What antihistamine (anti-allergic medication) is safe for a breastfeeding woman to use?

Antihistamines Safe for Breastfeeding

Loratadine and cetirizine are the preferred antihistamines for breastfeeding women, with loratadine being the most extensively studied and safest option. 1

Primary Recommendations

The ERS/TSANZ Task Force explicitly recommends loratadine or cetirizine as preferred antihistamines during breastfeeding because they have been most extensively used and studied. 1 These second-generation antihistamines are classified as "compatible" with breastfeeding in international guidelines. 1

Loratadine - First Choice

• Only 0.029% of the maternal dose transfers into breast milk as loratadine and its active metabolite combined 2
• A breastfed infant would receive only 0.46% of the weight-adjusted maternal dose 2
• Milk concentrations parallel plasma levels, with peak milk concentration of 29.2 ng/mL occurring 0-2 hours after maternal dosing 2
• Considered safe by multiple guideline organizations 1, 3

Cetirizine - Alternative Option

• Listed as compatible with breastfeeding in respiratory disease guidelines 1
• However, the FDA label states "not recommended" during breastfeeding 4, creating a discrepancy with international guidelines that favor it as a preferred option 1
• Despite FDA labeling, international respiratory societies recommend it alongside loratadine 1

First-Generation Antihistamines

Triprolidine combined with pseudoephedrine is considered compatible with breastfeeding by the American Academy of Pediatrics and should be a first-line choice if second-generation agents are unavailable. 3 First-generation antihistamines transfer into breast milk at low levels and are considered safe. 3, 5

Important Caveats

• All antihistamines may theoretically reduce milk production, though this is not well-documented 1
• Infants may experience paradoxical CNS stimulation from antihistamines 3
• Avoid combination products containing unnecessary ingredients like alcohol, aspirin, or multiple active ingredients 3

Practical Guidance

Take antihistamines immediately after breastfeeding to minimize infant exposure at peak milk concentrations. 6 Use the lowest effective dose for the shortest duration needed. 6

Monitoring

• Watch for irritability, drowsiness, or paradoxical excitation in the infant 3
• No specific laboratory monitoring is required 5

What to Avoid

• Antihistamine use during the last 2 weeks of pregnancy has been associated with retrolental fibroplasia in premature infants in one study, though this has not been corroborated 1
• Avoid multi-ingredient cough and cold preparations that contain unnecessary medications 3

The evidence strongly supports that all antihistamines are safe during breastfeeding, with minimal amounts excreted in breast milk that would not cause adverse effects in breastfeeding infants. 5