Key takeaways:
- Acetaminophen (Tylenol) is the safest over-the-counter (OTC) pain reliever to consider during pregnancy. But as a best practice, only use it if your healthcare provider gives you the green light.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) have a high risk of causing birth defects and other pregnancy-related problems.
- You generally shouldn’t use cannabidiol (CBD) to treat pain during pregnancy. In fact, the FDA recommends against using any type of CBD during pregnancy.
If you or a loved one are pregnant, you may find yourself bogged down by aches, pains, and feelings of discomfort. These symptoms are irritating, but know that you’re not alone. It’s estimated that about 1 in 4 women have chronic pain during pregnancy. Neck pain, back pain, and headaches often top the list of complaints.
When these kinds of symptoms appear, it’s common to want some sort of relief. But if you want to turn to medications, caution is often needed. Some over-the-counter (OTC) pain relievers are generally safe to use while pregnant, but others have a few risks to be aware of. So how do you know which ones are fair game?
Below, we’ll discuss which pain medications are safe during pregnancy, and which ones you should avoid.
What OTC pain relief medications are safe during pregnancy?
Many people take OTC pain relievers because they’re so accessible. But if you’re expecting, you’ll want to make sure that any medications you take are safe for you and your developing baby.
So, is there a go-to pain reliever you should consider using? Does the risk vary by trimester?
Acetaminophen
Acetaminophen (Tylenol) is the preferred OTC pain reliever to use during pregnancy. It’s considered safe and effective for pain relief in all trimesters. Studies suggest that about 65% of pregnant women take acetaminophen during pregnancy.
But even though acetaminophen is a go-to option, it still has some risks. Because of this, pregnant women should only use acetaminophen at recommended doses for a short period of time. And out of caution, make sure to talk to your healthcare provider about acetaminophen before using it.
What OTC pain relief medications are not safe during pregnancy?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular medications for pain relief and inflammation. OTC NSAIDs include medications such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). But your healthcare provider may not recommend NSAIDs during pregnancy.
We’re not exactly sure how safe NSAIDS are in early pregnancy. NSAIDs taken before 20 weeks (4 to 5 months) of pregnancy have a potential risk of miscarriage and birth defects. So to play it safe, it’s probably best to avoid them.
And in 2020, the FDA warned that using NSAIDs around 20 weeks or later in pregnancy may cause serious kidney problems in an unborn baby. They also warned that they can lead to low amounts of amniotic fluid, which is the liquid that surrounds a baby in the womb. Plus, using NSAIDs like ibuprofen during the later stages of pregnancy may also cause certain heart and lung problems.
If using an NSAID is necessary, try to limit it to the lowest effective dose and for the shortest amount of time possible. The FDA suggests an ultrasound to monitor for side effects if a pregnant woman uses an NSAID for more than 48 hours.
What about low-dose aspirin?
There’s one exception to what’s mentioned above. Low-dose aspirin (81 mg) is an NSAID that may be necessary to prevent a condition called preeclampsia. This is a common complication of pregnancy that’s characterized by high blood pressure.
Pregnant women who are at high risk of preeclampsia may need low-dose aspirin to prevent health complications. High risk women may include those with pre-existing high blood pressure or diabetes. Your healthcare provider might recommend it in other situations too, such as if you’ve had preeclampsia in the past.
Still, use low-dose aspirin with caution. If aspirin is necessary, talk with your healthcare provider about how long to take it. If taken too soon before labor, aspirin might cause excessive bleeding during delivery.
Plus, low-dose aspirin rarely relieves pain. It likely won’t make a big difference for your aches and pains.
Certain combination products
NSAIDs are often available by themselves in OTC products, but they can also be combined with other medications. It’s important to check the “Active Ingredients” section on an OTC product’s “Drug Facts” label to see if it contains an NSAID.
For example, Excedrin Migraine contains acetaminophen, aspirin, and caffeine. Excedrin Migraine generally should be avoided in pregnancy, especially after week 20.
Are topical pain relief medications safe during pregnancy?
It depends on the medication.
OTC topical products that contain menthol are often considered safe to use during all trimesters of pregnancy. Topical OTC products that contain lidocaine may also be safe. Animal studies haven’t linked pregnancy complications to these products, but human studies are rather limited. Make sure to ask your healthcare provider if either is OK for you to use.
On the other hand, it’s important to try to avoid topical NSAIDs.
Just like their oral counterparts, they’re not usually considered safe during pregnancy. Many products — such as Bengay, IcyHot, and Aspercreme — contain a NSAID called methyl salicylate. Voltaren gel, which went OTC in 2020, contains a NSAID called diclofenac. Topical NSAIDs have been connected to possible birth defects in case reports.
Are opioid medications safe to take during pregnancy?
No. Pregnant women shouldn’t use opioids. Opioids are powerful pain relievers that need a prescription — they’re not available OTC. The Drug Enforcement Agency (DEA) categorizes opioids as narcotics. The DEA monitors opioids for opioids for misuse because of serious risks and dependence potential.
In pregnancy, opioids shouldn’t be used due to risks of miscarriage, poor fetal growth, and premature birth. Birth defects and neonatal abstinence syndrome (when a baby is born dependent on a medication) are also possible.
Common opioid pain relievers include medications like:
- Codeine
- Meperidine (Demerol)
- Morphine
- Hydrocodone (Vicodin)
- Oxycodone (OxyContin, Percocet)
- Fentanyl (Duragesic)
Are CBD and herbal pain relievers safe to take during pregnancy?
In short, no.
Cannabidiol (CBD) and other herbal products are available OTC and are popular options for a variety of conditions, including pain relief. CBD comes from the marijuana plant, but it’s not psychoactive.
The FDA advises against the use of any form of CBD during pregnancy. These products aren’t regulated for dosing or contaminants by the FDA. The American Pregnancy Association also urges women to consult both their healthcare provider and a trained herbalist if they want to take herbal products during their pregnancy.
Ultimately, the FDA needs more research to confirm the safety of CBD and herbal supplements in pregnancy.
What are other things I can do to treat pain while I’m pregnant?
To help relieve pain, you can try alternatives to medication.
For instance, hot or cold pack therapy at the site of pain can be helpful. Massage and acupuncture treatments by a pregnancy-trained therapist may also be beneficial. You can also try sleeping in a different posture, stretching, or low-impact exercise.
The bottom line
Acetaminophen is considered the safest OTC option for pain relief during pregnancy. OTC topical medications, like menthol or lidocaine, may also be considered safe to use. But make sure to avoid NSAIDs — both oral and topical — unless otherwise directed.
But before you go to the pharmacy to purchase any OTC pain reliever, make sure to talk with your healthcare provider. They can tell you what the safest choice is for your situation, and if medication is needed in the first place.