Is It Safe to Take Dextromethorphan During Pregnancy? Effects and Cautions
Medically Reviewed 
Key Points
- Dextromethorphan is considered to have a relatively low risk during pregnancy and breastfeeding, but available evidence is limited, and its safety has not been definitively established.
- Dextromethorphan is a member of a class of drugs known as antitussives and can be found under its brand names, Robitussin, Delsym, and Vicks Dayquil Cough.
- Side effects include dizziness, anxiety, restlessness, nervousness, upset stomach, confusion, hallucinations, slow breathing, and shallow breathing.
- Natural remedies such as honey and saline drops should be considered first-line treatments for cough and cold while expecting.
- Always talk to your doctor before taking prescription or over-the-counter medication during pregnancy, especially during the first trimester.
Dextromethorphan is one of the cough and cold medicines considered generally safe to take during pregnancy. Still, there could be some risks to be aware of when taking this drug while pregnant. Moreover, further research is needed to confirm its safety to unborn babies.
Taking any medications and even some herbal supplements during pregnancy can be risky, especially during your first trimester. Certain prescription medications and over-the-counter drugs can cause birth defects or other pregnancy complications. Medical researchers are still studying the effects of many medications on unborn babies.
What Is Dextromethorphan?
Dextromethorphan is an over-the-counter cough suppressant used to treat coughs associated with the common cold, flu, and respiratory infections. This substance is a member of a class of drugs known as antitussives. [1] You might recognize its brand names, which include Robitussin, Delsym, and Vicks DayQuil Cough.
Dextromethorphan is also a common ingredient in many combination drugs, including both over-the-counter and prescription medications. It is essential to be aware of this, especially during pregnancy.
Taking Dextromethorphan During Pregnancy
Only take dextromethorphan during pregnancy if you need it to suppress a nasty cough. Although it’s generally considered safe, further research is needed to confirm its safety for an unborn child. Here are some other safety tips to follow when taking this cough medicine while pregnant:
- Ask your doctor before taking dextromethorphan or any other medication.
- Only take dextromethorphan as indicated. Read all packaging material and inserts carefully.
- Don’t take more than the suggested dose, even if the medicine isn’t as effective as you would like.
- Avoid any combination medications that have other ingredients besides dextromethorphan, as these may be harmful to the unborn baby.
- Check the label. Some products containing dextromethorphan also contain alcohol, which could pose risks during pregnancy.
- Dextromethorphan is only recommended as a short-term treatment. If your symptoms don’t improve after a week, tell your doctor.
- Consider natural remedies instead, but tell your doctor before taking any herbal supplements.
What To Expect When Taking Dextromethorphan: Side Effects
When taking dextromethorphan during pregnancy, it’s a good idea to be aware of any side effects you might experience and monitor them for your health and the safety of your baby. Tell your doctor if you experience any of the following dextromethorphan side effects: [2]
- Dizziness
- Anxiety
- Restlessness
- Nervousness
- Upset stomach
- Confusion
- Hallucination
- Slow breathing
- Shallow breathing
If you experience serious side effects or those that persist for more than a few days, contact your doctor immediately. Adverse side effects from dextromethorphan could cause harm to your unborn baby in some rare cases.
Recent Study Raises Concerns on the Risk of Birth Defects
Much of the existing research on the safety of dextromethorphan during pregnancy was published over a decade ago. One recent study in particular has some healthcare providers reconsidering their recommendation of cough medicines like dextromethorphan during pregnancy.
Led by researchers from the University of Iowa College of Public Health, the study found that cough medications containing either dextromethorphan, guaifenesin, or both during the first trimester of pregnancy could be linked to some birth defects, including “certain brain and spinal, heart, intestinal, and musculoskeletal defects.” [3]
Taking Dextromethorphan While Breastfeeding
Research is limited regarding the safe use of dextromethorphan while breastfeeding. A recent observational study raised potential concerns about associations between first-trimester exposure to cough medications containing dextromethorphan or guaifenesin and certain birth defects, though causality was not established. Researchers determined that the concentration of the medicine was not enough to have any significant effect.[4] The study did have some limitations, including a small sample size of only 20 new mothers. More research is needed to fully justify recommendations of dextromethorphan during lactation.
Which Are the Safest Cold Medicines to Use During Pregnancy?
No prescription or over-the-counter medicine has been determined completely safe to use during pregnancy. It’s essential to consult your healthcare provider to weigh the risks against the benefits before taking any medication for a cough or cold while pregnant.
Cold Medicines That May Be Safe While Pregnant
Many healthcare providers recommend using certain cough medicines during pregnancy. More research is needed to confirm the safety of some of these medications. It’s best to avoid any cough medicine unless it’s necessary. Always talk to your doctor before taking a new medication, even if it’s thought to be safe to take while pregnant: [5]
- Robitussin (dextromethorphan) – only formulas without alcohol
- Mucinex (guaifenesin) – only take the plain version
- Loratadine (Claritin)
- Diphenhydramine (Benadryl)
- Mentholated chest rub (Vicks Vapor Rub)
Natural Remedies for Cough and Cold During Pregnancy
Some women choose to avoid over-the-counter (OTC) medications during pregnancy, and this may be the safest route. Below are some doctor-recommended natural remedies that may help with cold and cough symptoms: [6]
- Saline-based nose drops
- Humidifier
- Warm salt water gargle
- Honey
- Rest
Cold prevention may be the best approach. Remember that during pregnancy, it’s more important than ever to keep yourself healthy. General guidelines for preventing a cold or cough include:
- Wash your hands frequently.
