Is Tamiflu (oseltamivir) safe to use during breastfeeding?

Tamiflu (Oseltamivir) Safety During Breastfeeding

Oseltamivir is safe to use during breastfeeding and is not a reason to discontinue nursing. 1, 2

Primary Recommendation

If a breastfeeding mother requires antiviral treatment for influenza, oral oseltamivir is the preferred agent. 1, 2 The American Academy of Pediatrics explicitly states that none of the influenza antiviral agents, including oseltamivir, are reasons to discontinue breastfeeding. 1

Evidence Supporting Safety

• Oseltamivir and its active metabolite (oseltamivir carboxylate) are present in human milk at low levels that are unlikely to cause toxicity in breastfed infants. 3 The FDA drug label confirms this based on published data.

• Postmarketing surveillance has not identified any serious adverse effects in breastfed infants exposed to oseltamivir through breast milk. 3

• The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for treatment. 3 Given that pregnant and postpartum women are at higher risk for severe influenza complications, treating the mother effectively is critical. 3

Dosing for Breastfeeding Mothers

• Treatment dose: 75 mg orally twice daily for 5 days 1, 2

• Prophylaxis dose: 75 mg orally once daily for 10 days after exposure 1, 2

• Administer with food to improve gastrointestinal tolerability, though it can be taken without regard to meals. 1, 2

Renal Dosing Adjustments

For mothers with renal insufficiency (creatinine clearance 10-30 mL/min):

• Treatment: 75 mg once daily for 5 days 1, 2
• Prophylaxis: 30 mg once daily for 10 days 1, 2

Infant Monitoring

• Monitor the breastfed infant for unusual symptoms or changes in feeding patterns, though adverse effects are not expected at standard maternal doses in full-term, healthy infants. 2

• The most common maternal side effects are gastrointestinal (nausea, vomiting), which are mild and transient. 4 These do not affect the infant through breast milk.

Clinical Context

Early initiation of oseltamivir treatment (within 48 hours of symptom onset) provides the greatest clinical benefit in reducing symptom severity and duration. 2 This is particularly important for breastfeeding mothers, as untreated influenza poses greater risks to both mother and infant than the minimal drug exposure through breast milk.

Common Pitfalls to Avoid

• Do not advise mothers to "pump and dump" or temporarily discontinue breastfeeding while taking oseltamivir—this is unnecessary and potentially harmful to both mother and infant. 1, 2

• Do not withhold treatment from breastfeeding mothers due to unfounded concerns about infant exposure—the benefits of treating maternal influenza far outweigh theoretical risks. 3

• Do not confuse treatment dosing (twice daily) with prophylaxis dosing (once daily) when prescribing for household contacts. 1, 2