Medications to Avoid While Pregnant: Safety Warnings and Safe Alternatives

When you're pregnant, every pill, drop, or supplement feels like a decision that could change your baby’s life. You’re not just thinking about your own health anymore-you’re carrying someone else’s. That’s why knowing which medications to avoid isn’t just smart, it’s essential. The truth is, more than 90% of pregnant women take at least one medication during pregnancy. But not all of them are safe. Some can cause serious harm, from birth defects to developmental delays. And the rules have changed-fast.

NSAIDs: The Hidden Risk After 20 Weeks

Ibuprofen, naproxen, aspirin-these are the go-to painkillers for headaches, backaches, and cramps. But if you’re past 20 weeks pregnant, using them can be dangerous. The FDA issued a clear warning in October 2020: NSAIDs can cause fetal kidney failure and dangerously low levels of amniotic fluid (oligohydramnios). This isn’t a rare side effect. Studies show a 1.5 to 2 times higher risk. The damage isn’t always obvious right away, but it can lead to premature birth or even stillbirth.

Even low-dose aspirin, often prescribed for preeclampsia prevention, needs careful monitoring. Only use it if your doctor specifically tells you to-no more than 60-150 mg daily. For anything else, skip the ibuprofen and naproxen. Instead, reach for acetaminophen-but even that comes with new warnings.

Acetaminophen: The New Controversy

For decades, acetaminophen (Tylenol) was the gold standard for pain and fever relief in pregnancy. But in September 2025, the FDA issued a Notice to Physicians that changed everything. New data from a 2021 JAMA Pediatrics study tracking 95,000 mother-child pairs found a 28.6% higher risk of ADHD and a 20.4% higher risk of autism spectrum disorder with prolonged use-especially when taken throughout pregnancy.

Does that mean you can’t use it at all? No. But it means you need to be smarter about it. The American Academy of Family Physicians still says acetaminophen is the safest option-but only when used at the lowest dose for the shortest time. Stick to 325-650 mg every 4-6 hours, and never exceed 3,000 mg in a day. If you’re taking it for more than a few days straight, talk to your provider. A low-grade fever under 100°F? Try a cool compress and rest. A high fever over 102°F? That’s a different story. Untreated high fever can raise the risk of neural tube defects by 8.2 times, according to a 2020 meta-analysis. So don’t panic over one dose-but don’t treat it like candy either.

Antibiotics: Some Are Safe, Others Are Not

Not all antibiotics are created equal when you’re pregnant. Tetracyclines like doxycycline can permanently stain your baby’s teeth and slow bone growth. Fluoroquinolones like ciprofloxacin have been linked to a 1.9-fold increase in musculoskeletal problems. Both are off-limits.

Safe options? Penicillins (like amoxicillin) and cephalosporins (like cephalexin) are well-studied and considered low-risk. If you have a urinary tract infection or sinus infection, ask your doctor for one of these instead. Always finish the full course-even if you feel better. Stopping early can lead to resistant infections, which are even harder to treat during pregnancy.

High Blood Pressure Meds: Stop Immediately If Pregnant

If you’re on blood pressure medication and find out you’re pregnant, don’t wait. ACE inhibitors like lisinopril and ARBs like valsartan can cause fetal kidney failure, low amniotic fluid, and even death. The risk? As high as 30-50%. These drugs are not just risky-they’re dangerous. If you’re planning a pregnancy and take one of these, talk to your doctor now. Switching to methyldopa or labetalol is often the safest move.

Acne and Seizure Meds: High Risk, But Manageable

Isotretinoin (Accutane) is one of the most dangerous drugs you can take during pregnancy. It causes severe birth defects in more than 25% of cases-craniofacial deformities, heart problems, brain abnormalities. If you’re on it, you must use two forms of birth control and wait at least one month after stopping before trying to conceive. The FDA’s iPLEDGE program exists for a reason: to prevent this.

For epilepsy, valproic acid carries a 10.7% risk of major birth defects. That’s nearly four times higher than the general population. If you have seizures and are planning a pregnancy, work with your neurologist to switch to lamotrigine or levetiracetam. Both have far lower risks-around 2-3%-and are now the preferred choices.

Safe Alternatives for Common Pregnancy Complaints

You don’t have to suffer through pregnancy discomforts without relief. Here’s what’s safe:

• Pain and fever: Acetaminophen (Tylenol), 325-650 mg every 4-6 hours, max 3,000 mg/day. Use only when needed.
• Allergies: Loratadine (Claritin), cetirizine (Zyrtec), or fexofenadine (Allegra). All have strong safety data from over 2,000 pregnancies.
• Nasal congestion: Saline nasal spray first. If you need more, pseudoephedrine (Sudafed) is okay after the first trimester-no more than 120 mg daily. Avoid if you have high blood pressure.
• Constipation: Start with fiber (25-30g daily) and water. If that’s not enough, docusate sodium (Colace) or polyethylene glycol (Miralax) are both Category B and safe in over 700 documented pregnancies.
• Depression and anxiety: SSRIs like sertraline and citalopram are often safer than stopping medication. Untreated depression increases preterm birth risk by 64%. Never stop antidepressants cold turkey-work with your doctor to adjust safely.

What to Do If You’ve Already Taken Something Risky

You’re not alone. The MotherToBaby service reports that 78% of their calls come from women who’ve already taken a medication they later learned was risky. If you took ibuprofen at 22 weeks, or accidentally used isotretinoin before you knew you were pregnant, don’t panic. Don’t self-diagnose. Call your OB or a teratology specialist.

Most exposures don’t lead to problems. But knowing what you took-and when-helps your provider assess the risk. Use the MotherToBaby website or call 1-866-626-6847. They offer free, confidential advice from specialists trained in pregnancy exposures. Their fact sheets have been viewed over 2.3 million times a year for a reason: they’re accurate, clear, and trustworthy.

Preconception Planning: The Best Protection

The safest time to review your medications isn’t after you miss your period-it’s before you even try to conceive. If you have a chronic condition like epilepsy, high blood pressure, or depression, talk to your doctor before getting pregnant. Switching from valproate to lamotrigine, or from lisinopril to methyldopa, takes time. You need to stabilize your condition before conception.

Women on warfarin (Coumadin) should switch to low molecular weight heparin (like Lovenox) before pregnancy. Warfarin crosses the placenta; heparin doesn’t. This simple change can prevent fetal warfarin syndrome, which causes facial deformities and bone problems.

Keep a Medication List-Every Single One

Don’t forget about over-the-counter meds, herbal supplements, and vitamins. Some herbal teas, like black cohosh or pennyroyal, can trigger contractions. High-dose vitamin A (over 10,000 IU daily) can be toxic. Even some “natural” prenatal vitamins contain ingredients that aren’t safe.

Write down everything you take: name, dose, why you take it, and how often. Bring it to every appointment. Your provider can’t help if they don’t know what you’re using.

The Bottom Line: Stay Informed, Don’t Panic

The landscape of pregnancy medication safety is changing fast. What was considered safe five years ago might now carry new warnings. That doesn’t mean you can’t take any meds-it means you need to be more thoughtful.

Don’t avoid all medications out of fear. Untreated conditions-like high blood pressure, depression, or infections-can be just as dangerous as the drugs used to treat them. The goal isn’t to be perfect. It’s to be informed.

When in doubt, ask. Use trusted resources like MotherToBaby, the FDA’s Pregnancy and Lactation Labeling Rule documents, or your OB-GYN. You’re not alone in this. Thousands of women have walked this path before you. With the right information, you can protect your baby and take care of yourself-at the same time.