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©2013 UpToDate ® Print Email Therapies for allergic rhinitis in lactating women Drug category Amount passed to infant in breastmilk Conclusions about maternal use during breastfeeding Intranasal glucocorticoid sprays (budesonide preferred) Minimal Compatible Second generation oral antihistamines Cetirizine Minimal to small amounts Large doses or prolonged use may cause sedation in nursing infant; may decrease milk supply if combined with a sympathomimetic Loratadine Minimal to small amounts Compatible but might reduce milk supply if combined with a sympathomimetic such as pseudoephedrine Antihistamine nasal sprays Minimal Probably compatible; use intranasal steroid preferentially Oral decongestants Pseudoephedrine Passes into milk Use short-acting preparations only and take just after breastfeeding to minimize amount entering milk. Use intranasal steroid preferentially for persistent congestion; topical vasoconstrictor nasal spray for therapy of less than four days. Phenylephrine Little information available Not recommended Cromolyn nasal spray Insignificant Compatible Leukotriene receptor antagonists Montelukast Unknown Use only if other compatible agents not sufficient and symptoms are significant; avoid in newborn or preterm infant Zafirlukast About 20 percent Use only if other compatible agents not sufficient and symptoms are significant; avoid in newborn or preterm infant Ipratropium nasal spray Unknown; maternal serum levels are negligible and milk levels will be very low, if at all; any drug in milk would not be absorbed by the infant Probably compatible The US Food and Drug Administration has developed a drug classification system consisting of five pregnancy precaution categories, A, B, C, D, and X; no similar classification exists for lactation. No rhinitis medication meets the requirements for pregnancy category A: well controlled human studies show no risk for the developing child. There are several rhinitis drugs within category B, for which either animal studies show no fetal risk and human studies are unavailable, or animal studies show a risk but human studies have not. References: Incaudo AF, Takach P. The diagnosis and treatment of allergic rhinitis during pregnancy and lactation. Immunol Allergy Clin N Am 2006; 26:137. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation, 9th ed, Lippincott Williams & Wilkins, Philadelphia 2011. LactMed: United States National Library of Medicine. file://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT .