From the Guidelines
Most antihistamines and topical steroids are generally considered safe during breastfeeding. According to the European Respiratory Journal study 1, antihistamines like loratadine or cetirizine are preferred as they have been most used and are considered probably safe. The study notes that antihistamines may, in theory, reduce milk production, but this is not a significant concern.
Key Considerations
- Second-generation antihistamines like loratadine or cetirizine are preferred options as they have been most used and are considered probably safe 1.
- Topical steroids are also considered safe when applied to small areas of skin, as minimal amounts are absorbed systemically and even less transfers into breast milk.
- For more extensive skin conditions requiring stronger steroids, it's best to apply them after breastfeeding and wipe the area clean before the next feeding if the application area might contact the baby during nursing.
Medication Safety
The safety profile of these medications during breastfeeding is based on their limited transfer into breast milk and minimal effects on the nursing infant, but it's always advisable to use the lowest effective dose for the shortest duration needed to control symptoms. As noted in the study 1, there is no data to suggest that antihistamines or topical steroids cause significant harm to the nursing infant.
Recommendations
- Use loratadine or cetirizine as the preferred antihistamine options during breastfeeding.
- Apply topical steroids to small areas of skin and use the lowest effective dose for the shortest duration needed.
- Consider applying stronger steroids after breastfeeding and wiping the area clean before the next feeding if necessary.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The FDA drug label does not answer the question.
From the Research
Safety of Antihistamines and Topical Steroids During Breastfeeding
- Antihistamines are considered safe for use during breastfeeding, as minimal amounts are excreted in breast milk and would not cause any adverse effects on a breastfeeding infant 2.
- First-generation antihistamines are considered safe to use during pregnancy, and all antihistamines are considered safe to use during breastfeeding 2.
- Second-generation antihistamines have been studied and are reassuring, with minimal amounts excreted in breast milk 2.
- Topical corticosteroids are preferred for asthma and rhinitis treatment during pregnancy and breastfeeding, as they are considered safe and effective 3.
- Inhaled therapies, such as topical corticosteroids and beta2-agonists, are preferred over systemic therapies during breastfeeding 3.
Precautions and Considerations
- Breastfeeding mothers should take their medication after breastfeeding, at the lowest effective dose, and for the shortest duration possible 4.
- Mothers taking antihistamines and topical steroids should watch for adverse events in their breastfed infants, such as paradoxical central nervous stimulation and irritability 4.
- Combination products containing antihistamines, decongestants, and other medications should be avoided, as they may contain ingredients that are not compatible with breastfeeding 4.
- The benefits of breastfeeding should be weighed against the potential risks of adverse drug effects in the infant, and the lowest effective maternal dose should be given 5.