- Practice good hygiene.
- Avoid touching your eyes, nose, or face unnecessarily.
- Stay away from people who are sick.
- Stay up to date on current vaccinations.
- Tell your doctor immediately if you begin to experience cold or flu symptoms, including a cough.
Which Cold Medicines Should Be Avoided By Pregnant Women?
If you do get sick, be especially cautious about which cold medicines you take. Some are considered safer than others during pregnancy. Generally speaking, the following cold and cough medications should be avoided during pregnancy: [7]
- Decongestants containing pseudoephedrine (e.g., Sudafed PE)
- Nonsteroidal nasal sprays
- DayQuil and NyQuil
- NSAIDs (i.e., nonsteroidal anti-inflammatory drugs) such as aspirin, naproxen, and ibuprofen
A Note On Dextromethorphan Abuse
In high doses, dextromethorphan can cause psychosis, including hallucinations, and have a euphoric effect. [8] Thus, it carries a risk of addiction and abuse. Before taking dextromethorphan, tell your doctor about any history of substance abuse, including alcohol or drug misuse. The use of recreational substances, including alcohol and marijuana, has been linked to an increased risk of birth defects.
Frequently Asked Questions About Taking Dextromethorphan During Pregnancy
Can I use Afrin during pregnancy or while breastfeeding?
Afrin (oxymetazoline) may be used cautiously during pregnancy for short durations, but prolonged use is discouraged due to risks such as rebound congestion and limited safety data. Like all medications, it should be used with caution while expecting. Only your healthcare provider can tell you what your personal risk level is for any drug.
What over-the-counter pain relievers are safe during pregnancy?
No over-the-counter pain relievers have been determined completely safe to use during pregnancy. Most doctors agree to avoid NSAIDs like ibuprofen or naproxen. Acetaminophen is generally considered the safest over-the-counter pain reliever during pregnancy when used as directed, though some observational studies have raised concerns about long-term use and neurodevelopmental outcomes. Talk to your healthcare provider before taking any over-the-counter medications for pain, especially during early pregnancy.
Are sore throat lozenges safe to take while expecting?
Most lozenges are likely safe to take during all three trimesters of pregnancy. Still, it’s important to check the ingredients as some cough drops may contain potentially harmful substances like aspartame.
Can I take decongestants during pregnancy?
Decongestants like pseudoephedrine, or Sudafed, are unlikely to affect pregnancy outcomes during the second or third trimester. Don’t take these medications early in your pregnancy, though, as they have been linked to certain birth defects when taken during the first trimester. [9]
Are antihistamines harmful during pregnancy?
Many antihistamines are considered generally safe to take while pregnant, including loratadine (Claritin), hydroxyzine, cetirizine (Zyrtec), chlorpheniramine, and dexchlorpheniramine. Still, you should ask your doctor first before taking any medication while expecting.
How can I prevent birth defects in general?
Not all birth defects can be prevented, as some are caused by genes passed down from parents, but you may be able to reduce the risk. Here are some tips for lowering the risk of birth defects from The American College of Obstetricians and Gynecologists: [10]
- Take a daily multivitamin, especially if it contains folic acid.
- Maintain a healthy weight.
- Prevent infections when possible.
- Discuss your personal risk factors with your doctor.
- Use discretion when taking medications or herbal supplements.
- Avoid alcohol, marijuana, and any other recreational drugs.
- Tell any prescriber you see that you’re pregnant before they write you a prescription. This includes mental health professionals and dentists.
Sources
[1] Dextromethorphan uses, dosage, side effects. Drugs.com. (n.d.-b). https://www.drugs.com/dextromethorphan.html
[2] Dextromethorphan side effects: Common, severe, long term. Drugs.com. (n.d.-a). https://www.drugs.com/sfx/dextromethorphan-side-effects.html
[3] News. University of Iowa College of Public Health. (2022, January 3). https://www.public-health.uiowa.edu/news-items/study-finds-possible-link-between-cough-medication-use-and-certain-birth-defects/
[4] Shum, S., Yadav, A., Fay, E., Moreni, S., Mao, J., Czuba, L., Wang, C., Isoherranen, N., & Hebert, M. F. (2022, June). Infant dextromethorphan and dextrorphan exposure via breast milk from mothers who are CYP2D6 extensive metabolizers. Journal of clinical pharmacology. https://pmc.ncbi.nlm.nih.gov/articles/PMC9153952/#S14
[5] [6] [7] Person. (2025, January 8). Safe cold and flu medications while pregnant. Nebraska Medicine Omaha, NE. https://www.nebraskamed.com/health/healthy-lifestyle/womens-health/safe-cold-and-flu-medications-while-pregnant
[8] Martinak, B., Bolis, R. A., Black, J. R., Fargason, R. E., & Birur, B. (2017, September 15). Dextromethorphan in cough syrup: The poor man’s psychosis. Psychopharmacology Bulletin. https://pmc.ncbi.nlm.nih.gov/articles/PMC5601090/
[9] Cleveland Clinic. (2025, April 22). What medication can you take when pregnant? https://health.clevelandclinic.org/pregnancy-safe-medications
[10] Reducing risks of birth defects. ACOG. (n.d.). https://www.acog.org/womens-health/faqs/reducing-risks-of-birth-defects