Flonase (Fluticasone) is Safe During Breastfeeding
Fluticasone nasal spray is explicitly classified as "probably safe" and "compatible" with breastfeeding and should be continued at the lowest effective dose without any need to interrupt nursing. 1
Why Fluticasone is Safe
The safety of fluticasone during breastfeeding is based on its pharmacologic properties:
- Minimal systemic absorption occurs with intranasal administration, resulting in extremely low amounts potentially transferred to breast milk 1, 2
- Modern nasal corticosteroids including fluticasone have been used extensively during breastfeeding without documented adverse effects in nursing infants 1
- The European Respiratory Society/Thoracic Society of Australia and New Zealand provides the highest-level guideline support for its safety 1
Practical Management
Continue fluticasone without modification to your breastfeeding routine:
- No need to pump and discard breast milk 1
- No need to time doses around feeding schedules 1
- No need to discontinue or interrupt breastfeeding 1
- Use the lowest effective dose that controls your symptoms 1
Context: Intranasal vs. Systemic Corticosteroids
Understanding the safety margin helps put this in perspective:
- Intranasal fluticasone has far less systemic absorption than oral corticosteroids, making its safety margin even greater 1
- For comparison, oral prednisone ≤20 mg daily is considered compatible with breastfeeding without any restrictions 1
- Since intranasal fluticasone achieves negligible systemic levels compared to oral prednisone, the infant exposure is essentially insignificant 1
Alternative Considerations
If you're considering switching medications (though this is unnecessary):
- Budesonide and beclomethasone have slightly more published safety data during lactation 1
- However, fluticasone should be continued if it effectively controls your symptoms rather than switching to potentially less effective alternatives 1
- Inhaled and nasal treatments for allergic rhinitis are unlikely to affect breastfed infants 3
Critical Pitfall to Avoid
The most important consideration: uncontrolled maternal allergic rhinitis poses greater risks than the minimal medication exposure from fluticasone. 1
- Do not switch to less effective treatments if fluticasone adequately controls your symptoms 1
- Undertreated maternal disease can impact your quality of life and ability to care for your infant, which outweighs the negligible theoretical risk from intranasal corticosteroid exposure 4