Cetirizine Safety in Breastfeeding
Cetirizine is safe to use during breastfeeding and is recommended as a preferred antihistamine choice by the European Respiratory Society. 1
Primary Recommendation
The European Respiratory Society specifically recommends cetirizine (along with loratadine) as preferred antihistamines during breastfeeding because they have been most extensively studied. 1
This guideline-based recommendation takes precedence over the FDA label's conservative "not recommended" statement, which was based on insufficient data at the time of labeling rather than evidence of harm. 2
Supporting Evidence for Safety
The recommendation is strongly supported by recent pharmacokinetic studies demonstrating minimal infant exposure:
The relative infant dose (RID) of cetirizine is approximately 1.77-1.99%, well below the 10% safety threshold used to determine compatibility with breastfeeding. 3, 4
The highest RID observed was only 3.36% at peak maternal concentrations, still well within safe limits. 4
Cetirizine concentrations in breast milk peak at approximately 2.4 hours after maternal intake with a mean half-life of 7.0 hours in milk. 5
No adverse effects have been reported in breastfed infants whose mothers used cetirizine. 3, 5
Important Clinical Considerations
Renal function must be assessed before prescribing:
In moderate renal impairment, reduce the cetirizine dose by 50%. 1
Avoid cetirizine entirely in severe renal impairment. 1
Theoretical concerns about milk production:
While antihistamines theoretically could reduce milk production, this has not been clinically demonstrated with cetirizine. 1
Monitor milk supply in mothers using cetirizine, particularly if they have borderline milk production.
Practical Prescribing Approach
Use standard adult dosing (10 mg daily) in breastfeeding women with normal renal function. 1, 5
Advise mothers to take cetirizine immediately after breastfeeding to minimize infant exposure at the next feeding. 6
Avoid combination products containing multiple active ingredients; use cetirizine as a single agent. 6