Is Phenergan (promethazine) safe to use while breastfeeding?

Promethazine (Phenergan) Use During Breastfeeding

Promethazine (Phenergan) is generally not recommended during breastfeeding due to potential risks to the infant and safer alternatives being available. 1

Safety Profile

• The FDA drug label indicates that it is not known whether promethazine is excreted in human milk, and recommends that a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother 2

• Promethazine belongs to the phenothiazine class of medications, which can:

  • Potentially cause sedation in breastfed infants
  • Inhibit platelet aggregation in newborns if administered within two weeks of delivery 2
  • Have anticholinergic properties that may affect milk production

Safer Alternatives

For mothers requiring antiemetic therapy while breastfeeding, several safer options exist:

• Prochlorperazine: Has low oral bioavailability due to high first-pass metabolism and is compatible with breastfeeding 1

• Metoclopramide: Can be used in lactating women and may actually increase milk supply as it acts as a galactagogue 1

• Ondansetron: While there are limited studies on transfer into breast milk, it is likely to have low transfer 1

• Domperidone: When taken orally, levels in milk are low due to first-pass hepatic and intestinal metabolism; may increase milk supply 1

Clinical Decision Making

When considering promethazine use in a breastfeeding mother:

1. Evaluate necessity: Determine if the medication is absolutely necessary or if symptoms can be managed with non-pharmacological approaches

2. Consider infant factors:

   • Extra caution with infants less than 6 weeks of age due to immature hepatic and renal function 3
   • Older infants (>6 months) have more mature metabolism and lower risk for adverse effects 3

3. Timing considerations: If promethazine must be used:

   • Take immediately after breastfeeding to maximize clearance time before next feeding
   • Use the lowest effective dose for the shortest duration possible 3

Key Considerations

• The benefits of breastfeeding generally outweigh minimal medication exposure risks, but safer alternatives to promethazine should be prioritized 3

• Most medications have not been shown to cause adverse effects during lactation, and temporary interruption of breastfeeding can be difficult for the nursing dyad 4

• Risk assessment should consider not only the drug's potential risk but also the benefits of breastfeeding, risks of untreated maternal conditions, and maternal willingness to breastfeed 5

Bottom Line

For antiemetic needs during breastfeeding, alternatives like prochlorperazine, metoclopramide, or ondansetron are preferable to promethazine. If promethazine must be used, minimize exposure by using the lowest effective dose for the shortest duration and timing administration to minimize infant exposure.