Is it safe for a lactating woman to take Tamiflu (oseltamivir) for influenza treatment or prophylaxis?

Oseltamivir (Tamiflu) is Safe During Breastfeeding

Oseltamivir is safe for use in breastfeeding women, and breastfeeding should not be discontinued during treatment. 1

Primary Recommendation

• The American Academy of Pediatrics explicitly recommends that oseltamivir is safe for breastfeeding mothers, and none of the influenza antiviral agents, including oseltamivir, are reasons to discontinue breastfeeding. 1

• If a breastfeeding mother requires antiviral treatment for influenza, oral oseltamivir is the preferred agent. 1

Standard Dosing for Lactating Women

• 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

• Taking oseltamivir with food may improve gastrointestinal tolerability (nausea and vomiting are the most common side effects). 1, 2

Renal Impairment Considerations

• If the mother has renal insufficiency (creatinine clearance 10-30 mL/min), adjust dosing to 75 mg once daily for treatment or 30 mg once daily for prophylaxis. 1

Infant Monitoring

• Monitor the breastfed infant for unusual symptoms or changes in feeding patterns, assuming the infant is full-term and healthy. 1

• Importantly, oseltamivir is FDA-approved for treatment in infants as young as 2 weeks of age, and the American Academy of Pediatrics supports its use from birth, including in preterm infants. 3, 2 This underscores the safety profile even if small amounts transfer through breast milk.

Clinical Context: Why Treatment Matters

• Early initiation of oseltamivir provides greater clinical benefits in reducing severity and duration of influenza symptoms. 1

• Pregnant and postpartum women (up to 2 weeks after delivery) are at high risk for serious influenza complications, making treatment particularly important. 2, 4

• Treatment should be initiated as soon as possible, ideally within 48 hours of symptom onset, but should not be withheld even if presenting beyond 48 hours, especially in high-risk patients. 2

Common Pitfall to Avoid

• Do not delay treatment while waiting for laboratory confirmation during influenza season—clinical judgment is sufficient to initiate therapy in breastfeeding women with suspected influenza. 2

• Do not discontinue breastfeeding due to oseltamivir use or maternal influenza infection. 1