Hydroxyzine Use During Breastfeeding
Hydroxyzine should be avoided during breastfeeding and safer alternative antihistamines should be used instead. While data on hydroxyzine specifically during lactation are limited, this medication has been implicated in adverse drug reactions in breastfed infants and safer alternatives with better-established safety profiles are readily available.
Evidence Against Hydroxyzine Use
Hydroxyzine is specifically contraindicated during early pregnancy based on animal data showing it induced fetal abnormalities in rats and mice at doses substantially above the human therapeutic range, and this same concern extends to the breastfeeding period where caution is warranted 1, 2.
A French pharmacovigilance study identified hydroxyzine among drugs implicated in adverse drug reactions in breastfed infants, demonstrating that this medication—previously thought to be relatively benign—can cause adverse effects when transmitted through breast milk 3.
The sedating properties of hydroxyzine increase the risk of infant drowsiness and poor feeding, which are concerning adverse effects in breastfed newborns 4.
Recommended Safer Alternatives
Cetirizine is the preferred alternative, as it is the active metabolite of hydroxyzine but has a well-established safety record during breastfeeding:
Cetirizine and loratadine are considered safe during breastfeeding with excellent safety profiles confirmed through large registries and studies 2, 5.
All antihistamines are generally considered safe during breastfeeding as minimal amounts are excreted in breast milk, but cetirizine specifically has more robust safety data than hydroxyzine 5.
First-generation antihistamines like chlorpheniramine also have long safety records during breastfeeding, though they cause more sedation 1, 6.
Monitoring Recommendations
If any antihistamine must be used during breastfeeding:
Advise the mother to observe the infant for signs of drowsiness and poor feeding, and to contact a medical professional if these occur 4.
Instruct mothers to take medication immediately after breastfeeding to minimize infant exposure, using the lowest effective dose for the shortest duration 6.
Timing medication after breastfeeding allows maximum time for drug clearance before the next feeding 6.
Common Pitfalls to Avoid
Do not assume hydroxyzine is safe simply because it is an antihistamine—it has specific safety concerns that distinguish it from other agents in this class 3.
Avoid combination products containing multiple active ingredients (antihistamines plus decongestants, analgesics, or alcohol), as these increase complexity and potential for adverse effects 6.
Do not use pseudoephedrine or other oral decongestants during breastfeeding, as these have been implicated in adverse reactions and can reduce milk production 3, 6.