Is Flonase (fluticasone) safe during breastfeeding?

Fluticasone (Flonase) Safety During Breastfeeding

Fluticasone (Flonase) is considered safe to use during breastfeeding as there is minimal systemic absorption and negligible transfer into breast milk. 1

Safety Profile

• The FDA drug label for fluticasone notes that "it is not known whether fluticasone propionate is excreted in human breast milk," but also states that "other corticosteroids have been detected in human milk" 1
• Intranasal corticosteroids like fluticasone have minimal systemic absorption, making the amount potentially transferred to breast milk extremely low 2
• Modern nasal corticosteroids including fluticasone are considered safe to use for maintenance during pregnancy and, by extension, during breastfeeding at recommended doses 2

Clinical Considerations

• The amount of medication that would potentially reach an infant through breast milk is significantly less than therapeutic doses given directly to infants 3
• Most commonly used drugs, including corticosteroids, are relatively safe for breastfed babies due to the small dose received via milk 3
• Intranasal administration results in limited systemic absorption compared to oral or injectable routes, further reducing potential infant exposure 2

Recommendations for Use

• Continue using prescribed intranasal corticosteroids during breastfeeding without interruption 2
• Use the lowest effective dose that controls symptoms to minimize any potential systemic effects 1
• No need to time breastfeeding sessions around medication administration due to minimal systemic absorption 2

Important Caveats

• Off-label use of budesonide irrigations or corticosteroid nasal drops is not recommended during breastfeeding (different from standard nasal spray) 2
• Monitor the infant for any unusual symptoms, although adverse effects are extremely unlikely due to minimal transfer 3
• If concerned about potential effects, consult with the infant's pediatrician, but reassure that intranasal corticosteroids are generally considered compatible with breastfeeding 2

General Principles of Medication Use While Breastfeeding

• Most medications can be used safely during breastfeeding at recommended doses, with few exceptions 4
• The benefits of treating maternal symptoms often outweigh the theoretical minimal risks to the breastfed infant 3
• Topical medications like nasal sprays have significantly less systemic absorption and transfer to breast milk compared to oral medications 2