Oseltamivir Safety During Breastfeeding
Oseltamivir (Tamiflu) is safe for use in breastfeeding women, and breastfeeding should not be discontinued during treatment. 1
Safety Profile in Breastfeeding
- Oseltamivir and its active metabolite (oseltamivir carboxylate) are present in breast milk but at concentrations significantly lower than therapeutic doses for infants 2
- The FDA drug label confirms that postmarketing experience has not reported any serious adverse effects in infants exposed to oseltamivir through breast milk 3
- If a breastfeeding mother requires antiviral treatment for influenza, oral oseltamivir is the preferred agent 1
- None of the influenza antiviral agents, including oseltamivir, are reasons to discontinue breastfeeding 1
Pharmacokinetics in Breastfeeding Women
- Oseltamivir appears in breast milk later and at lower concentrations than in maternal plasma 2
- The active metabolite (oseltamivir carboxylate) is present in breast milk but at concentrations significantly lower than what would be considered therapeutic for infants 2
- Oseltamivir has simple, uncomplicated pharmacology with limited potential for drug-drug interactions, making it suitable for diverse patient populations 4, 5
Dosing Recommendations
- Standard adult dosing for treatment is 75 mg twice daily for 5 days 1
- For prophylaxis, the standard adult dose is 75 mg once daily for 10 days after exposure 1
- Dosage adjustment is required in patients with renal insufficiency (creatinine clearance 10-30 mL/min): 75 mg once daily for treatment or 30 mg once daily for prophylaxis 1
- Administration with food may improve gastrointestinal tolerability 1
Clinical Considerations
- Pregnant and postpartum women are at increased risk for complications from influenza, making prompt treatment important 6
- The benefits of treating maternal influenza with oseltamivir generally outweigh the theoretical risks of medication exposure through breast milk 7, 6
- Early initiation of treatment provides greater clinical benefits in reducing severity and duration of symptoms 1, 8
- The most common adverse effects are nausea and vomiting, which can be reduced by taking oseltamivir after a light snack 8, 5
Monitoring Recommendations
- Monitor the infant for unusual symptoms or changes in feeding patterns 7
- The safety profile assumes full-term, healthy infants and standard recommended medication doses 7
- Continue to support breastfeeding even during maternal oseltamivir treatment, as breastfeeding provides important immune protection to infants 7
In conclusion, oseltamivir is considered safe during breastfeeding, with minimal infant exposure through breast milk. Treatment of maternal influenza should not be delayed, and breastfeeding should be continued during therapy.