PREGNANT WOMEN WILL ASK THE PHARMACIST about OTCs for GI complaints. We know nausea and vomiting in pregnancy is common. But be ready to help manage other GI problems if nondrug measures aren't enough.
HEARTBURN ― Suggest an antacid with calcium first or one with aluminum/magnesium (Maalox, etc). These are considered safe at labeled doses, work quickly and can be taken when symptoms occur. For further information see topic Dyspepsia and gastro-esophageal reflux during pregnancy. Point out that antacids can decrease absorption of iron in prenatal vitamins. Tell women to space these by at least 2 hours.
Avoid sodium bicarbonate as it may lead to alkalosis. If an antacid isn't enough, consider famotidine (Antodine) 20 mg at bedtime when an H2-blocker is needed or omeprazole (Losec) 10 to 20 mg morning as the PPI of choice for more severe symptoms. For further information see topics on (1) Gastrointestinal agents during pregnancy and breastfeeding. (2) Medication safety and drug exposure in pregnancy.
CONSTIPATION ― Recommend a bulk laxative (Metamucil, etc). They're not absorbed and considered first-line. But remind women to drink plenty of water and slowly titrate the dose to minimize gas and bloating. Or consider PEG 3350 (Miralax, etc). It's minimally absorbed and may be better tolerated. Advise saving stimulants (senna, bisacodyl) for short-term use. These may cause cramping, dehydration, etc. Docusate can also be used in pregnancy, but may not help much. And keep in mind, it may already be in prenatal vitamins.
HEMORRHOIDS ― It's okay to suggest external topicals, such as (Anusol or Proctosedyl, etc), an anesthetic (pramoxine, etc) for pain or hydrocortisone 1% cream short-term for more severe itching. Daflon may be used, it considered to be safe during pregnancy. Also advise to avoid phenylephrine products (H-formula) as vessel constriction may reduce blood flow to the uterus. For further information see topic on Over-the-counter (OTC) medication in pregnancy.
REFERENCES
Body, C. and Christie, J.A. (2016). Gastrointestinal Diseases in Pregnancy. Gastroenterology Clinics of North America, 45(2), pp.267–283. Available at: https://www.sciencedirect.com/science/article/abs/pii/S088985531630005X?via%3Dihub
Gomes, C.F., Sousa, M., Lourenço, I., Martins, D. and Torres, J. (2018). Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Annals of Gastroenterology, [online] 31(4), pp.385–394. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033757