From the Guidelines
Most antihistamines are generally considered safe for breastfeeding women, but some are preferred over others. Second-generation antihistamines like loratadine (Claritin) 10mg daily or cetirizine (Zyrtec) 10mg daily are the first-choice options as they pass minimally into breast milk and cause less drowsiness 1. Fexofenadine (Allegra) is also considered safe. First-generation antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine can be used if needed, but they may cause drowsiness in both mother and infant and could potentially reduce milk supply. If using these, take the lowest effective dose (diphenhydramine 25mg every 6 hours as needed) and monitor your baby for sedation, irritability, or feeding problems.
Key Considerations
- Nasal antihistamine sprays like azelastine have minimal systemic absorption and are considered safe options.
- For severe allergies, consult your healthcare provider about continuing your regular medication, as untreated allergies can interfere with breastfeeding success.
- Taking antihistamines right after nursing or before the baby's longest sleep period can minimize infant exposure.
- The relative infant dose is a valuable guide to the safety of a drug taken by a breastfeeding woman, with a dose < 10% considered safe 1.
Preferred Antihistamines
- Loratadine (Claritin) 10mg daily
- Cetirizine (Zyrtec) 10mg daily
- Fexofenadine (Allegra)
Alternative Options
- Diphenhydramine (Benadryl) 25mg every 6 hours as needed
- Chlorpheniramine
It's essential to consult with a healthcare provider before taking any medication while breastfeeding, as they can provide personalized advice and guidance. Additionally, monitoring the baby for any potential side effects and adjusting the medication regimen as needed is crucial.
From the FDA Drug Label
If pregnant or breast-feeding: if breast-feeding: not recommended If pregnant or breast-feeding, ask a health professional before use.
Antihistamine use in breastfeeding women is approached with caution.
- For cetirizine, it is not recommended for breastfeeding women 2.
- For loratadine, it is advised to ask a health professional before use 3. Given the uncertainty and potential risks, it is best to consult a healthcare professional before taking any antihistamine while breastfeeding.
From the Research
Antihistamine Use During Breastfeeding
- The use of antihistamines during breastfeeding has been studied, and the results suggest that they are generally safe for breastfeeding women 4, 5.
- However, it is essential to note that the amount of antihistamine that enters breast milk depends on various factors, such as the dose, timing of breastfeeding, and duration of therapy 4.
- Some studies have investigated the levels of specific antihistamines in breast milk, including cetirizine, loratadine, and triprolidine, and found that they are excreted in small amounts 6, 7.
- The American Academy of Pediatrics (AAP) considers some antihistamines, such as triprolidine and pseudoephedrine, to be compatible with breastfeeding 4.
- Breastfeeding women should be cautious when taking antihistamines, as they may cause adverse effects in infants, such as paradoxical central nervous stimulation, irritability, and insomnia 4.
- It is recommended that breastfeeding women take antihistamines at the lowest effective dose and for the shortest duration necessary, and to avoid combination products that may contain other ingredients, such as alcohol, aspirin, or caffeine 4, 8.
Key Findings
- A systematic literature review found that the relative infant dose of antihistamines was below 5% for all studied antihistamines, ranging from 0.3% for terfenadine to 4.5% for clemastine 7.
- Most product labels of antihistamines report a lack of evidence and recommend avoiding use during breastfeeding, highlighting the need for further human studies 7.
- A study developed a method for determining the levels of 11 antihistamines in breast milk, which can be used to investigate antihistamine-related clinical cases and pharmacokinetic studies 6.