Guide March 2026 · 8 min read

Medications during pregnancy: what you may take and what not

Pregnant and ill — what now? The package leaflet is frightening: with almost every medication it says "contraindicated". The truth is more nuanced: many medications are well studied and safe during pregnancy. With others it depends on the trimester. And only a few are actually strictly forbidden.

The most important rule: never act on your own During pregnancy, never stop medications without consulting and do not take any new ones without asking your doctor or your midwife. Discuss every decision individually.

The most common mistakes — and why they are dangerous

⚠ These are the mistakes pregnant women make most often

Mistake 1
Stopping medications on your own. Anyone who simply leaves out antidepressants or thyroid medications risks a relapse that endangers mother and child more than the medication itself.
Mistake 2
No treatment out of fear. Untreated infections, uncontrolled high blood pressure or severe depression are more dangerous for the child than therapy with a suitable active ingredient.
Mistake 3
Trusting the package leaflet blindly. "Contraindicated in pregnancy" often only means: not sufficiently tested on pregnant women — not automatically harmful. The manufacturer is protecting itself legally.
The golden rule
Doctor + Embryotox. Discuss every decision with the doctor and at the same time check on embryotox.de — the independent database of the Charité Berlin with information on over 400 active ingredients.

Quick overview: what is allowed and when?

Medication1st trimester2nd trimester3rd trimester
paracetamol✓ Safe✓ Safe✓ Safe
ibuprofen⚠ With caution⚠ Until week 28⛔ Forbidden
amoxicillin✓ 1st choice✓ 1st choice✓ 1st choice
doxycycline⛔ Forbidden⛔ Forbidden⛔ Forbidden
ciprofloxacin⛔ Not recommended⛔ Not recommended⛔ Not recommended
pantoprazole✓ Safe✓ Safe✓ Safe
levothyroxine✓ Required✓ Required✓ Required
ramipril / candesartan⚠ Weigh up⛔ FORBIDDEN⛔ FORBIDDEN
citalopram / sertraline⚠ With doctor⚠ With doctor⚠ With doctor
loratadine / cetirizine✓ Safe✓ Safe✓ Safe

Painkillers

Painkillers during pregnancy

paracetamol: The painkiller of 1st choice throughout pregnancy. In a normal dose (up to 3 g/day) safe according to the current state of knowledge. Do not use as a continuous therapy.

ibuprofen: Possible as needed in the 1st and 2nd trimester. Forbidden from week 28 — it can damage the fetal circulation (premature closure of the ductus arteriosus). The same applies to diclofenac.

Low-dose ASA (100 mg): In pregnancy it is even used in a targeted way — to prevent pre-eclampsia. Only on medical prescription.

Colds & infections

Antibiotics & cold remedies

amoxicillin and penicillins: Antibiotics of 1st choice during pregnancy. Well studied, no indications of harm to the child.

Doxycycline and tetracyclines: Forbidden — they deposit in the child's tooth buds and cause permanent discolouration.

Ciprofloxacin and fluoroquinolones: Not recommended — a risk of cartilage damage in the child.

Saline nasal spray: Harmless — the first choice for a blocked nose. Decongestant nasal sprays (xylometazoline) only briefly and after consultation.

Heartburn & nausea

Heartburn, nausea & vomiting

pantoprazole and omeprazole: Safe during pregnancy according to the current state of knowledge. They are frequently prescribed, since heartburn is one of the most common pregnancy complaints.

Antacids (Rennie, Maaloxan): Harmless for short-term relief. Do not use aluminium-containing antacids permanently in high doses.

Vitamin B6 (pyridoxine): The first measure for pregnancy nausea, available without prescription.

Doxylamine + vitamin B6 (Cariban®): The only approved combination against pregnancy nausea in Germany.

High blood pressure

Blood pressure-lowering medications during pregnancy

Methyldopa: The blood pressure-lowering medication of 1st choice during pregnancy. Well studied and proven.

metoprolol: An alternative for high blood pressure during pregnancy. Better tolerated than many other beta blockers.

ramipril (ACE inhibitor) and candesartan (sartan): Strictly forbidden in the 2nd and 3rd trimester — they can cause severe kidney and liver damage in the child. Anyone who takes ACE inhibitors before pregnancy has to be switched over before a planned pregnancy.

Thyroid & mental illnesses

Thyroid & antidepressants

levothyroxine: Has to be continued during pregnancy — an untreated underactive thyroid is more dangerous for the child than the medication. The dose usually has to be increased (by 25–50 %). Take on an empty stomach, at least 30 minutes before breakfast.

citalopram, escitalopram, sertraline (SSRIs): Can be continued under medical supervision. Sertraline is regarded as the best studied. Do not stop on your own — a relapse into severe depression is more dangerous for mother and child than the therapy.

Paroxetine: A somewhat higher risk of heart malformations — if possible, switch to sertraline or citalopram before pregnancy.

Benzodiazepines: Avoid as far as possible during pregnancy — a risk of muscle weakness in the newborn (floppy infant syndrome). If necessary, only briefly and under medical supervision.

Embryotox — your most important resource

embryotox.de is the independent database of the Charité Berlin — the nationwide advisory centre for embryotoxicology (in German). There you find evidence-based assessments on over 400 active ingredients that are often more nuanced than the package leaflet.

When you should use Embryotox:

  • You find out that you are pregnant and are already taking medications → check Embryotox and call the doctor.
  • You become ill during pregnancy and need a medication → ask the doctor and check Embryotox at the same time.
  • You are planning a pregnancy and take continuous medication → talk to the doctor now about a possible switch.

Common questions

In the 1st and 2nd trimester (until week 28): yes, as needed and in a normal dose. From week 28: no — ibuprofen can damage the fetal circulation. In the 3rd trimester, paracetamol is the safe alternative.
No, not on your own. SSRIs like sertraline or citalopram can be continued under medical supervision. Abruptly stopping carries a high risk of relapse. Discuss the therapy with your psychiatrist and gynaecologist.
Yes — certain ones. Penicillins (amoxicillin) are the 1st choice and are regarded as safe. Doxycycline and ciprofloxacin are forbidden. The doctor chooses an antibiotic suitable for pregnancy. More: Taking antibiotics correctly.
The first measure: small meals, do not lie down after eating, sleep with the upper body raised. If that is not enough: antacids (Rennie, Maaloxan) are harmless. Pantoprazole can be prescribed and is regarded as safe.
No panic. With most common active ingredients (paracetamol, ibuprofen, amoxicillin) the risk is extremely low. Check the active ingredient on Embryotox and discuss it with your doctor. In the vast majority of cases there is no reason to worry.
Not across the board. "Herbal" does not automatically mean harmless — some active ingredients (senna leaves, kava) are forbidden during pregnancy. Folic acid and iodine, on the other hand, you should definitely supplement. Discuss everything else with the doctor.

Keep an eye on all your medications

With the digital brite medication plan you have all active ingredients, dosages and times in one place — ready to show your gynaecologist, GP and pharmacist immediately.

Start for free
Medical disclaimer: This page does not replace medical advice. Every medication decision during pregnancy should be discussed individually with the doctor or the midwife. When in doubt: check embryotox.de and contact the doctor. As of: March 2026.