • Category C – drugs that are more likely to cause problems for the mother or fetus. Also includes drugs for which safety studies have not been finished. The majority of these drugs do not have safety studies in progress. These drugs often come with a warning that they should be used only if the benefits of taking them outweigh the risks. This is something a woman would need to carefully discuss with her doctor. These drugs include prochlorperzaine (Compazine), Sudafed, fluconazole(Diflucan), and ciprofloxacin (Cipro). Some antidepressants are also included in this group.

  • Category D – drugs that have clear health risks for the fetus and include alcohol, lithium (used to treat manic depression),phenytoin (Dilantin), and most chemotherapy drugs to treat cancer. In some cases, chemotherapy drugs are given during pregnancy.

  • Category X – drugs that have been shown to cause birth defects and should never be taken during pregnancy. This includes drugs to treat skin conditions like cystic acne(Accutane) and psoriasis (Tegison or Soriatane); a sedative(thalidomide); and a drug to prevent miscarriage used up until 1971 in the U.S. and 1983 in Europe (diethylstilbestrol or DES).

Aspirin and other drugs containing salicylate are not recommended during pregnancy, especially during the last three months. In rare cases, a woman’s health care provider may want her to use these type of drugs under close watch. Acetylsalicylate, a common ingredient in many OTC painkillers, may make a pregnancy last longer and may cause severe bleeding before and after delivery.