Flonase (Fluticasone) During Breastfeeding
Fluticasone nasal spray is compatible with breastfeeding and can be safely used by nursing mothers. 1
Safety Profile
Intranasal corticosteroids like fluticasone have minimal systemic absorption and pose negligible risk to breastfed infants. 1 The European Respiratory Society/Thoracic Society of Australia and New Zealand explicitly classifies fluticasone nasal spray as "probably safe" and "compatible" with breastfeeding. 1
Key Evidence Supporting Safety
Minimal systemic exposure: Inhaled and nasal corticosteroid treatments are unlikely to affect breastfed infants due to their route of administration and limited systemic absorption. 2
Low milk transfer: While the FDA label notes that it is unknown whether fluticasone propionate is excreted in human breast milk, other corticosteroids detected in milk appear in very small amounts. 3 The dose received by infants via milk is generally much less than known safe doses given directly to infants. 4
Established clinical use: Fluticasone has been used extensively during breastfeeding without documented adverse effects in nursing infants. 1
Practical Recommendations
Continue fluticasone nasal spray at the lowest effective dose that controls your symptoms. 1 There is no need to:
Comparison with Other Corticosteroids
If you were already using another intranasal corticosteroid before breastfeeding and it effectively controls your symptoms, you can continue that medication. 1 However, budesonide and beclomethasone have slightly more safety data during lactation if a change is being considered. 1
Systemic Corticosteroids During Breastfeeding
For context, even systemic corticosteroids are considered compatible with breastfeeding at lower doses:
- Prednisone <20 mg daily is compatible with breastfeeding without restrictions. 1
- Prednisone ≥20 mg daily requires delaying breastfeeding 3-4 hours after the dose to minimize milk transfer. 1
Since intranasal fluticasone has far less systemic absorption than oral prednisone, the safety margin is even greater. 1
Common Pitfalls to Avoid
Do not unnecessarily discontinue breastfeeding due to unfounded concerns about intranasal corticosteroid use—the benefits of continued breastfeeding far outweigh the minimal theoretical drug exposure. 2, 4
Do not rely on outdated product labeling that may contain overly cautious warnings not supported by clinical evidence. 3, 2 The FDA label's cautionary language reflects lack of controlled studies rather than evidence of harm. 3
Do not switch to less effective treatments when fluticasone adequately controls your allergic rhinitis symptoms, as uncontrolled maternal disease poses greater risks than minimal medication exposure. 1, 2