A PharmD’s Evidence-Based Guide for New & Expecting Parents

You’re standing in a pharmacy.

Your baby has a cold. Or you have a headache at 32 weeks pregnant. Or your toddler has been running a fever since last night.

The shelves are full of options. The labels look reassuring. The packaging says “gentle” and “safe.”

But should you just pick one up and go?

💛 As a PharmD, my answer is always: pause, read, and ask before you buy.

OTC (Over-The-Counter) medicines are medicines available without a prescription but that does not make them risk-free, especially for pregnant mothers, breastfeeding mothers, and infants.

Let’s navigate this together, clearly and safely.

🌼 What Are OTC Medicines?

OTC medicines are drugs you can purchase directly from a pharmacy without a doctor’s prescription.

Common categories include:

• fever and pain relievers
• cold and cough medicines
• antacids and digestive medicines
• allergy medicines (antihistamines)
• vitamins and supplements
• topical creams and ointments

👉 Just because they don’t need a prescription does not mean they are always safe especially during pregnancy, breastfeeding, or for infants.

🤰 OTC Medicines During Pregnancy — A Careful Guide

Pregnancy changes how your body processes everything including medicines. What was safe before pregnancy may not be safe now.

✅ Generally Considered Safe (Under Doctor Guidance)

🌡 Fever & Pain

• Paracetamol (Crocin, Dolo, Calpol) — first choice for fever and mild pain in pregnancy
• Use the lowest effective dose for the shortest time
• Recent research suggests avoiding prolonged use — always consult your doctor

🤢 Nausea & Vomiting (Morning Sickness)

• Vitamin B6 (Pyridoxine) — safe, often recommended as first step
• Antacids (like Digene, Gelusil) — generally safe for acidity in pregnancy
• Avoid antacids with sodium bicarbonate in large amounts

🤧 Nasal Congestion

• Saline nasal drops or sprays — safe, effective, and recommended
• Steam inhalation — gentle and safe

👁 Eye Care

• Plain lubricating eye drops (artificial tears) — safe for dryness

❌ OTC Medicines to Avoid in Pregnancy

Medicine	Why to Avoid
Ibuprofen (Brufen, Combiflam)	Can affect baby’s kidneys and heart, especially in third trimester
Aspirin (high dose)	Risk of bleeding complications
Decongestants (Pseudoephedrine, Phenylephrine)	May reduce blood flow to placenta
Most cough syrups with codeine or dextromethorphan	Not well studied; avoid in first trimester
Antidiarrheal drugs (Loperamide)	Avoid especially in first trimester
Medicated skin creams with salicylic acid or retinol	Can be absorbed and affect baby

👉 When in doubt about any OTC product during pregnancy always ask your doctor or pharmacist first.

🤱 OTC Medicines During Breastfeeding What Passes Into Milk?

Most medicines pass into breastmilk in very small amounts. But some categories need more care.

✅ Generally Safe While Breastfeeding

🌡 Fever & Pain

• Paracetamol — preferred choice; passes into milk in tiny amounts, considered safe
• Ibuprofen — short-term use generally considered safe while breastfeeding (unlike in pregnancy)

🤧 Allergy & Cold

• Cetirizine (Cetzine, Alerid) — preferred antihistamine; less sedating
• Loratadine — another safe option
• Saline nasal drops — always safe

🩺 Acidity

• Antacids — generally safe
• Omeprazole — commonly used; considered compatible with breastfeeding

⚠️ Use With Caution While Breastfeeding

• Older antihistamines (Chlorpheniramine, Phenergan) — cause sedation in baby; avoid if possible
• Decongestants (Pseudoephedrine) — may reduce milk supply; avoid
• Medicated cough syrups — check ingredients carefully; avoid codeine completely

❌ Strictly Avoid While Breastfeeding

• Codeine-containing medicines — can cause dangerous sedation in baby
• Aspirin (regular doses) — risk of Reye’s syndrome
• Iodine-containing products (topical) — excess iodine passes into milk

👶 OTC Medicines for Infants

This is where the most mistakes happen.

Infants are not small adults. Their livers and kidneys are immature. Doses and formulations matter enormously.

✅ Safe & Recommended for Infants (With Correct Dosing)

🌡 Fever

• Paracetamol infant drops (Calpol, Crocin drops) — safe from birth with correct weight-based dosing
• Ibuprofen suspension — safe from 6 months onwards only

💧 Nasal Congestion

• Saline nasal drops — always the first choice; safe from newborn
• Nasal suction bulb — to clear blocked nose gently

💨 Gas & Colic

• Simethicone drops (Colicaid, Mylicon) — commonly used; considered safe
• Evidence is limited but generally well tolerated

💧 Diarrhoea & Dehydration

• ORS (Electral, Pedialyte) — first line; safe and essential
• Zinc supplements — recommended by WHO for diarrhoea in infants above 6 months

❌ OTC Medicines to NEVER Give Infants

Medicine	Why It’s Dangerous
Adult cough & cold syrups	Overdose risk; can cause breathing problems
Aspirin	Risk of Reye’s syndrome — never give to children
Antihistamines under 2 years	Can cause dangerous sedation
Loperamide (Imodium)	Not safe for infants with diarrhoea
Honey (as remedy)	Risk of infant botulism under 1 year
Ibuprofen under 6 months	Not safe for young infants
Nasal decongestant drops (Xylometazoline)	Can be toxic in infants — never use

📏 The Biggest OTC Mistake Parents Make — Wrong Dosing

Dosing errors are the number one cause of medicine-related harm in children.

