How to treat a cold during pregnancy

Getting a cold during pregnancy can be a hassle: Not only do you have even more reasons to feel tired, achy, and uncomfortable, but you also have to find pregnancy-safe medications to treat your symptoms. Many traditional cold medicines are safe to use during pregnancy, but some aren’t—and still others are only safe to use during certain trimesters.

Here’s what you need to know about treating a cold during pregnancy, including what medications you can take and when, what treatments you should avoid, and what natural remedies may help alleviate your symptoms.

What cold medicine can I take while pregnant?

It’s important to remember that a cold is a viral illness—that means there’s no cure, but you can manage your symptoms until you start feeling better, says Alyssa Dweck, MD, an OB-GYN and medical advisor for INTIMINA in Westchester County, New York. Antibiotics won’t make a viral illness go away more quickly, so you shouldn’t use them unless you develop a secondary bacterial infection, like a sinus or upper respiratory infection.

Here’s a breakdown of cold medicines you can safely use to manage your symptoms during pregnancy:

Fever reducers 

If you have a fever during pregnancy, you can take the over-the-counter medication Tylenol (acetaminophen) in the short term, Dr. Dweck says, though studies have found long-term use may increase the risk of having a child with attention deficit hyperactivity disorder (ADHD). Acetaminophen can also relieve cold symptoms like body aches, sore throat, and headaches.

If you want to take acetaminophen for cold symptoms, though, it’s better to take it by itself and not in a combination medicaton. Meaning, take regular Tylenol and not Tylenol Cold and Flu (or any other variations, like Tylenol Cold and Flu Severe). That’s because these combination formulations typically contain phenylephrine as a decongestant, says Erika Gray, Pharm.D., chief medical officer and co-founder of Toolbox Genomics, which is not advisable for use during pregnancy.

Decongestants 

The best way to clear a stuffy nose is with the oral decongestant Sudafed (pseudoephedrine). Dr. Dweck says it’s best to avoid Sudafed in your first trimester, but the drug is generally safe for use in the second and third trimesters. Pregnant individuals with high blood pressure, however, should always avoid Sudafed, especially throughout their pregnancy. 

If you’re looking for a decongestant to use in the first trimester, Dr. Gray says nasal sprays, both steroid-based (like Flonase) and oxymetazoline-based (like Afrin), are generally considered safe during pregnancy. Be aware that oxymetazoline-based decongestants if used for more than three consecutive days causes rebound congestion. 

Cough suppressants 

Dealing with a nagging, hacking cough during pregnancy can be even more uncomfortable than usual, but there’s good news: Dr. Gray says both Robitussin (dextromethorphan) and Robitussin DM (dextromethorphan-guaifenesin) are safe cough syrups to use during all three trimesters at the standard recommended doses. 

Dr. Gray also says guaifenesin, an expectorant that can help break up mucus for more productive coughs and which is often sold in tablet form as Mucinex, is also safe to take. Pregnant women can also safely apply a topical menthol, like Vicks VapoRub, to relieve congestion and coughing.

Antihistamines

Antihistamines can help decrease the allergic component and relieve post-nasal drip in the form of a scratchy throat and runny nose. Several antihistamines are considered safe to use during pregnancy, including first-generation drugs like Benadryl (diphenhydramine) and newer antihistamines like Zyrtec (cetirizine) and Claritin (loratadine).

Cold medications to avoid during pregnancy

While the list of pregnancy-safe cold medications is probably a bit longer than you expected, there are still meds to avoid during pregnancy (unless your OB-GYN has decided the benefits outweigh the risks for you, individually). Here’s what to skip.

Phenylephrine

In September 2023, the FDA announced that a common decongestant found on shelves, phenylephrine, is not actually effective to decrease congestion. Phenylephrine became popular after a federal law was passed in 2006 requiring sales of Sudafed (pseudoephedrine) to be moved behind the pharmacy counter (though you still don’t need a prescription to get it). Phenylephrine, on the other hand, was available as a decongestant in many cold medications found right on pharmacy shelves. 

