Is Pepcid (famotidine) safe during breastfeeding?

From the Guidelines

Famotidine (Pepcid) is considered safe for use during breastfeeding, as the relative infant dose is less than 10%. The relative infant dose is a valuable guide to the safety of a drug taken by a breastfeeding woman, and a drug with a proportion less than 10% is considered the preferred option 1. When calculating the relative infant dose, the dose in the infant (mg/kg/day) is compared to the dose in the woman (mg/kg/day), and for famotidine, this proportion is well below the 10% threshold.

• The standard adult dosage of famotidine is 20-40 mg once or twice daily, and no dosage adjustment is needed specifically for breastfeeding mothers.
• Only small amounts of the medication pass into breast milk, with infant exposure estimated to be less than 0.5% of the maternal dose adjusted for weight.
• This minimal exposure is unlikely to cause adverse effects in breastfed infants, and mothers can continue breastfeeding as normal without timing feeds around medication doses.
• Famotidine works by reducing stomach acid production by blocking histamine H2 receptors, making it effective for treating conditions like heartburn, acid reflux, and ulcers, which some mothers may experience increased acid production postpartum.
• If concerns about using this medication while breastfeeding arise, discussion with a healthcare provider is recommended, but be reassured that it's one of the preferred acid reducers for nursing mothers.

From the FDA Drug Label

1. 2 Lactation Risk Summary There are limited data available on the presence of famotidine in human breast milk. There were no effects on the breastfed infant. There are no data on famotidine effects on milk production.

• The limited data available suggest that famotidine is present in human breast milk, but there were no effects on the breastfed infant.
• However, there are no data on famotidine effects on milk production.
• Considering the limited data and the potential risks, it is recommended to exercise caution when using Pepcid (famotidine) during breastfeeding, and weigh the benefits against the potential risks to the infant 2.

From the Research

Medication Safety During Breastfeeding

• The safety of medications during breastfeeding depends on various factors, including the type of medication, its concentration in breast milk, and the infant's age and health status 3, 4.
• Generally, medications with low risk to the infant should be selected, and dosing should be timed to minimize exposure to the infant 3.
• Resources such as LactMed can provide information on the safety of specific medications during breastfeeding 3.

Pepcid (Famotidine) and Breastfeeding

• Famotidine is excreted into breast milk to a lesser extent than some other histamine antagonists, such as cimetidine or ranitidine 5.
• According to one study, famotidine may be a preferred histamine antagonist during breastfeeding due to its lower excretion into breast milk 5.
• However, it is essential to consult with a healthcare provider before taking any medication, including Pepcid, while breastfeeding to discuss the potential risks and benefits 3, 4, 6.

General Guidelines for Medication Use During Breastfeeding

• Most medications can be used safely during breastfeeding at the recommended dose, but there are exceptions that require caution 6.
• Medications that are poorly absorbed orally or have a low concentration in breast milk are generally considered safer for breastfeeding mothers 4.
• Topical therapies or medications with a short duration of use may also be preferred during breastfeeding 4.