Is it safe to breastfeed while taking hydroxyzine (antihistamine)?

Hydroxyzine and Breastfeeding

Hydroxyzine should not be given to nursing mothers as it is not known whether this drug is excreted in human milk. 1

Safety Concerns

• Hydroxyzine is specifically mentioned as an anxiolytic antihistamine that should not be prescribed in cases of breastfeeding (professional consensus) 2
• The FDA drug label explicitly states that hydroxyzine should not be given to nursing mothers since many drugs are excreted in human milk and it's unknown if hydroxyzine is among them 1
• Sedating antihistamines like hydroxyzine may cause drowsiness and other side effects that could potentially affect the breastfed infant 3

Considerations for Antihistamines During Breastfeeding

• Most commonly used drugs are relatively safe for breastfed babies, with the dose received via milk generally being small 4
• However, hydroxyzine specifically carries warnings against use during breastfeeding that distinguish it from other antihistamines 1, 2
• Sedating antihistamines as a class raise concerns about reduced concentration and performance in the mother, which could affect infant care 3

Alternative Options

• Non-sedating antihistamines may be preferable if antihistamine therapy is needed during breastfeeding 3
• When antihistamine therapy is necessary during breastfeeding, medications with established safety profiles should be chosen 3
• Loratadine and cetirizine are classified as FDA Pregnancy Category B drugs and may have better safety profiles, though caution is still advised 3

Monitoring Recommendations

• If a mother must take hydroxyzine while breastfeeding (despite recommendations against it), the infant should be closely monitored for:
  • Increased sleepiness 3
  • Poor feeding 3
  • Decreased alertness 3
• Women receiving chronic medications tend to initiate breastfeeding less often and discontinue earlier than the general population 5

Important Considerations

• The benefits of breastfeeding are significant and include nutrition, protection against infectious diseases, and promotion of development and psychological attachment 6
• However, these benefits must be weighed against potential risks of medication exposure 4
• Discussion with the mother about the possibility of negative product information is important to reduce confusion and anxiety 4
• Good resources about medicines and breastfeeding are available, including state-based medicines information services 4

Clinical Decision-Making

• Given the explicit warning in the FDA drug label 1 and professional consensus against using hydroxyzine during breastfeeding 2, alternative medications should be considered
• If antihistamine therapy is necessary, non-sedating options with better established safety profiles during lactation would be preferable 3
• The nursing infant's degree of drug exposure can be minimized by administering mixed nutrition if medication use cannot be avoided 6