Guide March 2026 · 8 min read

Medications During Pregnancy: What You Can and Cannot Take

Pregnant and unwell — what now? The package insert can be alarming: almost every medication says "contraindicated". The reality is more nuanced: many medications are well studied and safe in pregnancy. For others, it depends on the trimester. And only a few are truly strictly forbidden.

Most important rule: Never act on your own During pregnancy, never stop taking a medication without consulting your doctor, and never start a new one without asking your doctor or midwife first. Every decision should be discussed individually.

The Most Common Mistakes — and Why They're Dangerous

⚠ Mistakes pregnant women make most often

Mistake 1
Stopping medication without medical advice. Anyone who simply stops taking antidepressants or thyroid medication risks a relapse that poses a greater danger to mother and child than the medication itself.
Mistake 2
Avoiding treatment out of fear. Untreated infections, uncontrolled high blood pressure, or severe depression are more dangerous for the baby than treatment with an appropriate active substance.
Mistake 3
Blindly trusting the package insert. "Contraindicated in pregnancy" often just means: not sufficiently tested in pregnant women — not automatically harmful. Manufacturers protect themselves legally.
Golden rule
Doctor + Embryotox. Discuss every decision with your doctor and check embryotox.de — the independent database from Charité Berlin covering more than 400 active substances.

Quick Reference: What's Allowed and When?

Medication1st Trimester2nd Trimester3rd Trimester
Acetaminophen (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✓ Essential✓ Essential✓ Essential
Ramipril / Candesartan⚠ Weigh carefully⛔ FORBIDDEN⛔ FORBIDDEN
Citalopram / Sertraline⚠ With doctor⚠ With doctor⚠ With doctor
Loratadine / Cetirizine✓ Safe✓ Safe✓ Safe

Painkillers

Painkillers During Pregnancy

Acetaminophen (Paracetamol): The first-choice painkiller throughout the entire pregnancy. At normal doses (up to 3 g/day), it is considered safe based on current evidence. Do not use as long-term therapy.

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

Low-dose aspirin (100 mg): Is actually used during pregnancy for a specific purpose — to help prevent pre-eclampsia. Only under medical prescription.

Colds & Infections

Antibiotics & Cold Remedies

Amoxicillin and penicillins: The first-choice antibiotics during pregnancy. Well studied, with no evidence of harm to the baby.

Doxycycline and tetracyclines: Forbidden — they accumulate in the developing tooth buds of the baby and cause permanent discolouration.

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

Saline nasal spray: Completely safe — first choice for a blocked nose. Decongestant nasal sprays (xylometazoline) only for short-term use and after consultation.

Heartburn & Nausea

Heartburn, Nausea & Vomiting

Pantoprazole and omeprazole: Considered safe in pregnancy based on current evidence. Frequently prescribed, as heartburn is one of the most common pregnancy complaints.

Antacids (e.g. Rennie, Maalox): Safe for short-term relief. Aluminium-containing antacids should not be used long-term in high doses.

Vitamin B6 (pyridoxine): First-line option for pregnancy nausea, available without a prescription.

Doxylamine + vitamin B6 (Diclegis®): The only approved combination for pregnancy nausea.

High Blood Pressure

Blood Pressure Medications During Pregnancy

Methyldopa: The first-choice blood pressure medication during pregnancy. Well studied and established.

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

Ramipril (ACE inhibitor) and candesartan (ARB): Strictly forbidden in the 2nd and 3rd trimester — can cause severe kidney and liver damage in the baby. Anyone taking ACE inhibitors before pregnancy must switch to an alternative before planning a pregnancy.

Thyroid & Mental Health

Thyroid Medication & Antidepressants

Levothyroxine: Must be continued during pregnancy — untreated hypothyroidism is more dangerous for the baby than the medication. The dose usually needs 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 considered the best studied option. Do not stop on your own — a relapse into severe depression is more dangerous for both mother and baby than continuing the therapy.

Paroxetine: Slightly higher risk of cardiac defects — if possible, switch to sertraline or citalopram before pregnancy.

Benzodiazepines: Best avoided during pregnancy — risk of muscle weakness in the newborn (floppy infant syndrome). If necessary, use only short-term and under medical supervision.

Embryotox — Your Most Important Resource

embryotox.de is the independent database from Charité Berlin — Germany's national advisory centre for embryotoxicology. It provides evidence-based assessments for more than 400 active substances, often far more nuanced than the package insert.

When you should use Embryotox:

  • You find out you're pregnant while already taking medication → check Embryotox and call your doctor.
  • You become ill during pregnancy and need a medication → ask your doctor and check Embryotox in parallel.
  • You're planning a pregnancy and take long-term medication → speak with your doctor now about a possible switch.

Frequently Asked Questions

In the 1st and 2nd trimester (up to week 28): yes, if needed and at a normal dose. From week 28 onwards: no — ibuprofen can damage the fetal circulation. In the 3rd trimester, acetaminophen is the safe alternative.
No, not on your own. SSRIs such as sertraline or citalopram can be continued under medical supervision. Stopping abruptly carries a high risk of relapse. Discuss your treatment with your psychiatrist and gynaecologist.
Yes — certain ones. Penicillins (amoxicillin) are the first choice and are considered safe. Doxycycline and ciprofloxacin are forbidden. Your doctor will prescribe an antibiotic appropriate for pregnancy. More: How to Take Antibiotics Correctly.
First steps: small meals, don't lie down after eating, sleep with the head slightly elevated. If that isn't enough: antacids (e.g. Rennie, Maalox) are safe. Pantoprazole can be prescribed and is considered safe.
Don't panic. For most common substances (acetaminophen, ibuprofen, amoxicillin), the risk is extremely low. Check the active substance on Embryotox and discuss it with your doctor. In the vast majority of cases, there is no cause for concern.
Not automatically. "Herbal" does not mean harmless — some substances (senna, kava) are forbidden during pregnancy. Folic acid and iodine, on the other hand, are essential supplements. Everything else should be discussed with your doctor.

Keep all your medications in view

With the brite digital medication plan, you have all active substances, doses, and times in one place — ready to share instantly with your gynaecologist, GP, or pharmacist.

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