Some anti-emetics can be used with caution during breastfeeding, depending on the clinical situation. Recommendations apply to full term, healthy infants.

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

This article includes the most commonly used medicines for treating nausea. Many other medicines for nausea are also available. Contact our specialist service for further advice.

Recommendations

The choice of anti-emetic will depend on the individual clinical situation and the indication which includes general nausea and vomiting, motion sickness, or after chemotherapy or surgery.

Treatment choice should primarily be directed at controlling symptoms, with safety in breastfeeding a secondary consideration. Therefore, recommending preferred choice anti-emetic is not always possible. Non-pharmacological measures could be tried first, if appropriate.

Where possible, use the lowest effective dose and use short-term.

Most of the anti-emetics can cause drowsiness. The National Institute for Healthcare Excellence (NICE) advises avoiding sharing a bed with the infant when sedating medication has been used, due to the increased risk of sudden unexpected death in infancy.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific medicines in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the medicine in question is not included here
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

Full referencing is available on request.

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