Mothers who breastfeed often worry about which drugs are safe to take while they are breastfeeding. Colds and allergies are sometimes treated with over-the-counter drugs. Decongestants are drugs used for the relief of sinus congestion which often accompanies colds and allergies.
The American Academy of Pediatrics, or AAP, now recommends that mothers breastfeed their babies exclusively for the first six months, and that they should try to continue for the first year. During this time a mom may come down with a cold or have allergies. The AAP has a list of drugs that can be used in what they consider the safest category: Maternal Medication Usually Compatible with Breastfeeding.
The decongestant pseudoephedrine is contained on the list of drugs usually compatible with breastfeeding, according to the AAP Policy and the American Academy of Family Physicians. Although small amounts of the drug are excreted in breast milk and some women may have a reduction in milk, pseudoephedrine remains the drug of choice because it has been studied. Pseduoephedrine is marketed as a generic brand and under the brand name, Sudafed. This decongestant has been used illegally in the manufacturing of drugs and therefore is monitored. A government identification card is required for purchasing pseudoephedrine.
Researchers at the Curtin University of Technology in Western Australia studied the effects of pseudoephedrine on milk volume and the extent to which the drug went into the milk. They studied lactating women who took 60 mg of ephedrine or a placebo. Milk production was measured for 24 hours and analyzed for drug availability to the infant. The results showed that a single dose of pseudoephedrine significantly reduced milk production. The infant dose delivered via milk was < 10% of the maternal dose, and unlikely to affect the infant adversely. This study was published in the July 2003, “British Journal of Clinical Pharmacology.”
The American Academy of Family Physicians recommends that mothers of newborns avoid taking pseudoephedrine until their milk supply is fully established, which becomes more stable after the first month of breastfeeding. Short-term use is preferable to long term use in order to minimize any problems with milk supply. Also, a mother can take less than the 60 mg dose to minimize interference with her milk supply.
Topical Nasal Decongestants:
Over-the-counter nasal decongestants contain either oxymetazoline or phenylephrine. These products are applied topically by squeezing a misting bottle into the nostrils and spraying the product onto the nasal tissues.
Although there are no studies on oxymetazoline or phenylephrine during breastfeeding, it is considered to have limited absorption into the maternal bloodstream. “Due to their local activity and minimal systemic absorption, nasal decongestants may have a low concentration in breast milk and are preferred over systemic oral decongestants” as referenced in the journals, “U.S. Pharmacist”: Breastfeeding and OTC Medications, Jul 2007 and the “Journal of Human Lactation”: Review: Breastfeeding and Over-the-Counter Medications Review, Nov 2000.
When taking medications, breastfeeding mothers should take their medication after breastfeeding, using the lowest effective dose and for the shortest duration. All mothers and infants respond differently to drugs. Health care professionals should be consulted before taking any over-the-counter medicines.