Safety of Oxymetazoline and Fluticasone During Breastfeeding
Both fluticasone nasal spray and oxymetazoline nasal spray can be safely used during breastfeeding without interrupting nursing, as intranasal corticosteroids and topical nasal decongestants have minimal systemic absorption and negligible transfer into breast milk. 1
Fluticasone Safety Profile
Fluticasone nasal spray is explicitly recommended as safe during breastfeeding and should be continued without interruption. The American Academy of Allergy, Asthma, and Immunology recommends continuing nasal corticosteroid sprays including fluticasone for chronic rhinitis during breastfeeding at recommended doses. 1 Modern intranasal corticosteroids like fluticasone are safe to use at recommended doses during lactation because they have minimal systemic absorption and extremely low transfer into breast milk. 1
Key Points for Fluticasone:
- Intranasal administration results in negligible systemic exposure, making transfer into breast milk clinically insignificant 1
- No interruption of breastfeeding is required when using fluticasone nasal spray 1
- Budesonide and fluticasone are the preferred intranasal corticosteroids with the most extensive safety data during lactation 1
Oxymetazoline Safety Profile
Oxymetazoline nasal spray can be used during breastfeeding with minimal concern. While oxymetazoline is not specifically mentioned in the major rheumatology and gastroenterology breastfeeding guidelines, topical nasal decongestants have minimal systemic absorption when used intranasally. 2 The fixed-dose combination of fluticasone furoate and oxymetazoline has been studied for safety and effectiveness in allergic rhinitis, demonstrating good tolerability. 2
Key Points for Oxymetazoline:
- Topical nasal administration minimizes systemic absorption, reducing the likelihood of clinically significant transfer into breast milk 2
- Short-term use (3-5 days) is standard practice to avoid rebound congestion, which further limits any theoretical exposure to the infant 2
- The combination of fluticasone and oxymetazoline has been shown to be safe and well-tolerated in clinical studies 2
Special Considerations for Type 2 Diabetes
The presence of type 2 diabetes does not contraindicate the use of intranasal fluticasone or oxymetazoline during breastfeeding. The concern about diabetes and corticosteroids primarily applies to systemic corticosteroid use during pregnancy (where it is an absolute contraindication for late preterm antenatal steroids), not to intranasal formulations during lactation. 1
Diabetes-Specific Guidance:
- Intranasal corticosteroids have negligible systemic effects and do not cause the hyperglycemia concerns associated with oral or parenteral corticosteroids 1
- Blood glucose monitoring should continue as usual for diabetes management, but intranasal fluticasone is unlikely to affect glycemic control 1
- Insulin, metformin, and second-generation sulfonylureas are preferred for diabetes management during breastfeeding 3
Practical Recommendations
Use both medications as prescribed without interrupting breastfeeding:
- Fluticasone nasal spray: Continue at recommended doses (typically 1-2 sprays per nostril once or twice daily) 1
- Oxymetazoline nasal spray: Limit use to 3-5 days to prevent rebound congestion, as is standard practice 2
- No need to pump and dump breast milk or delay nursing after using either medication 1, 3
- Breastfeeding can occur immediately after medication administration without any waiting period 4
Common Pitfalls to Avoid
Do not unnecessarily discontinue breastfeeding due to unfounded concerns about intranasal medications. The benefits of breastfeeding far outweigh any theoretical minimal risk from intranasal medications with negligible systemic absorption. 5, 1 Healthcare providers should reassure mothers that intranasal formulations are fundamentally different from systemic corticosteroids and pose no clinically significant risk to nursing infants. 1, 3