Common mistakes:

• using a kitchen spoon instead of the measuring syringe
• giving adult tablets crushed and divided for a baby
• repeating doses too soon thinking the medicine didn’t work
• giving two medicines that both contain paracetamol (double dosing)

✔ Always use the weight-based dose recommended by your doctor

✔ Use the measuring syringe or dropper that comes with the medicine

✔ Read the label every single time even for medicines you’ve used before

✔ Check if any two medicines you are giving have the same active ingredient

🧠 How to Read an OTC Medicine Label — A Quick Guide

Before giving any OTC medicine, check for:

• Active ingredient — what the medicine actually contains
• Dose — how much to give, based on weight or age
• Frequency — how many times per day
• Age/weight restrictions — is it suitable for your child’s age?
• Warnings — any conditions where it should be avoided
• Expiry date — never use expired medicines
• Storage instructions — some medicines need refrigeration

👉 If you cannot understand the label ask your pharmacist. That is exactly what we are here for.

🌿 What About OTC Herbal & Home Remedies?

Many families reach for herbal syrups, gripe water, or Ayurvedic formulations available over the counter.

A few things to keep in mind:

• Gripe water — not evidence-based; some formulations contain sugar or alcohol; consult before use
• Tulsi, ginger, honey-based syrups — honey is unsafe under 1 year; others lack clinical safety data in infants
• Herbal cough syrups — often unstudied in infants and young children

👉 Traditional use does not equal proven safety in babies. Always check with a pharmacist or pediatrician before giving any herbal OTC product to a child.

🧠 Common Myths About OTC Medicines

❌ “OTC means it is completely safe for everyone”

👉 False OTC medicines have real risks, especially in pregnancy, breastfeeding, and infants.

❌ “If I take double the dose it will work faster”

👉 Dangerous overdosing on even simple medicines like paracetamol can cause serious organ damage.

❌ “My neighbour gave the same medicine to her baby, so it must be fine”

👉 Every baby’s weight, age, and health condition is different. Always get individual guidance.

❌ “It’s just a cold — cough syrup will help my baby”

👉 Most coughs and colds in babies are viral and resolve on their own. Cough syrups in infants can be more harmful than helpful.

❌ “Herbal OTC products are always safe during pregnancy”

👉 Absolutely not several herbal products can stimulate uterine contractions or affect the baby.

💡 When Should You Just Ask a Pharmacist?

Your pharmacist is an accessible, qualified medicine safety expert.

Come to us when:

✔ You are pregnant or breastfeeding and unsure about an OTC product

✔ You want to check if two medicines can be taken together

✔ Your baby has been given a new prescription and you want to understand it

✔ You’re unsure about the right dose for your child’s weight

✔ You want to know if a medicine is truly necessary or if home care is enough

✔ You want to compare two products and choose the safer option

👉 You don’t need an appointment. Just ask.

🚨 When OTC Is NOT Enough — See a Doctor

Do not rely on OTC medicines if your baby or you have:

• Fever in a baby under 3 months
• Fever lasting more than 2–3 days in any child
• Difficulty breathing or fast breathing
• Signs of dehydration (no tears, dry lips, sunken eyes)
• Blood in stools or vomit
• Severe or worsening symptoms
• Rash along with fever
• No improvement after 48 hours of home care

These need a doctor’s assessment not a pharmacy shelf.

💛 A Gentle Message to Parents & Mothers

I know how tempting it is to pick something up quickly when your child is unwell or when you’re struggling through pregnancy symptoms.

But your pharmacist is there to make that moment easier and safer.

You don’t have to figure this out alone.

Ask questions. Read labels. Seek guidance. Because every little life including yours deserves safe care.

✨ Final Takeaway

✔ OTC does not mean risk-free always read labels and check with a pharmacist

✔ Paracetamol is the safest first choice for fever in pregnancy, breastfeeding, and infants

✔ Never give adult OTC medicines to infants

✔ Dosing errors are common and preventable always use a proper measuring tool

✔ When unsure about any product ask your pharmacist before you buy

💛 The right medicine, at the right dose, for the right person that is safe care.

Disclaimer

The information on this website is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for personal medical concerns.