Safety in Lactation: Drugs used in nausea and vertigo

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

The choice of anti-emetic will depend on the indication – general nausea and vomiting, motion sickness, after chemotherapy or surgery, vestibular disorders (vertigo, Meniere’s).

Short-term prochlorperazine is acceptable for more severe conditions. Sedation in the infant and suppression of lactation may theoretically occur with frequent or high-dose use. Monitor infants, especially neonates, for sedation, poor feeding, behavioural effects and extrapyramidal symptoms with phenothiazines, especially with longer-term use.

Domperidone and metoclopramide are considered to be compatible with breastfeeding as anti-emetics for short-term, low-dose use. Used mainly as galactogogues to increase milk production (off-label use) when they should only be used where there is objective evidence to support diagnosis and where non-drug methods have failed. Domperidone is considered to be the agent of choice for inadequate lactation because of its superior side effect profile, efficacy, and minimal passage into breast milk. Both should only be used short-term.

There is little evidence on safety in breastfeeding for the anti-emetics used for nausea and vomiting associated with cancer chemotherapy. The use of concomitant anticancer drugs will limit ongoing breastfeeding in this situation. Ondansetron and granisetron appear to be compatible with breastfeeding and have limited adverse effects in normal use.

Betahistine, used for vestibular disorders, is associated with gastrointestinal disturbances and signs of histamine release (rash, pruritus)  in normal adult use. The choice of a safe and effective alternative is limited.

AprepitantBetahistineChlorpromazineCinnarizineCyclizineDomperidoneDoxycyclineDoxylamine + PyridoxineDroperidolFosaprepitantGastrointestinal disordersGranisetronHyoscine hydrobromideMental health and illnessMetoclopramideNabiloneNetupitant + PalonosetronObstetrics and gynaecologyOndansetronPaediatric and neonatal medicinePalonosetronPerphenazineProchlorperazinePromethazine hydrochloridePromethazine teoclateSafety in LactationTrifluoperazine