Is Theraflu safe during pregnancy?

What does the evidence say about theraflu during pregnancy?

1. The Theraflu Multi-Symptom Severe Cold packet contains acetaminophen 500 mg, dextromethorphan HBr 20 mg, and phenylephrine HCl 10 mg, is labeled at no more than 6 packets in 24 hours, and warns that severe liver damage may occur above 4,000 mg of acetaminophen in 24 hours. 1
2. The Nighttime version is a different formula: acetaminophen 650 mg, diphenhydramine HCl 25 mg, and phenylephrine HCl 10 mg per packet, capped at 5 packets in 24 hours. 2
3. Studies of more than 1,500 pregnant people who took phenylephrine in the first trimester did not show an increased chance of birth defects, and taking phenylephrine could raise your blood pressure. 3
4. At recommended dosages acetaminophen has not been shown to increase the chance of birth defects, and because it appears in many combination products, every label needs checking to avoid taking it twice. 4
5. Dextromethorphan taken as directed for cough is not expected to increase the chance of birth defects, and some over-the-counter liquid products containing it also contain alcohol. 5

Is theraflu safe in each trimester?

• First trimester. The decongestant is the first-trimester question. Studies of more than 1,500 pregnant people who took phenylephrine in the first trimester did not show an increased chance of birth defects, though one study found a slightly higher chance of minor differences of the eyes or ears.
• Second trimester. This is where the acetaminophen arithmetic matters. Six Multi-Symptom packets a day is 3,000 mg of acetaminophen before you add anything else, against a 4,000 mg daily threshold above which severe liver damage may occur.
• Third trimester. Multi-symptom powders are the hardest products to reason about late in pregnancy, because you are taking three or four drugs for two symptoms. Single-ingredient products let your provider approve exactly what you need.

What is in each Theraflu packet