Syrups in pregnancy: which can and which cannot?

Most often, the question of what syrups can be taken during pregnancy concerns cough medicines. It is generally accepted that since most of these syrups contain extracts of medicinal herbs, it means that pregnant women can safely take them. But this is not true.

Some pharmacopoeial plants contain biologically active substances that can cause harm, for example, cause uterine contractions that can lead to termination of pregnancy, or disrupt the normal development of the embryo and fetus.

What syrup for dry and wet cough can be used during pregnancy?

Despite the fact that all indications for the use of dry cough syrups are reduced to the fight against unproductive cough caused by inflammation of the upper respiratory tract (from colds to bronchitis and pneumonia), when prescribing drugs, the need to liquefy and remove the resulting sputum should be taken into account.

In addition, when choosing a syrup for dry and wet cough during pregnancy, you need to focus not only on the nature of the cough, but also on the gestational period, since many of the mucolytic and expectorant agents - including those of plant origin - are contraindicated for use during the first trimester, when all organs are laid down and the life-support systems of the body of the future child are formed.

In case of dry cough, pregnant women are recommended to take plantain syrup (one dessert spoon three times a day), Dr. Theiss syrup with plantain and Gerbion syrup with extract of lanceolate plantain leaves (Plantago lanceolata) and mallow flowers (Malva silvestris). For how to take it, see – Gerbion for dry and wet cough.

When the cough is wet, a secretomotor drug or expectorant is needed - an expectorant syrup during pregnancy, and here the most commonly recommended remedy is one with an extract of the root of Althaea officinalis - marshmallow syrup. All the details of its use, including contraindications and possible side effects, are described in the material - Marshmallow for cough with bronchitis.

Traditionally, the pharmacodynamics of herbal syrups describes the end result of their action without delving into its biochemical mechanism (which is unknown in many cases). However, the pharmacological effect is determined by specific bioactive substances. For example, organic carboxylic and phenolic acids in plantain leaves relieve inflammation, and the anticatarrhal and antispasmodic effects are the result of the action of aucubin and its derivatives, which are monoterpene compounds.

The softening of cough and relief of expectoration of sputum when using marshmallow root is explained by the action of flavonoids (kaempferol, hypolaetin-8-glucoside, isoquercitrin) and high-molecular acidic polysaccharides - mucus.

What cough syrups should not be used during pregnancy in the 1st, 2nd, and 3rd trimesters?

Unless absolutely necessary, do not take risks by taking medications that state in the instructions that they should be used with caution during pregnancy or that have no information about safety during pregnancy, that is, the possibility of safe use has not been tested or confirmed in any way.

Without going into pharmaceutical details, one could simply list the names of such drugs, but – to make it clear why manufacturers make a reservation regarding their use during pregnancy – it is necessary to briefly describe their composition.

To ensure that expectorant syrup does not cause harm during pregnancy, it should not contain plant extracts used to treat coughs but contraindicated for pregnant women. These include licorice (Glycyrrhiza glabrа), thyme (Thymus serpyllum), ivy (Hedera helix), oregano (Origanum vulgare), sage (Salvia officinalis), coltsfoot (Tussilago farfara), elecampane (Inula helenium), and turmeric (Curcuma longa).

Herbalists have no complaints about peppermint (Mentha piperita), but marsh mint (Mentha pulegium), especially its essential oil, causes strong contractions of the uterus with the threat of miscarriage.

Read also – Herbs during pregnancy

Licorice syrup

Contraindications to the use of licorice during pregnancy are associated with the hormonal (estrogenic and antiestrogenic) activity of its organic compounds of the flavone class.

In addition, the main active ingredient of the plant root and its extract - saponin glycyrrhizin (a derivative of glycyrrhizic acid) is similar to the endogenous hormone adrenocorticotropin (ACTH) not only in structure, but also in action, retaining sodium ions and water, causing edema, increased blood pressure, loss of potassium ions and muscle weakness.

Pertussin syrup and its analogues

Pertussin, which is used to treat cough in children from the age of three, is not suitable for pregnant women for two reasons. Firstly, the basis of this remedy is thyme extract, which is contraindicated for pregnant women due to the stimulating effect of its phytosterols (luteolin and apigenin) on the estrogen receptors of the uterine muscle tissue. Secondly, Pertussin contains potassium bromide, which has a sedative effect, slowing down the conduction of nerve signals of the central nervous system.

Thyme extract is included in such cough remedies as Bronchicum syrup, Altemix Broncho, Eukabal syrup (in addition to thyme, it contains plantain extract, synonym – Stopussin phyto), Bronchipret.

Syrups with ivy extract

Hederin syrup with ivy extract, as well as its analogues - Gedelix syrup, Pectolvan, Prospan, Herbalor - relieve cough, providing mucolytic, antispasmodic and expectorant action, caused by saponins α-hederin and hederacoside C, which indirectly enhance the response of β2-adrenoreceptors of the bronchioles. But at the same time, ivy promotes the removal of salt and water from the body and reduces blood pressure.

The potential threat of negative impact of these agents in the treatment of cough during pregnancy may be associated with the presence of a significant amount of steroids in ivy, including sitosterol, stigmasterol, α-spinasterol. Experts know the ability of these compounds to influence cholesterol metabolism, the level of which increases during pregnancy - to ensure the synthesis of hormones that support its normal development. And interference in this process is extremely undesirable, which is why plant steroids are included in the list of contraindications for pregnant women.

