Antihistamines and Breastfeeding

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The information provided is taken from various reference sources.  It is provided as a guideline.  No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.  Clinical decisions remain the responsibility of medical and breastfeeding practitioners.  The data presented here is intended to provide some immediate information but cannot replace input from professionals.

Optimal treatment choice:

·       Non-sedating antihistamine

·       Nasal spray

·      Eye drops

Can breast feeding mothers take antihistamines for allergies?

Whilst many mothers prefer to take as few medicines as possible whilst they are breastfeeding, allergies may need to be treated urgently. 

Most of the drugs to treat allergies are available to buy over the counter but the leaflets may say that they are not suitable to take whilst you are breastfeeding.  This does not necessarily mean that they are dangerous, merely that the drug company has not undertaken trials itself and has chosen not to recommend its use in this situation.  (See information sheet on Patient Information Leaflets on www.breastfeedingnetwork.org.uk.)

For treatment of hayfever please see sheet “Hayfever and breastfeedingwww.breastfeedingnetwork.org.uk/drugs-factsheets

Nasal sprays

Some people have chronic allergies to things like dust mite or cat fur.  Steroid nasal sprays can be very effected with virtually no passage into milk as they only act locally.  (Jones 2018)

E.g. Beclometasone (Beconase®), Fluticasone (Flixonase® Pirinase®), Budesonide (Rhinocort®), Dexa-methasone (Dexa-Rhinospray®), Mometasone (Nasonex®), Triamcinolone (Nasocort®). 

Other products are designed to block the passage of pollen into the nose thus preventing the reaction e.g. Prevalin allergy®, NasalGuard Allergie Block® and similar own brand pharmacy products.  These will not pass into breastmilk.

Tablets

Non-sedating antihistamines are the preferred choice for a breastfeeding mother:

  • Loratadine (Clarityn®) (Powell 2007, Hilbert 1997),
  • Cetirizine (Zirtek®, BecoAllergy®, Piriteze®, Benadryl®) reaches low levels in breastmilk and is recommended by the British Society for Allergy and Clinical Immunology (Powell 2007)
  • Fexofenadine (Telfast®) is a newer antihistamine with similar low levels of transfer and no reports of adverse events (LactMed).
  • Acrivastin (Benadryl Relief®) can cause drowsiness in mother and baby (Lucas 1995). As there is less research it is the least favoured option in younger babies unless it is the only drug that the mother finds effective.  In such a situation the baby should be observed for drowsiness. 

Most multiple pharmacies make their own brands of these drugs.  Many are both available as paediatric syrups to be given to children over 2 years. 

Short courses of sedating antihistamines e.g. chlorpheniramine (Piriton®), Promethazine (Phenergan®) and Trimeprazine (Vallergan®) taken three times a day to control urticaria (nettle rash) or severe reaction to an insect bite are unlikely to cause significant drowsiness in the baby but are best avoided long term as use may cause the baby to become drowy, miss feeds and fail to thrive (LactMed). 

Eye drops

Eye drops also act only locally and can be used during lactation e.g. sodium cromoglycate (Opticrom®) (Jones 2018)

References

  • Hale T. W Medications in Mothers Milk
  • Hilbert J, Radwanski E, Affine MB et al. Excretion of loratadine in human breast milk.  J Clin Pharmacol. 1998;28:234-9
  • Jonews W Breastfeeding and Medication Routledge 2018
  • Lactmed website https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
  • Lucas BD J, Purdy CY, Scarim SK et al. Terfenadine pharmacokinetics in breast milk in lactating women.  Clin Pharmacol Threr. 1995; 57:398-402
  • Powell RJ, Du Toit GL, Siddique N et al. BSACI guidelines for the management of chronic urticarial and angio-oedema.  Clin Exp Allergy. 2007; 37:631-50.

Bibliography

  • British National Formulary

© Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019