From the Guidelines
Most antiemetics are safe to use during lactation, with first-line options including metoclopramide, ondansetron, prochlorperazine, and promethazine, as they have minimal transfer into breast milk or are considered compatible with breastfeeding. According to the most recent study 1, the following antiemetics are compatible with breastfeeding:
- Metoclopramide
- Ondansetron
- Prochlorperazine
- Promethazine
- Domperidone
- Cyclizine
- Doxylamine/pyridoxine These medications can be used to manage nausea and vomiting in lactating women, with the caveat that the lowest effective dose should be used for the shortest duration needed. It is essential for mothers to monitor their infants for unusual drowsiness, feeding difficulties, or irritability while using these medications and consult their healthcare provider if concerned. The study 1 provides the most up-to-date guidance on the use of antiemetics during lactation, and its recommendations should be followed to ensure the best possible outcomes for both mother and infant.
Some key points to consider when using antiemetics during lactation include:
- Metoclopramide and domperidone may increase milk production, making them useful options for lactating women 1
- Ondansetron has minimal transfer into breast milk, making it a safe choice for lactating women 1
- Prochlorperazine and promethazine are considered compatible with breastfeeding, although promethazine may cause drowsiness in infants 1
- Cyclizine and doxylamine/pyridoxine are also considered safe for use during lactation, although there may be limited data available on their transfer into breast milk 1
Overall, the use of antiemetics during lactation should be guided by the most recent and highest-quality evidence, with a focus on minimizing potential risks to the infant while effectively managing the mother's symptoms.
From the FDA Drug Label
It is not known whether ondansetron is present in human milk. There are no data on the effects of ondansetron tablets on the breastfed infant or the effects on milk production. However, it has been demonstrated that ondansetron is present in the milk of rats. When a drug is present in animal milk, it is likely that the drug will be present in human milk The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ondansetron tablets and any potential adverse effects on the breastfed infant from ondansetron tablets or from the underlying maternal condition.
The safety of ondansetron in lactating women is unknown. There is insufficient data to determine the effects of ondansetron on the breastfed infant or milk production. However, since ondansetron is present in the milk of rats, it is likely to be present in human milk as well. The decision to use ondansetron in lactating women should be made with caution, considering the potential benefits of breastfeeding and the mother's clinical need for the medication, as well as potential adverse effects on the infant 2.
From the Research
Antiemetics Safe with Lactating Women
- The safety of antiemetics during lactation is a concern for breastfeeding women, and several studies have investigated this issue 3, 4, 5.
- Metoclopramide is listed by the American Academy of Pediatrics (AAP) as a drug whose effect on nursing infants is unknown but may be of potential concern, although studies published to date have not reported any adverse effects 5.
- Ondansetron has been proposed as an effective drug for severe nausea and vomiting of pregnancy, and its use during lactation has been evaluated in some studies 6.
- A study comparing ondansetron and metoclopramide in the treatment of hyperemesis gravidarum found that ondansetron had a more favorable effect in controlling severe vomiting 6.
- Another study reviewed inquiries to a medicines information service and found that breastfeeding women often ask about the safety of antiemetics during lactation, and that there is a need for more information on this topic 4.
Specific Antiemetics and Lactation
- Metoclopramide is considered compatible with breastfeeding by some sources, but its use should be approached with caution 5.
- Ondansetron has been used during lactation, but its safety has not been extensively studied 6.
- Other antiemetics, such as meclizine, promethazine, and aprepitant, have not been extensively studied during lactation, and their safety is not well established 4.
General Principles for Antiemetic Use during Lactation
- The use of antiemetics during lactation should be based on accurate and up-to-date information, and decisions should be made on a case-by-case basis 7.
- Breastfeeding should be interrupted only when the needed drug might be harmful to the nursing child and exposure via the breast milk will be sufficient to pose a risk 7.
- Safer alternatives should be considered instead of drugs with potential risks, and the benefits of breastfeeding should be weighed against the potential risks of antiemetic use 7.