Pharmacy Times 2008 OTC Products - (Page 57) Safety of OTC Medications in Pregnant Women: A Guide for Pharmacists also may be recommended for up to 3 days for symptomatic congestion. It should not be used beyond the recommended period because of rebound congestion, which could lead to overuse of the medication and previously unseen teratogenic effects.2,7 For cough and sore throat, pregnant patients may be advised to gargle with saltwater and use nonmenthol cough drops.8 If these methods do not provide adequate relief of symptoms, guaifenesin, an expectorant, and dextromethorphan, a cough suppressant, are recommended alone or in combination in the case of severe maternal discomfort.2 are often futile, and, in some cases, may actually aggravate the condition.2 Like NSAIDs, bismuth subsalicylate may cause premature closure of the fetal ductus arteriosus and may lead to subsequent persistent pulmonary hypertension of the newborn.2,5 Nausea/Motion Sickness Medications The results of several studies suggest that the antihistamines meclizine and dimenhydrinate can be used by pregnant women for the prevention or treatment of nausea or motion sickness with minimal risk to the fetus. Allergy Medications The antihistamines chlorpheniramine and diphenhydramine are most often used for allergies in pregnant patients.2 Loratadine is a newer nonsedating antihistamine that has recently switched to OTC.2 Based on evidence regarding its use as a prescription medication, it is classified as pregnancy risk category B (Table 2).7 It is recommended that it be used only when allergy symptoms cannot be relieved by first- and second-line alternatives.2 Topical Medications The imidazole agents, including clotrimazole, butoconazole, miconazole, and tioconazole, are the most commonly used OTC antifungal treatments.1 Both topical and vaginal formulations have low systemic absorption and are considered safe for use by pregnant women.2 Trials have not shown an association between birth defects and the use of these medications at any time during pregnancy.1 Like the topical antifungal treatments, most other topical medications are poorly absorbed through the skin and pose little danger to the fetus. Examples of topical drugs that are considered safe for use by pregnant women include: benzoyl peroxide for acne, zinc pyrithione for dandruff, hydrocortisone for inflammation, and bacitracin and benzocaine often used in combination as an antiseptic and anesthetic.2 Antacids Nonpharmacologic remedies are of particular importance when considering afflictions of the gastrointestinal tract. Lifestyle and dietary changes are often effective without medications. Pregnant women suffering from gastroesophageal reflux disease should eat small, frequent meals; avoid caffeine and spicy foods; avoid any food before bedtime; and elevate the head while sleeping.4 These alternatives may provide sufficient relief alone. If medication is necessary for the relief of symptoms, aluminum, calcium, and magnesium preparations are generally recommended.4 Sodium bicarbonate is not recommended as an antacid because of sodium’s potential to cause fluid and electrolyte imbalances in both the mother and the fetus.4 Smoking Cessation Products Patient education and the development of an individualized plan are the preferred methods for smoking cessation in pregnant women. When this approach is not successful, nicotine replacement therapy should be considered as an alternative to continued smoking. Despite the risk of nicotineinduced fetal abnormalities, cigarette smoke contains >3000 chemicals, many of which are more harmful to the fetus than nicotine alone.1 When recommending nicotine replacement therapy to pregnant women, immediate-release products, such as gum, spray, or inhalers, are preferred to patches, which are continuous-release. The amount of nicotine should be limited to what is absolutely necessary to stop smoking. Antiflatulents, Laxatives, and Antidiarrheals Constipation is common during pregnancy and may be corrected without medication through increased intake of dietary fiber and fluids and physical exercise.4 Some health care professionals believe medications for constipation and diarrhea General Factors to Consider When recommending OTC products, pharma- Pharmacy Times 57 OTC Supplement 2008
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