Histex DM Safety in Breastfeeding
Histex DM should be used with caution during breastfeeding, with pseudoephedrine and brompheniramine being relatively acceptable for short-term use, though pseudoephedrine may reduce milk supply and both components can cause infant irritability.
Component-Specific Safety Profile
Pseudoephedrine (Decongestant Component)
- Pseudoephedrine is considered compatible with breastfeeding based on evidence showing low levels reach breastfed infants 1
- The Association of Anaesthetists notes that pseudoephedrine on an acute basis is not likely to harm a breastfeeding infant due to poor oral bioavailability of 38% 2
- Critical caveat: Pseudoephedrine may significantly reduce milk supply, which is a major concern for lactating mothers 1
- Infants may experience irritability and insomnia from decongestant exposure 1
Brompheniramine (Antihistamine Component)
- First-generation antihistamines like brompheniramine are considered safe during breastfeeding, as minimal amounts are excreted in breast milk 3
- All antihistamines are considered safe to use during breastfeeding and would not cause adverse effects on breastfeeding infants 3
- However, infants may experience paradoxical central nervous system stimulation from antihistamines 1
Practical Recommendations for Use
Dosing Strategy
- Take medication immediately after breastfeeding to minimize infant exposure at peak maternal drug concentrations 1, 4
- Use the lowest effective dose for the shortest duration necessary 1
- Avoid combination products when possible; use single-ingredient medications targeting specific symptoms 1
Monitoring Requirements
- Watch for infant irritability, insomnia, or paradoxical CNS stimulation 1
- Monitor milk supply closely, as pseudoephedrine can reduce production 1
- Observe for feeding problems or changes in infant behavior 1
Preferred Alternatives
- Triprolidine combined with pseudoephedrine is specifically recommended as a first-line choice by the American Academy of Pediatrics for cough/cold symptoms during breastfeeding 1
- Consider single-ingredient products rather than combination formulations 1
- For cough suppression specifically, codeine is considered compatible with breastfeeding for short-term use 1
Important Caveats
The milk supply reduction risk with pseudoephedrine is the most significant concern and may outweigh benefits if the mother is struggling with lactation 1. This is particularly important for mothers who are already experiencing low milk supply or have infants who are exclusively breastfed.
Premature or compromised infants may require altered maternal dosing to avoid drug accumulation and toxicity 4.
Avoid products containing alcohol, as many liquid cough and cold preparations contain significant alcohol content 1.