Are antiviral (antiviral) medications safe during breastfeeding?

From the Guidelines

Breastfeeding mothers can safely use antiviral medications, such as oseltamivir, while nursing, as the benefits of treating the maternal infection outweigh the potential risks to the infant. According to the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP), oseltamivir is the preferred antiviral agent for treatment and chemoprophylaxis of influenza in breastfeeding mothers 1. The medication is administered orally, and its use is recommended for breastfeeding women, as it does not pose a significant risk to the nursing infant. In fact, the CDC states that "none of the antiviral agents are reasons to discontinue breastfeeding" 1.

Key considerations for antiviral use during breastfeeding include:

• The molecular size, protein binding, and oral bioavailability of the medication, which determine how much transfers into breast milk
• The specific antiviral medication being used, as some may be safer than others during lactation
• The benefits of treating the maternal infection, which often outweigh potential risks to the infant
• Monitoring the baby for potential side effects, as some antiviral medications may pass into breast milk in small amounts

It is essential for breastfeeding mothers to inform their healthcare provider about their nursing status before starting any antiviral medication, as they may need to adjust the treatment plan or monitor the baby for potential side effects 1. Overall, the use of antiviral medications, such as oseltamivir, is considered safe during breastfeeding, and the benefits of treating the maternal infection outweigh the potential risks to the infant.

From the FDA Drug Label

Based on limited published data, oseltamivir and oseltamivir carboxylate have been shown to be present in human milk at low levels considered unlikely to lead to toxicity in the breastfed infant. Postmarketing experience has not reported any information to suggest serious adverse effects of oseltamivir exposure via breast milk in infants The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for oseltamivir phosphate and any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition.

Antiviral medications, specifically oseltamivir, are considered safe during breastfeeding. The drug is present in human milk at low levels, and there have been no reports of serious adverse effects in breastfed infants. However, the decision to use oseltamivir during breastfeeding should be made considering the mother's clinical need and potential risks to the infant 2.

• Key points:
  • Low levels of oseltamivir in human milk
  • No reported serious adverse effects in breastfed infants
  • Consider mother's clinical need and potential risks to infant

From the Research

Safety of Antiviral Medications during Breastfeeding

• The safety of antiviral medications during breastfeeding is a concern for many mothers and healthcare providers 3, 4, 5.
• Most medications, including antivirals, should have no effect on milk supply or infant well-being, and treatment plans should include encouragement to continue breastfeeding 3.
• When considering the use of antiviral medications during breastfeeding, healthcare providers should consult reliable sources and take a cautious approach to minimize potential risks to the infant 3, 5.
• The majority of recommendations from health authorities do not regard treatment with oseltamivir, an antiviral medication, as a contraindication to breastfeeding 5.

Guidelines for Healthcare Providers

• Determine if medication is necessary and choose the safest drug available 3.
• Consult with the infant's pediatrician and advise the mother to take the medication just after breastfeeding or before the infant's longest sleep period 3.
• If there is a possibility that a drug may risk the health of the infant, arrange for monitoring of serum drug levels in the infant 3.
• Healthcare providers should have a positive attitude towards the use of medications during breastfeeding and assess the latest evidence and risk-benefit ratio before advising to interrupt breastfeeding 6.

Specific Antiviral Medications

• Oseltamivir is an antiviral medication that has been studied in the context of breastfeeding, and most recommendations suggest that it is safe to use during breastfeeding 4, 5.
• Zanamivir is another antiviral medication that has been used to treat influenza, but there is limited data on its use during pregnancy and lactation 4.
• Neuraminidase inhibitors, such as oseltamivir and zanamivir, have been shown to be effective in reducing the risk of complications among pregnant women and attenuating the teratogenic effects of influenza infection 7.