Skip to Main Content
The first stop for professional medicines advice

Treating nausea during breastfeeding

Published
Topics: CyclizineGastrointestinal disordersHyoscine hydrobromide · MetoclopramideOndansetronProchlorperazinePromethazine hydrochlorideSafety in Breastfeeding ·

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

Contents

  1. General considerations
  2. Recommendations
  3. Specific recommendations
    1. Cyclizine
    2. Hyoscine hydrobromide
    3. Metoclopramide
    4. Ondansetron
    5. Prochlorperazine
    6. Promethazine
  5. Patient Information
  6. Contact us
  7. About our recommendations
  8. Bibliography

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) 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 (SPS page) 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

Use with caution

Cyclizine, for short-term use, can be used with caution during breastfeeding, but monitoring is required.

Infant monitoring

As a precaution, monitor the infant for drowsiness, poor feeding (including not waking to feed) and urinary retention.

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

Cyclizine is an antihistamine anti-emetic. There is no published evidence of use during breastfeeding.

Repeated use may pose a risk of infant sedation.

Cyclizine, used at normal therapeutic doses, is unlikely to affect breast milk production.

Preferred choice for motion sickness

Hyoscine hydrobromide, for occasional short-term use, can be used with caution during breastfeeding, but precautionary monitoring is required.

Infant monitoring

As a precaution, monitor the infant for drowsiness, irritability, dry mouth (which may cause difficulty feeding), dry eyes, urinary retention and constipation.

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use and low levels are anticipated in breast milk due to the medicine’s properties.

There is a small risk that repeated use may interfere with milk production, although there is no published evidence to support this.

Hyoscine hydrobromide is used in infants over 1 month old and is the preferred medicine for motion sickness during breastfeeding.

Use with caution

Metoclopramide, for short-term use, can be used with caution during breastfeeding for nausea, but monitoring is required.

Infant monitoring

As a precaution, monitor the infant for sedation, gastro-intestinal disturbances, difficulty feeding, irritability, and extrapyramidal symptoms such as, tremor, or sudden or jerky movements.

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

There is a moderate amount of published evidence of use during breastfeeding which shows very small to moderate amounts in breast milk.

Adverse effects have not been reported in infants exposed via breast milk, except for occasional and mild gastrointestinal discomfort.

The dose should not exceed 30mg daily for a maximum of five days. Avoid in people with a history of depression.

Use with caution

Ondansetron can be used with caution during breastfeeding, but monitoring is required.

Infant monitoring

As a precaution, monitor for sedation, irritability, diarrhoea, or constipation and urinary retention.

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breastfeeding. Its properties make it unlikely that it will be excreted in breast milk in significant quantities. No problems have been reported in breastfed infants.

Use with caution

Prochlorperazine, used for occasional doses and short term, can be used with caution during breastfeeding, but monitoring is required.

Infant monitoring

As a precaution, monitor infants for sedation, irritability, poor feeding, dry mouth, adequate weight gain, and extrapyramidal symptoms, such tremor and sudden jerky movements .

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

There is no published evidence of use during breast feeding. Its properties make it highly unlikely that significant quantities will pass into breast milk. It also has low oral bioavailability, therefore any that does pass into breast milk is unlikely to be absorbed by the infant in significant quantities.

Repeated use may pose a risk of infant sedation and may affect lactation.

Use with caution

Promethazine, used for occasional doses and short term, can be used with caution during breastfeeding, but monitoring is required.

Infant monitoring

As a precaution, monitor for sedation or irritability, not waking to feed/poor feeding, dry mouth, adequate weight gain, extrapyramidal symptoms such as tremor and sudden jerky movements.

Monitoring the infant should quickly identify any potential issues. However, further investigation is usually required before the cause can be attributed to the medicine.

Further information

Promethazine is an antihistamine anti-emetic.

There is no published evidence of use during breastfeeding, but there is extensive experience of use in breastfeeding.

Its properties make it highly unlikely that significant quantities will pass into breast milk. It also has low oral bioavailability; therefore any that does pass into breast milk is unlikely to be absorbed by the infant in significant quantities.

Repeated use may pose a risk of infant sedation and may interfere with lactation.

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) (SPS page), 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.