What Over-the-Counter Pain Relievers Are Safe During Pregnancy?
Key takeaways:
Acetaminophen (Tylenol) is the safest over-the-counter (OTC) pain reliever in pregnancy. As a best practice, though, only use it if a healthcare professional gives you the green light.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), have a risk of causing birth defects and other pregnancy-related problems. It’s best to avoid them if you’re expecting. One exception is low-dose aspirin (81 mg); it can help prevent complications related to preeclampsia.
You generally shouldn’t use cannabidiol (CBD) to treat pain during pregnancy. In fact, the FDA doesn’t recommend using any type of CBD during pregnancy.
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If you or a loved one is pregnant, you may find yourself bogged down by aches, pains, and discomfort. Neck pain, back pain, and headaches often top the list of complaints.
When these symptoms appear, it’s natural to want some sort of relief. But you may wonder, what pain reliever can I take while pregnant? Some over-the-counter (OTC) pain relievers are generally safe, 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.
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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 taking? Does the risk vary by trimester?
Acetaminophen
Acetaminophen (Tylenol) is the preferred OTC pain reliever to take during pregnancy. It’s considered safe and effective for pain relief in all trimesters.
Even though acetaminophen is a go-to option during pregnancy, it hypothetically has some risks. The research is mixed about whether acetaminophen contributes to certain developmental conditions down the road in kids, such as attention-deficit hyperactivity disorder (ADHD).
This cause-and-effect relationship hasn’t been confirmed. Still, only taking acetaminophen occasionally or for a short period of time helps minimize potential risks. Talk to your healthcare professional about acetaminophen before taking it to make sure it’s right for you.
Good to know: Your acetaminophen dosage should not exceed 4,000 mg in a 24-hour period. If you have other health conditions, such as liver problems, you may need a lower acetaminophen dose. Or your prescriber may suggest avoiding acetaminophen altogether.
What OTC pain relief medications are not safe during pregnancy?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular medications for pain and inflammation. NSAIDs available OTC include medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). But they're not considered first-choice pain relievers during pregnancy.
This is because we’re not exactly sure how safe NSAIDS are in pregnancy. In the first half of pregnancy (before week 20, or in the first 4 to 5 months), some research shows a potential risk of miscarriage and birth defects. However, evidence on these risks and their association with NSAIDs is conflicting. Still, to play it safe, your healthcare professional may recommend avoiding NSAIDs during your entire pregnancy.
Medications to avoid: Several medications are unsafe while you’re pregnant. Here are the top ones to steer clear of.
Headache troubles: Headaches are common during pregnancy. Pharmacists explain which headache medications are safe to take while pregnant.
Acetaminophen safety: Acetaminophen (Tylenol) is a first-choice pain reliever in pregnancy. Although some research has linked acetaminophen use during pregnancy to problems in infants and kids, most experts believe it's safe to take.
After week 20 of pregnancy, there’s evidence that NSAIDs can cause serious kidney problems in an unborn baby. NSAIDs could also contribute to low amounts of amniotic fluid (liquid that protects a baby in the womb) and raise the risk of certain heart and lung problems. That’s why avoiding NSAIDs after the 20th week of pregnancy is universally recommended.
If taking an NSAID is necessary, try to limit it to the lowest effective dose and for the shortest amount of time possible. The FDA suggests performing an ultrasound to monitor for side effects if a pregnant woman takes an NSAID for more than 48 hours after week 20 of pregnancy.
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 and kidney problems.
Pregnant women who are at moderate or high risk of preeclampsia may need low-dose aspirin to prevent health complications. In this situation, low-dose aspirin should be started between weeks 12 to 28 of pregnancy. Having high blood pressure, diabetes, or a history of preeclampsia are a few examples of risk factors that put you at high risk of preeclampsia. Your healthcare professional might recommend it in other situations, too, such as if you’re 35 years or older and are considered obese.
Keep in mind that 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’re also found in many combination medications. It's important to check the active ingredients section on a product’s Drug Facts label to see if it contains an NSAID.
For example, Excedrin Migraine contains acetaminophen, aspirin, and caffeine. You should generally avoid Excedrin Migraine in pregnancy, especially after week 20, because it contains high-dose aspirin. Reach out to your pharmacist with any questions about OTC combination products.
Are topical pain relief medications safe during pregnancy?
It depends on the medication.
OTC topical products that contain menthol are considered safe to use during all trimesters of pregnancy. Topical OTC products with the active ingredient lidocaine (Salonpas Pain Relieving Flex Patch) may also be safe. Animal studies haven’t linked pregnancy complications to either of these products, but human studies are rather limited. Just make sure to ask a healthcare professional if either are OK for you to use.
Topical NSAIDs, like their oral counterparts, aren't first-choice medications for pain during pregnancy. This is largely due to a lack of safety data — especially after week 30. Many products — such as Bengay, IcyHot, and Aspercreme — contain an NSAID called methyl salicylate. Voltaren gel, which went OTC in 2020, contains an NSAID called diclofenac.
Are opioid medications safe to take during pregnancy?
No. Pregnant women shouldn’t take opioids.
Opioids are powerful prescription-only pain relievers. The Drug Enforcement Administration (DEA) categorizes opioids as controlled substances. The DEA monitors opioids for misuse because of serious risks and dependence potential.
Pregnant women shouldn't take opioids due to risks of birth defects and neonatal abstinence syndrome (NAS). NAS happens when a baby is born dependent on an opioid.
Common opioid pain relievers include:
Codeine
Meperidine (Demerol)
Morphine (MS Contin)
Hydrocodone (Hysingla ER)
Oxycodone (OxyContin)
Oxycodone / acetaminophen (Percocet)
Fentanyl
Good to know: Sometimes, the benefits of taking an opioid during pregnancy outweigh the risks. If you or a loved one is pregnant and living with opioid use disorder (OUD), there are some recommended opioids to choose from. Buprenorphine / naloxone (Suboxone), buprenorphine (Subutex), and methadone (Methadose) are first-choice medications for OUD during pregnancy.
Are CBD and herbal pain relievers safe to take during pregnancy?
In short, no.
Cannabidiol (CBD) and other herbal products are available OTC. They’re 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 dosages or contaminants. The American Pregnancy Association also urges women to consult both their healthcare professional and a trained herbalist if they want to take herbal products during their pregnancy.
What are other things I can do to treat pain while I’m pregnant?
Nonmedication options are always an option. 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 after the first trimester. You can also try sleeping in a different posture, stretching, or low-impact exercise. Just make sure to get the OK from your healthcare professional first.
The bottom line
Acetaminophen (Tylenol) is considered a first choice over-the-counter (OTC) pain reliever during pregnancy. Most OTC topical medications, such as menthol or lidocaine, are also considered safe.
If you're considering a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin), make sure to talk to a healthcare professional first. NSAIDs aren't first-choice medications in most cases. And you should avoid them entirely after your 20th week of pregnancy.
Before you go to the pharmacy to purchase any OTC pain reliever, talk with a healthcare professional. Every person and pregnancy is different, so they can advise you on the safest choice for your situation — and if medication is needed in the first place.
Why trust our experts?
References
Alsaad, A. M. S., et al. (2015). Toxicology and teratology of the active ingredients of professional therapy MuscleCare products during pregnancy and lactation: A systematic review. BMC Complementary and Alternative Medicine.
American College of Obstetricians and Gynecologists. (2021). ACOG response to consensus statement on paracetamol use during pregnancy.
American College of Obstetricians and Gynecologists. (2021). Low-dose aspirin use for the prevention of preeclampsia and related morbidity and mortality.
American Pregnancy Association. (n.d.). Herbs and pregnancy.
Anbalagan, S., et al. (2024). Neonatal abstinence syndrome. StatPearls.
Drug Enforcement Administration. (2020). Drug fact sheet: Narcotics.
Interrante, J. D., et al. (2017). Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997–2011. Annals of Epidemiology.
Patel, V. M., et al. (2016). Safety of topical dermatologic medications in pregnancy. Journal of Drugs in Dermatology.
Servey, J., et al. (2014). Over-the-counter medications in pregnancy. American Family Physician.
Shah, S., et al. (2015). Pain management in pregnancy: Multimodal approaches. Pain Research and Treatment.
U.S. Food and Drug Administration. (2016). FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy.
U.S. Food and Drug Administration. (2019). What you should know about using cannabis, including CBD, when pregnant or breastfeeding.
U.S. Food and Drug Administration. (2020). Nonsteroidal anti-inflammatory drugs (NSAIDs): Drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later.
U.S. Food and Drug Administration. (2023). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid.