Recent evidence suggests phenylephrine doesn’t work as a nasal decongestant, though—and because it carries the risk of side effects such as nervousness, dizziness, and sleeplessness, it’s best to avoid it when pregnant. This medication has risk and no proven benefit. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) 

Dr. Gray says pregnant women should exercise caution with NSAID pain relievers like aspirin, Advil or Motrin (ibuprofen), and Aleve (naproxen). Research has shown a small risk of congenital disabilities associated with NSAID use in the first and second trimesters of pregnancy and a greater risk of pregnancy complications and congenital disabilities associated with use after 20 weeks gestation. 

Codeine 

Codeine is sometimes added to combination cough suppressants to help people with severe coughs, but because it’s an opioid, pregnant individuals should not take it. Taking codeine during pregnancy can increase your risk for pregnancy complications like premature birth, low birth weight, postpartum hemorrhage, and infant opioid withdrawal symptoms after birth.

Combination formulations

Many cold medicines contain multiple active ingredients, which can make it even more confusing to determine if they’re safe. For example, NyQuil and DayQuil often contain pregnancy-safe acetaminophen and dextromethorphan but may also contain a small amount of alcohol and phenylephrine, neither of which are considered safe for use during pregnancy, says Gray. (Both ingredients, she explains, have been associated with an elevated risk of birth defects). 

Meanwhile, Theraflu preparations—of which there are many variations—also typically include phenylephrine, so those are not safe to take during pregnancy, either. 

Dr. Dweck says any pregnant woman considering a cold formulation with multiple ingredients should closely vet each one separately to make sure it’s pregnancy-safe. In general, it’s better to avoid combination formulas and take individual doses of only the medications you actually need and that are safe during pregnancy. 

Home remedies for a cold during pregnancy

You probably won’t love this recommendation, but the fastest way to get rid of a cold while pregnant isn’t by taking any of the safe medications listed above—it’s by getting plenty of rest and fluids. It seems simple enough, but slowing down for several days to recover from a cold is easier said than done in many cases. 

These home remedies may speed up the recovery process and help kick your cold to the curb while pregnant:

• Stay hydrated. Increasing your fluid intake will help your body fight the viral infection, so drink lots of water, sip clear broth and herbal tea, or even mix up some Jell-O. While you’re at it, limit or avoid beverages like soda and coffee, which can have the opposite effect.
• Increase sleep. It might be difficult if your symptoms are making you uncomfortable, but try to get as much sleep as possible. If true shuteye evades you, try to at least rest  (versus working, running errands, or doing housework) as much as possible—reducing everyday stress allows your body to recover faster. 
• Use a humidifier. It may help to run a humidifier or even inhale warm steam; moisture can keep your nasal passages from drying out and feeling even more swollen and congested, and it may help loosen and clear out mucus.
• Use saline rinses. Saline rinses are pregnancy-safe, and this practice can flush out virus particles and mucus, soothe your nasal passages, and keep your sinuses clear. Examples of this are the Neti Pot. 
• Eat nutritious foods. Fruits and vegetables are full of vitamins and nutrients (like vitamin C and beta carotene) that can boost the immune system when you’re sick. Meanwhile, ginger and turmeric are often touted as at-home cold remedies for their combined anti-inflammatory benefits, so drink some homemade tea—with honey, to soothe your throat!—or make an anti-inflammatory chicken soup. Some studies suggest curcumin, the active compound in turmeric, may even have antiviral properties.

When to see your healthcare provider 

Anytime you have a question about safe medications to take during pregnancy, contact your healthcare provider or local pharmacist. They can advise you on what (and how much) to take and what to avoid based on your specific circumstances. Dr. Dweck says any persistent or worsening symptoms, including fever, intractable headache, shortness of breath, or chest pain, should be brought to your provider’s attention.