Hydroxychloroquine is Safe During Breastfeeding
Yes, a lactating mother can safely breastfeed while taking hydroxychloroquine. Both the most recent international guidelines and FDA labeling consistently support breastfeeding continuation during hydroxychloroquine therapy 1, 2.
Evidence Supporting Safety
Guideline Recommendations
The 2025 EULAR guidelines explicitly list hydroxychloroquine among antirheumatic drugs compatible with pregnancy and lactation 1. This represents the highest-quality, most recent guidance available and emphasizes that women should be informed about the beneficial effects of breastfeeding while taking compatible medications like hydroxychloroquine.
FDA Drug Label Position
The FDA label clearly states that hydroxychloroquine is present in human milk at low levels 2. Critically:
- No adverse reactions have been reported in breastfed infants
- No retinal toxicity, ototoxicity, cardiotoxicity, or growth/developmental abnormalities have been observed in children exposed through breastmilk
- The developmental and health benefits of breastfeeding should be considered alongside the mother's clinical need for the medication
Quantitative Safety Data
Research demonstrates remarkably low infant exposure 3:
- Breast milk concentrations range from 0.4-1.4 μg/mL depending on maternal dose
- Infants receive only 0.26-0.29% of the maternal daily dose through breastmilk
- The weight-adjusted relative infant dose is approximately 1.9-3.2% of the maternal dose per kilogram—well below the 10% safety threshold typically used for medication compatibility with breastfeeding
Long-term Infant Outcomes
A prospective study following 24 infants (including 13 who were breastfed) found normal visual function and neurodevelopmental outcomes in all children exposed to hydroxychloroquine through breastmilk 4.
Clinical Approach
Recommend continuing breastfeeding while the mother takes hydroxychloroquine for her rheumatic condition. The key considerations are:
- Disease control is paramount: Untreated or poorly controlled maternal disease (lupus, rheumatoid arthritis) poses greater risks to both mother and infant than the minimal drug exposure through breastmilk 2
- Breastfeeding benefits are substantial: Protection against infections, reduced risk of inflammatory bowel disease, obesity, diabetes, and childhood cancers for the infant; reduced maternal risks of diabetes, hypertension, and multiple cancers 1
- No special monitoring required: The infant does not need routine ophthalmologic or other specialized monitoring based solely on breastmilk exposure
Important Caveat
While hydroxychloroquine itself is safe during breastfeeding, ensure the mother's underlying condition is stable. Severe maternal disease activity could necessitate temporary separation for other clinical reasons unrelated to medication safety 5.
The evidence overwhelmingly supports that mothers taking hydroxychloroquine should breastfeed without concern for medication-related infant harm 1, 2, 3, 5, 4.