Breastfeeding While Taking Tamiflu for Influenza
Yes, mothers with influenza taking Tamiflu (oseltamivir) should absolutely continue breastfeeding—oseltamivir is the preferred antiviral for breastfeeding mothers and is not a reason to discontinue nursing. 1, 2
Primary Recommendation
Oseltamivir is explicitly recommended as the preferred antiviral agent for breastfeeding mothers with influenza, and breastfeeding should not be interrupted during treatment. 2, 3 The American Academy of Pediatrics clearly states that none of the influenza antiviral agents, including oseltamivir, are reasons to discontinue breastfeeding. 2
Safety Profile and Drug Excretion
- Oseltamivir and its active metabolite (oseltamivir carboxylate) are present in human milk at low levels that are considered unlikely to cause toxicity in breastfed infants. 4
- Postmarketing surveillance has not identified any serious adverse effects in infants exposed to oseltamivir through breast milk. 4
- The FDA label explicitly supports that oseltamivir levels in breast milk pose minimal risk to nursing infants. 4
Treatment Dosing
- The standard treatment dose is oseltamivir 75 mg twice daily for 5 days, with breastfeeding continuing without interruption throughout the treatment course. 1, 2
- Treatment should ideally be initiated within 48 hours of symptom onset for maximum benefit, though later initiation can still provide clinical benefit. 2
Protective Benefits of Continued Breastfeeding
Breastfeeding during maternal influenza provides critical protective benefits to the infant that should not be sacrificed:
- Breast milk activates innate antiviral mechanisms in infants, specifically type 1 interferons, which help protect against influenza viruses. 5, 1, 2
- Maternal vaccination during the third trimester results in higher levels of influenza-specific immunoglobulin A in breast milk. 5, 2
- Greater exclusivity of breastfeeding in the first 6 months decreases episodes of respiratory illness with fever in infants of vaccinated mothers. 5
- There is no evidence of influenza viral transmission through breast milk itself. 1
Practical Management During Active Maternal Infection
When the mother has active influenza symptoms, implement these infection control measures while continuing to breastfeed:
- Practice hand hygiene before every feeding. 1
- Wear a surgical mask while breastfeeding to minimize droplet exposure to the infant. 1
- If the mother or infant is too ill for direct breastfeeding, pump and feed expressed breast milk. 5, 1
- Direct breastfeeding should be encouraged even with confirmed maternal influenza unless illness severity prevents it. 5, 2
Critical Clinical Pitfalls to Avoid
Never advise discontinuation of breastfeeding due to maternal oseltamivir use—this is explicitly contraindicated by AAP guidelines. 2
- Do not withhold oseltamivir treatment from breastfeeding mothers due to concerns about infant exposure through breast milk. 2
- Do not delay treatment while determining breastfeeding status—the benefits of treating maternal influenza outweigh any theoretical risks to the nursing infant. 2
- Oseltamivir is FDA-approved for treatment in infants as young as 2 weeks of age, further supporting its safety profile in the breastfeeding context. 2, 4
Alternative Antiviral Considerations
Baloxavir is NOT recommended for breastfeeding mothers due to lack of safety data on its presence in breast milk, effects on breastfed infants, or effects on milk production. 5, 1 This makes oseltamivir the clear first-line choice for nursing mothers with influenza.