Which oral antihistamines are safe to use whilst breastfeeding?

This updated UKMi Q & A looks at the use of non-sedating and sedating antihistamines during breastfeeding

Summary

  • There are very limited studies or case reports for the use of antihistamines in breastfeeding.
  • Studies of the non-sedating antihistamines, loratadine and cetirizine, show low levels of transfer into breast milk and these would be considered the preferred choice antihistamines for a breastfeeding mother.
  • Limited data suggests the transfer of fexofenadine into breast milk is low and could be considered acceptable where loratadine and cetirizine are either ineffective or contraindicated.
  • Although there is no specific evidence for the use of the other non-sedating antihistamines during breastfeeding, based on pharmacology and the evidence available for other non-sedating antihistamines, problems would not be anticipated. Therefore, their use would be considered acceptable during breastfeeding, with caution.
  • The use of sedating antihistamines may cause adverse effects in the breastfed infant such as drowsiness and irritability.
  • Cyproheptadine is contraindicated in breastfeeding due to its potential effects on lactation.
  • If treatment with a sedating antihistamine is required then occasional doses of chlorphenamine would be preferred, with infant monitoring for drowsiness and irritability. Data on the use of other sedating antihistamines are lacking and cannot be confirmed as safe. However, small occasional doses would be acceptable with caution and infant monitoring.
  • Where a sedating antihistamine is prescribed, co-therapy with other sedating agents should be avoided; the mother should also be advised against co-sleeping.
  • Antihistamines may cause a reduction in serum prolactin but this probably has no effect on breast milk production where lactation is established, and when the doses used are low. However, cyproheptadine should be avoided because of the evidence that is available for interference with breast milk production.
  • There are no data on antihistamine use when breastfeeding a premature infant.

 

AcrivastineAlimemazineAllergy and immunologyBilastineCetirizineChlorphenamineClemastineCyproheptadineDesloratadineFexofenadineHydroxyzineKetotifenLevocetirizineLoratadineMizolastineObstetrics and gynaecologyPaediatric and neonatal medicinePromethazine hydrochloridePromethazine teoclateQ&ARupatadineSafety in Lactation

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