Decongestant Nasal Spray During Pregnancy and Breastfeeding

    Generic Name: Decongestant Nasal Sprays
    Indications: Treatment of nasal inflammation
    FDA Drug Category:
    C

    Summary Recommendations: Decongestant nasal sprays include sprays with many different medications.



    Nasal Decongestants and Pregnancy and Breastfeeding

    Pseudoephedrine, or Sudafed is a category C drug that constricts the flow of blood to the nasal passages. 

    Loratadine, or Claritin is an antihistamine, and is usually considered safe to take during pregnancy

    Saline-only nasal sprays are considered safe during pregnancy. Topical or nasal spray decongestants, such as Afrin, were once thought to be safe for most pregnant women. However, these too work by constricting blood flow to the sinuses, and it is now thought that it can be absorbed systemically.

    Like all other medications they should be used only as directed during pregnancy. Use should be limited to three days and use in excess of three days can lead to rebound nasal congestion. Pregnant women should talk with their obstetrician before choosing an over the counter decongestant nasal spray. The nasal decongestant spray of choice for many obstetricians is oxymetazoline. Common brands of decongestant nasal sprays include Afrin, Vicks Sinex, Sudafed OM, Dristan and Zycam.

    Decongestant nasal sprays are all applied to the nasal passages as tiny droplets of liquid, but the liquids delivered to the nasal passages are quite different. The four types of decongestant nasal sprays are antihistamine, topical, corticosteroid and natural (saline).

    • Antihistamines are azelastin hydrochloride and olopatadine hydrochloride.
    • Topicals include oxymetazoline hydrochloride and phenylephrine hydrochloride.
    • Corticosteroids are mometasone furoate monohydrate and budesonide. Both have been shown to cause headache and nosebleed, but they are clinically tested and proven effective.
    • Natural decongestant nasal sprays deliver nothing more than saline, but they can be effective for mild nasal congestion and they are safe for use in infants and children.

    Some decongestant nasal sprays are sold over the counter, but others require a prescription from your physician.

    General Precautions
    : Nasal congestion can be a sign of an underlying infection. Before using a decongestant nasal spray during pregnancy, talk with your physician about the symptoms you are experiencing. This is especially important if you have multiple symptoms, including fever, chest congestion, headache and other body pain.

    It is generally considered safe to use decongestant nasal sprays for up to three days. Over the counter sprays should contain approved decongestants only. Your obstetrician should have a list of approved medications you can choose from.

    Effect While Trying to Conceive
    : While nasal sprays don’t necessarily alter fertility, the drying action of the active ingredient could affect cervical mucus. Drying of the cervical mucus could impair fertility. There is no evidence that decongestant nasal sprays affect male fertility in any way.

    Effects on Pregnancy
    : Nasal stuffiness is a common occurrence during pregnancy. Decongestant nasal sprays are not associated with pregnancy complications or birth defects, so most obstetricians will allow infrequent use of approved nasal sprays as needed. Using decongestant nasal sprays for more than three days can cause increased nasal congestion.

    Safe During Breastfeeding
    : As long as decongestant nasal sprays are used as directed for no more than three consecutive days, there are no reported side effects on the breastfeeding infant. If there are other symptoms associated with your illness, like fever or body pain, contact your physician as there could be an underlying condition causing the nasal congestion.