Are vertigo medications, such as meclizine (antihistamine) or dimenhydrinate (antihistamine), safe to use during breastfeeding?

Safety of Vertigo Medications During Breastfeeding

Meclizine and dimenhydrinate (both antihistamines) should be used with caution during breastfeeding, with meclizine being preferred when necessary due to its more favorable safety profile.

Meclizine During Breastfeeding

• According to the FDA drug label, there are no data on the presence of meclizine in human milk, the effects on the breastfed infant, or the effects on milk production 1
• The FDA recommends considering the developmental and health benefits of breastfeeding along with the mother's clinical need for meclizine and any potential adverse effects on the breastfed infant 1
• Meclizine may cause drowsiness, which should be considered when prescribing to breastfeeding mothers 1

Dimenhydrinate During Breastfeeding

• The FDA drug label states that small amounts of dimenhydrinate are excreted in breast milk 2
• Because of the potential for adverse reactions in nursing infants from dimenhydrinate, the FDA recommends that a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother 2
• Dimenhydrinate poses a potentially higher risk than meclizine for breastfeeding infants due to its documented excretion into breast milk 2

Monitoring Recommendations

• When using either medication during breastfeeding, monitor the infant for:
  • Unusual drowsiness 1
  • Poor feeding 3
  • Irritability 3
  • Dry mouth 1

Alternative Approaches for Vertigo Management

• Non-pharmacological approaches should be considered first-line when possible for breastfeeding mothers 4
• If medication is necessary, consider using the lowest effective dose for the shortest duration 3
• For mild vertigo symptoms, physical therapy techniques may be beneficial before resorting to medication 4

General Principles for Medication Use During Breastfeeding

• Most medications with short half-lives and poor oral bioavailability pose minimal risk to breastfed infants 3
• Timing medication administration immediately after breastfeeding can minimize infant exposure 3
• Single doses of medications generally pose less risk than chronic use 3

Alternative Medications for Vertigo

• If antihistamines must be avoided, consider medications with established safety profiles during breastfeeding:
  • Paracetamol (acetaminophen) is considered the safest first-line medication during breastfeeding 5
  • NSAIDs like ibuprofen are generally considered safe during breastfeeding for short-term use 5
  • For migraine-associated vertigo, sumatriptan has minimal transfer into breast milk and no reported adverse effects in breastfed infants 5

Important Considerations

• The risk-benefit assessment should weigh the mother's need for symptom relief against potential risks to the infant 1, 2
• Multimodal analgesia with non-opioid drugs should be encouraged when possible, as paracetamol and NSAIDs are compatible with breastfeeding 3
• Day treatment is preferable for breastfeeding women when possible 3