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 interrupting nursing. 1
Safety Evidence
The European Respiratory Society/Thoracic Society of Australia and New Zealand provides the strongest guideline support for fluticasone use during lactation, based on its minimal systemic absorption profile. 1 This classification reflects extensive clinical experience showing no documented adverse effects in nursing infants despite widespread use. 1
The minimal systemic absorption of intranasal fluticasone creates an even greater safety margin than oral corticosteroids like prednisone (which is considered compatible at doses <20 mg daily without any restrictions). 1 Since intranasal administration results in far less systemic exposure than oral routes, the theoretical risk to the breastfed infant is negligible. 1
Practical Management
Continue fluticasone nasal spray at the lowest dose that effectively controls your patient's allergic rhinitis symptoms. 1 No special precautions are needed:
- 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
The FDA label notes that "it is not known whether fluticasone propionate is excreted in human breast milk," but emphasizes that subcutaneous studies in rats showed measurable radioactivity in milk, recommending caution. 2 However, this animal data should not override the clinical guideline recommendations, as intranasal administration in humans results in substantially lower systemic exposure than the subcutaneous route studied in animals. 1
Alternative Considerations
If medication changes are being considered for other clinical reasons, budesonide and beclomethasone have slightly more published safety data during lactation. 1 However, fluticasone should be continued if it effectively controls symptoms, as switching to less effective treatments poses greater risks from uncontrolled maternal disease than the minimal medication exposure. 1
Critical Pitfall to Avoid
The most important clinical error is discontinuing effective therapy due to unfounded safety concerns. 1 Uncontrolled allergic rhinitis in the mother creates more risk to both mother and infant than the negligible exposure from intranasal fluticasone. 1 The American Academy of Pediatrics emphasizes that most medications women take while breastfeeding are compatible with nursing, and appropriate substitutes exist for the limited number of contraindicated agents. 3
Human milk provides irreplaceable immunologic and nutritional benefits that should not be sacrificed unnecessarily. 3, 4