Safe Medications for Peripheral Vertigo During Lactation
Metoclopramide is the safest and most appropriate medication for treating peripheral vertigo in breastfeeding women, as it is explicitly compatible with lactation and FDA-approved for use in nursing mothers. 1
Primary Recommendation: Metoclopramide
Metoclopramide is identified by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists as explicitly compatible with use in lactating women and is FDA-approved. 1
The standard dosing for breastfeeding women is 10 mg three times daily (maximum 30 mg per day), which can be administered orally or intravenously. 1
The American Society of Anesthesiologists confirms there is no need to interrupt breastfeeding or pump and discard milk when taking metoclopramide at recommended doses. 1
A 2014 review specifically examining migraine and vertigo medications confirms metoclopramide is safe during breastfeeding. 2
Practical Considerations
Ensure the mother has access to a breast pump, as metoclopramide may increase milk supply before the infant can effectively remove it. 1
The medication has low oral bioavailability (30%) but achieves therapeutic effects through central dopamine antagonism, making it effective for vertigo while maintaining safety in lactation. 1
Most commonly used drugs transfer into breast milk in small amounts, generally much less than known safe doses given directly to infants, supporting the safety profile of metoclopramide. 3
Alternative Supportive Medications (If Needed)
NSAIDs like ketorolac or ibuprofen are safe options for associated pain or discomfort, as they transfer into breast milk in very low concentrations without demonstrable adverse effects. 4
The Association of Anaesthetists recommends ketorolac as a preferred option over opioids for breastfeeding women, though special consideration should be given to infants less than 6 weeks of age due to immature hepatic and renal function. 4
Important Caveats
The physician plays a critical role in assessing risks and benefits for both mother and child, as medication use and advice to stop nursing are common reasons for cessation of breastfeeding. 5
Few drugs are absolutely contraindicated during breastfeeding (anticancer drugs, lithium, oral retinoids, iodine, amiodarone, and gold salts), and metoclopramide is not among them. 3