Are oral and topical decongestants (such as pseudoephedrine and phenylephrine) safe to use while breastfeeding?

Safety of Oral and Topical Decongestants During Breastfeeding

Phenylephrine is safe to use while breastfeeding due to its poor oral bioavailability (38%), making it unlikely to produce clinical effects in a breastfed infant, while oral decongestants like pseudoephedrine should be avoided as they can decrease milk supply and may pose risks to the infant. 1

Topical Decongestants (Phenylephrine)

• Phenylephrine used topically or in limited oral doses is considered compatible with breastfeeding according to the Association of Anaesthetists guideline 1
• The poor oral bioavailability (38%) means that even if small amounts transfer into breast milk, they are unlikely to affect the breastfed infant 1
• Can be used safely for short-term symptom relief without interrupting breastfeeding

Oral Decongestants (Pseudoephedrine)

• Oral decongestants should generally be avoided during breastfeeding 1
• Pseudoephedrine has been shown to transfer into breast milk in low levels 2
• Important concern: Pseudoephedrine can significantly decrease milk production in nursing mothers 2
• May cause irritability and insomnia in breastfed infants 2

Key Considerations for Breastfeeding Mothers

Medication Administration Guidelines

• If decongestants must be used, take immediately after breastfeeding to minimize infant exposure 2
• Use the lowest effective dose for the shortest duration possible 2
• Avoid combination products containing multiple ingredients 2
• Monitor the infant for potential adverse effects such as irritability, insomnia, or poor feeding 2

Alternative Approaches

• Saline nasal rinses are considered safe and effective first-line therapy during breastfeeding 1
• Topical corticosteroid nasal sprays are generally considered safe for maintenance therapy during breastfeeding 1

Special Considerations

• For mothers with allergic rhinitis, topical nasal corticosteroids are preferred over oral decongestants 1
• First-generation antihistamines should be avoided due to their sedative and anticholinergic properties 1
• The benefits of breastfeeding generally outweigh the minimal risks of carefully selected medications 3

Common Pitfalls to Avoid

• Assuming all decongestants carry the same risk - topical preparations generally have less systemic absorption than oral forms
• Using combination cold/allergy products that may contain multiple ingredients with varying safety profiles
• Stopping breastfeeding unnecessarily when safe alternatives are available
• Failing to monitor for potential effects on milk supply, especially with pseudoephedrine

Remember that while most medications used at appropriate doses are relatively safe during breastfeeding, the dose received via milk is generally small and much less than known safe doses given directly to infants 4. However, when it comes to decongestants, phenylephrine is the safer option while pseudoephedrine should be used with caution due to its potential impact on milk supply.