Multi-component cough syrups

Syrups containing many plant-based components are also not recommended for pregnant women. Their list includes:

• Linkas cough syrup, which contains extracts of nine plants, including licorice root (mentioned above), vascular justice leaves (containing the alkaloid vasicine, which stimulates the myometrium of the uterus) and hyssop (blue St. John's wort), which are also contraindicated during pregnancy.
• Dr. MOM syrup containing justice and turmeric, more details – Dr. MOM during pregnancy in the 1st, 2nd, 3rd trimesters.
• Ayurvedic syrup Travisil - due to the content of extracts of licorice, justice and turmeric.
• homeopathic syrup Stodal, among the active components of which is an extract of black pasqueflower (Pulsatilla pratensis), the triterpenoid saponins of which are distinguished by hemolytic activity and cytotoxicity; ipecac root (ipecac), containing plant sterols (α-spinosterol, stigmasterol, etc.); poisonous white bryony (bryonia), which is prohibited during pregnancy.

Cough syrups with synthetic components

Ambroxol syrup, as well as other trade names of mucolytic (thinning thick sputum) cough remedies based on ambroxol hydrochloride - syrups Ambrobene, Ambrogeksal, Lazolvan, Bronkhoval, Koldak Broncho, Halixol - are contraindicated for use in the 1st trimester of pregnancy. Side effects, methods of administration and dosages - in a detailed description of Lazolvan syrup.

Despite the significant mucolytic effect and relief of sputum discharge, Bromhexine syrup is not prescribed to pregnant women during the first trimester. Bromhexine is a synthetic analogue of the alkaloid vascular justice, it penetrates the placenta, and this is a good reason to refuse to take this syrup at later stages.

Omnitus syrup (other trade names – Sinekod, Panatus) is used to treat dry cough; its active ingredient – butamirate – acts on the area of the brain that controls the cough reflex and suppresses it. Although controlled studies have not been conducted, this drug is contraindicated in the 1st trimester of pregnancy, and in the 2nd and 3rd trimesters it is prescribed under the supervision of a doctor, who must correlate the benefit to the pregnant woman with the potential risk to the unborn child. A single dose of syrup is 30 ml, the number of doses during one day is no more than four. Side effects may include dizziness, nausea, intestinal upset.

Stoptussin syrup has similar recommendations, except for butamirate, to facilitate the removal of bronchial secretions containing the anxiolytic guaifenesin, and drugs of this pharmacological group are contraindicated during pregnancy. In this case, the doctor, prescribing this drug, must be sure that the resulting marginal benefit to the mother will be higher than the risk to the fetus, especially in the early stages, when it is most vulnerable. According to some foreign studies, the use of guaifenesin against the background of fever in the 1st trimester increases the risk of neural tube defects in the fetus.

As indicated in the instructions, Ascoril syrup, which contains bromhexine, salbutamol and guaifenesin and is used for obstructive bronchitis and bronchial asthma, is contraindicated during pregnancy.

Prescribed for chronic bronchitis and bronchial asthma, Erespal syrup contains the antihistamine fenspiride, which can have a teratogenic effect and is contraindicated in pregnant women.

Some other syrups during pregnancy

During pregnancy, there may be a need for painkillers and antipyretics. Paracetamol syrup can be taken for headaches and fever, but it should be borne in mind that it is contraindicated in the 1st trimester of pregnancy. All details in the material - Paracetamol during pregnancy. A synonym for paracetamol, which contains the same active ingredient acetaminophen, is Panadol syrup.

But Nurofen Dr. Theiss syrup (synonyms - Ibuprofen, Ibuprof, Ibufen, etc.) is contraindicated for pregnant women. The use of non-steroidal anti-inflammatory drugs during the entire gestation period is unsafe, even when, as written in the instructions, "the expected benefit to the mother exceeds the possible threat to the fetus." And the threat to the fetus consists of termination of pregnancy and the appearance of congenital defects (in the first three months) and premature closure of the arterial duct and the development of cardiac pathologies in the child at later stages.

Gaviscon heartburn syrup (sodium alginate + potassium bicarbonate) is an antacid, all information in the article - Gaviscon forte mint suspension.

In case of bile stasis and cholecystitis, choleretic agents are necessary:

• rosehip syrup, for more details see - Rosehip during pregnancy in the early and late stages
• Holosas syrup (based on rosehip extract)
• Hofitol syrup - Hofitol during pregnancy: what it is prescribed for, how to take it and how much to drink.

For cystitis and kidney problems, Kanefron syrup with extracts of lovage root (Levisticum officinale), rosemary leaves (Rosmarinus officinalis) and centaury herb (Centaurium erythraea) is recommended - Kanefron during pregnancy. However, it should be borne in mind that centaury helps increase appetite and can stimulate intestinal motility and spasms of the muscular membrane of the uterus.

It is not yet known whether culinary maple syrup helps fight infections or how safe it is for pregnant women to use.

Is it possible to use the hyperosmotic laxative Dufalac syrup (containing lactulose, which breaks down in the intestine, increasing the volume of its contents)? For more details, see the article - Dufalac during pregnancy.

During pregnancy, iron deficiency in the body is unacceptable, and to cover it, drugs containing this important microelement are used. One of them is Ferrum Lek syrup with iron polyisomaltose. A detailed description can be found in the publication about the drug Maltofer, which is a synonym (another trade name) of Ferrum Lek.

Any medications and dietary supplements that stimulate the immune system are contraindicated for use during pregnancy, including Cytovir 3 syrup, which is positioned as an antiviral agent.

During pregnancy, it is unacceptable to use any medications based on positive reviews from others. A medicine that helped someone can cause serious harm to your health, because each organism and the effect of medications on the fetus are individual. Therefore, it is strongly recommended not to take medications on the advice of friends, even if they were prescribed to them by a doctor.