From the Guidelines
Loratadine and cetirizine are the preferred antihistamines for use during breastfeeding due to their minimal transfer into breast milk and low risk of sedation. These second-generation antihistamines have been most commonly used and are considered safe for breastfeeding mothers 1. The recommended dose for loratadine is 10mg once daily, while cetirizine is typically taken as 5-10mg once daily.
- Key considerations for antihistamine use during breastfeeding include:
- Minimal transfer into breast milk
- Low risk of sedation for both mother and infant
- Minimal impact on milk production
- First-generation antihistamines like diphenhydramine should be used with caution, as they may cause sedation in the infant or decrease milk supply 1.
- It is essential to take antihistamines after breastfeeding to minimize the amount in milk when the baby feeds next.
- The choice of antihistamine should be based on the medication's pharmacokinetic properties and its limited passage into breast milk, as well as the mother's individual needs and medical history 1.
From the FDA Drug Label
If pregnant or breast-feeding: if breast-feeding: not recommended The FDA drug label does not answer the question.
From the Research
Antihistamines Safe for Use During Breastfeeding
- The following antihistamines are considered safe to use during breastfeeding:
- Loratadine: Studies have shown that low levels of loratadine are excreted in breast milk, with a relative infant dose of 0.010% of the administered dose 2
- Triprolidine: Considered compatible with breastfeeding by the AAP, with low levels of the drug reaching the breastfed infant 3
- Pseudoephedrine: Also considered compatible with breastfeeding by the AAP, with low levels of the drug reaching the breastfed infant 3
- Cetirizine, clemastine, ebastine, epinastine, and terfenadine: These antihistamines have been studied in human lactation, with relative infant doses below 5% 4
- It is essential to note that while these antihistamines are considered safe, breastfeeding mothers should take their medication after breastfeeding, at the lowest effective dose, and for the shortest duration to minimize exposure to the infant 3
- Additionally, mothers taking antihistamines should watch for adverse events in their breastfed infants, such as paradoxical central nervous stimulation from antihistamines and irritability and insomnia from decongestants 3
General Guidelines for Antihistamine Use During Breastfeeding
- All antihistamines are considered safe to use during breastfeeding, as minimal amounts are excreted in breast milk and would not cause any adverse effects on a breastfeeding infant 5
- However, the knowledge gap on antihistamines and lactation is extensive, and further human studies are warranted to ensure optimal treatment of breastfeeding women with allergy 4
- Breastfeeding mothers should be aware of the potential adverse reactions that may occur in infants whose mothers require antihistamines, and should only take medications that are necessary, avoiding combination products whenever possible 3, 6