Antihistamines and Breastfeeding

When a product label states "not recommended in breastfeeding" or unlicensed, it can mean one of two things. Firstly, clinical trials or data collected from the public may have provided evidence of a damaging effect on you or your baby as it can be passed through the breast milk and absorbed into the baby's body. These are certainly ones to avoid.

Alternatively, it may mean the drug company making the product has not done clinical trials to test for safety in breastfeeding. Drug manufacturers these days avoid testing on pregnant or breastfeeding women, like any birth defects or harm to babies is not worth even the smallest legal risk unless targeted specifically for them. However, data is collected by regulators and drug manufacturers on anyone pregnant or breastfeeding who has tried these anyway, and any undesirable effects are declared. Additionally, regulators have data on each of the ingredients based on other research and products, and this also guides advice.

So, while the label may state that they are not recommended for breastfeeding, we can review this on a product-by-product basis. In some cases, there may be no evidence to suggest a particular product causes harm to you or your baby. From a legal standpoint, the pharmaceutical companies let any risk lie with doctors and their patients, rather than taking on any liability.

When breastfeeding, many women want to avoid taking medications, and drug-free products carry the lowest risk. They may also be enough for mild symptoms, together with practical steps to avoid pollen. Let’s consider a range of pharmacy products:

1. Topical nasal barriers aim to trap pollen around the nostril, preventing it from entering the nose and provoking an immune response. You could apply Vaseline around the nostrils or Haymax hay fever balm.

2. Drug-free nasal barrier sprays are inert powders or barriers that can be sprayed up the nose to prevent the trigger of histamine release and therefore hay fever symptoms. Becodefence nasal spray is one example.

3. Saline nasal lavage can help to wash away allergens including pollen from the nasal cavity, which may reduce ongoing irritation.

4. Eyelid wipes can do a similar job for the eyes.

5. Red light therapy devices are thought to suppress the mast cells that release histamine, thereby reducing hay fever symptoms.

6. Soothing the eyes can reduce eye symptoms - Optrex Sore eye drops contain witch hazel to clean and soothe the eyes.

Most manufacturers of antihistamine tablets or eye drops advise avoiding use during pregnancy. However, in consulting the British National Formulary (BNF), doctor’s & pharmacist’s trusted handbook for all UK medicines and any of their dangers, it suggests antihistamines may be present in breast milk, stating “ although not known to be harmful, most manufacturers advise avoiding their use in mothers who are breastfeeding." So, breastfeeding is a judgment call.

You have your own individual needs and concerns, so we would suggest you discuss this with your doctor.

Sodium cromoglicate eye drops do not contain antihistamines. Little is absorbed into the body. While over-the-counter products say to consult your doctor before taking them, the BNF states that they are unlikely to be present in breast milk, so they are suitable for both, after discussing with your doctor.

Steroid nasal sprays, such as those containing fluticasone or beclomethasone, are not known to be harmful in breastfeeding. The BNF refers to the safety of these when used as an asthma inhaler – where the steroid dose may be higher than in nasal sprays – and states, “inhaled drugs for asthma can be taken as normal during pregnancy and breastfeeding."

Similarly, a pharmacist won’t sell these directly to you, and you should seek advice from your doctor about your particular medical conditions and any concerns before starting them.

The BNF states decongestants are unsafe in breastfeeding as they may suppress lactation, so it’s suggested they are avoided in breastfeeding, too.

This information is intended as a guide, so you can consider any medicated options if your symptoms are severe and not relieved by drug-free products. But we recommend you speak to your doctor before taking any of these medications during pregnancy or whilst breastfeeding.