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Home > Is This Safe When Breastfeeding? > Medications Cold and Allergy Remedies Compatible with BreastfeedingThe common cold will usually run its course within 7 to 14 days. There are many natural remedies and over the counter products that are compatible with breastfeeding.
General
The 2004 edition of Medications and Mothers' Milk by Thomas Hale, PhD has information on many cold medications (including specific guidance on combination products) in the Appendix (p. 874-889). Many of the active ingredients in cold and allergy medications are listed below.
Both Advil/Motrin (Ibuprofen) and Tylenol (Acetaminophen) are considered compatible with breastfeeding and are approved by the AAP for use in nursing moms. Aleve (Naproxen) is also AAP-approved for nursing mothers, but (per Hale) should be used with caution due to its long half-life and its effect on baby's cardiovascular system, kidneys and GI tract; short-term, infrequent or occasional use is not necessarily incompatible with breastfeeding. Aspirin use is discouraged in children and nursing mothers due to the risk of Reye's syndrome and internal bleeding. See Pain medications and breastfeeding for more information.
Eye drops designed for cold/allergy symptom relief are considered compatible with breastfeeding. Nasal sprays are generally considered compatible with breastfeeding. Of the preparations available for treatment of allergic symptoms, the nasal steroids (e.g., Flonase, NasalCrom) are considered to be, by far, some of the most effective and safest to use in breastfeeding moms. Although there is so far no data specifically on these intranasal steroids, it is known that the plasma levels of the drug are extremely low, and thus milk levels would be even lower. Nasal sprays containing oxymetazoline are probably not a problem, but oxymetazoline is long-acting and thus not the first choice for nursing mothers. A shorter acting alternative is phenylephrine. Zicam, a homeopathic
nasal gel containing ionic zinc gluconate, is generally considered
to be compatible with breastfeeding. Zicam contains small amounts
of zinc (Zincum Gluconicum) - 266 micrograms per squirt; in one
study (Mossad
2003) the daily dosage used was 2.1 mg per day. Zinc
is considered compatible with breastfeeding, particularly in small
amounts (excessive amounts are not a good idea, for mom's sake rather
than baby's). In addition, nasal sprays/gels are generally a better
choice for nursing moms as compared to oral medicines. The amount
of systemic absorption of nasal sprays/gels is minimal compared
to oral ingestion. Although not related to lactation, it should
be noted that there are reports of loss of smell resulting from
the use of intranasal zinc gluconate (see Jafek BW, Linschoten MR,
Murrow BW. Anosmia
after intranasal zinc gluconate use. Am J Rhinol. 2004 May-Jun;18(3):137-41).
Both pseudoephedrine and phenylephrine are generally considered to be safe for the breastfed baby, but pseudoephedrine may reduce milk supply. Pseudoephedrine & milk supply: Thomas Hale Ph. D., a renowned breastfeeding pharmacologist (Breastfeeding Pharmacology), notes that "breastfeeding mothers with poor or marginal milk production should be exceedingly cautious in using pseudoephedrine" and that "it is apparent that mothers in late-stage lactation may be more sensitive to pseudoephedrine and have greater loss in milk production" (Medications and Mother's Milk, 2006 edition). Dr. Hale is referring to this study: Aljazaf K, et. al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 Jul;56(1):18-24. If you do take pseudoephedrine and notice a drop in milk supply (many moms do not, but research shows that it can decrease milk supply by as much as 24%), simply stop the medication and take measures to increase milk supply - the problem should resolve fairly quickly. Be very cautious about taking pseudoephedrine on a regular basis, as it has the potential to permanently decrease your milk supply. Regular use of pseudoephedrine (120 mg/day) has occasionally been used to decrease milk production in moms with overproduction, where the usual methods to regulate milk production were not working. Many meds have been reformulated so they no longer contain pseudoephedrine -- they're using phenylephrine instead. Per Hale, "Because of pseudoephedrine's effect on milk production, many have concerns that phenylephrine may suppress milk production as well. There is no evidence that this occurs at all."
Mom's use of Benadryl and Chlor-Trimeton are generally regarded to be compatible with breastfeeding, but always double-check the active ingredients. Monitor your infant for possible drowsiness if you use an antihistamine. The non-sedating antihistamines (below) are generally preferred and are less likely to sedate baby. The ingredients of Claritin, Claritin-D, Allegra, Allegra-D, Actifed (the decongestant pseudoephedrine plus triprolidine) and Seldane have been approved by the AAP for use by nursing moms. Loratadine (Claritin) has been studied and the amount of loratadine that passes into breastmilk is extremely low. Claritin-D and Allegra-D have pseudoephedrine added (which is AAP approved, but see above about possible effect on milk supply). Dr. Hale has said that he prefers the nonsedating antihistamines (even though they are long-acting) over the sedating allergy medications. Zyrtec is also generally considered to be compatible with breastfeeding. It is commonly used by nursing moms, although its levels in milk are not known. Hale rates Zyrtec in the lactation risk catagory L2 (safer). Clarinex (desloratadine): Desloratadine is another name for descarboethoxyloratadine, which is the main metabolite (breakdown product) of Claritin (loratadine). Per one study (Hilbert J, Radwanski E, Affrime MB et al. Excretion of loratadine in human breast milk. J Clin Pharmacol.1988:28:234-9), 0.019% of the descarboethoxyloratadine was transferred into breastmilk. Since Claritin (and thus its active metabolites, too) is considered safe for nursing moms (it's AAP approved, in fact), Clarinex should not be a problem either. Milk supply: A common concern is that antihistamines might lower milk supply but, per Dr. Thomas Hale, there is no current research supporting this belief. If you feel that your supply has decreased, it could simply be a byproduct of decreased nursing frequency or dehydration due to your illness. If you feel that a medication is the cause of a sudden drop in milk supply, then stop taking (or decrease your use of) the medication - if the med is indeed the cause, then supply should increase again soon after you stop taking it. When using an antihistamine, it can be helpful to step up your fluid intake quite a bit. As with any medication, take it only as needed, and discontinue use as soon as you can.
Page last modified:
09/23/2006
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