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Non sedating antihistamines breastfeeding in public

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QUESTION Many of my pregnant and breastfeeding patients suffer from allergies and frequently ask me about the safety of antihistamines during pregnancy and breastfeeding. Should I advise them to use the older sedating medications? I have heard that they might be safer than the newer nonsedating class of drugs. Or have the newer ones been studied as well? There are relatively fewer data on the nonsedating second-generation antihistamines; however, published studies are reassuring.

All antihistamines are considered safe to use during breastfeeding, as minimal amounts are excreted in the breast milk and would not cause any adverse effects on a breastfeeding infant. Common symptoms of allergic rhinitis include nasal congestion, discharge, and itching, as well as eye involvement such as conjunctival redness, swelling, "Non sedating antihistamines breastfeeding in public" excessive lacrimation.

Associated Data

The symptoms are typically triggered by airborne allergens eg, pollens from trees, grasses, weeds ; however, household allergens such as Non sedating antihistamines breastfeeding in public mites or animal dander are also common triggers.

Antihistamines targeting histamine—type 1 H 1 receptors are commonly used to treat allergic rhinitis. Examples Non sedating antihistamines breastfeeding in public first-generation antihistamines are brompheniramine, chlorpheniramine, dimenhydrinate, diphenhydramine, doxylamine, hydroxyzine, and pheniramine. Most—with the exception of doxylamine and dimenhydrinate, both used for the treatment of nausea and vomiting, and hydroxyzine prescription-only —are commonly found in over-the-counter allergy and cold medications.

None of the medications in this class of drugs has been reported to increase fetal risk when used at any time during pregnancy.

At present, medications from this class of drugs are preferred because they do not cause central nervous system adverse effects eg, drowsiness and because they are available without prescription. Examples of second-generation antihistamines are cetirizine, desloratadine, fexofenadine, and loratadine. