Is Pseudoephedrine Safe for Pregnancy and Breastfeeding?

My sinuses hate me.  I am prone to severe sinus headaches if I get the tiniest head cold.  Before I had Ewan, I would just pop two Sudafed (pseudoephedrine) and two Tylenol (aceteminophen) and it would clear it up.  Now, I have to use other methods.

Pseudoephedrine is known to decrease milk production by 24% with just one dose, according to Aljazaf et al, 2003.  Wow!

The other day I woke up with a really bad sinus headache.  I could barely open my eyes and I even felt a little nauseous when I got out of bed.  It was so bad that my husband called him mom to come over and babysit while I stayed in bed a while.  I am so grateful to have available grandparents nearby to allow me to sleep in when I need to.

I took two Tylenol, which are approved as safe, and a couple of spritzes of Afrin, also safe.

My doctor told me to try Afrin, or a similar over-the-counter nasal spray, when I told him I needed a reliable method of relief without risk.  This works for me.  I rarely have to take more than one dose.

(Note on Afrin: Follow the dosage directions carefully!  Using it too frequently or for too long can cause even more congestion to occur.)

I was avoiding pseudoephedrine during pregnancy, too.  We went to Park City, Utah for a week in January and stayed in a forced-air heated condo.  My sinuses protested the dry air by giving me a headache.  I tried hot tea.  I tried a hot shower.  I tried massaging my head.  I even tried filling the sink with hot water and sanding over it with a towel over my head, breathing in the steam.   I needed this website!  I also needed Afrin.  By the end of the day, the headache went away.

Although some doctors may say it is approved, not enough studies have been done to conclusively say that pseudoephedrine is safe for pregnancy.  Tom Hale, the authority on medications and lactation (author of Medications and Mother's Milk) rates pseudoephedrine a "C" for pregnancy.  This means "risk cannot be ruled out" because not enough studies have been done.  Hale also rates it a L3 ("moderately safe") for occasional use but an L4 ("potentially hazardous") for chronic use.

The lactation ratings are probably based on it's known side effect of decreasing milk supply, not on its effect on the baby, but I'm not sure.  The study by Aljazaf et al, 2003 previously mentioned says that less than 10% of the maternal dose gets to the breastfeeding baby, even if the mother takes the maximum amount allowed for a 24 hour period.

During pregnancy, the baby will receive significantly more of the dose taken by the mother, and some researchers believe there to be a risk of birth defects in multiple areas.  Here's a midwife's discussion of the possible risks.  And here is a listing from

I am not taking an chances, so I will be avoiding pseudoephedrine for the foreseeable future.

Click here for a list of medications and their ratings on

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