The most appropriate antihistamines for women who are breastfeeding are second-generation agents such as loratadine and cetirizine. These agents have minimal sedative effects and low transfer into breast milk, making them safer choices during lactation NICE CKS McMullan et al. 2024. First-generation antihistamines, while effective, can cause sedation in both mother and infant and are generally not preferred unless necessary NICE CKS. Loratadine and cetirizine have been studied and found to have low milk/plasma ratios and no reported adverse effects on breastfed infants, supporting their use as first-line options McMullan et al. 2024. Additionally, these drugs have more favourable safety profiles compared to some older antihistamines, aligning with NICE and UK clinical advice to minimise infant exposure through breastmilk NICE CKS. Therefore, in clinical practice within UK general practice, recommending loratadine or cetirizine is appropriate for breastfeeding women requiring antihistamines.
Key References
- CKS - Depression - antenatal and postnatal
- NG133 - Hypertension in pregnancy: diagnosis and management
- CKS - Pityriasis rosea
- CKS - Cow's milk allergy in children
- CKS - Food allergy
- NG245 - Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
- (Smit et al., 2016): Mirtazapine in pregnancy and lactation - A systematic review.
- (McMullan et al., 2024): Safety of dermatologic medications in pregnancy and lactation: An update - Part I: Pregnancy.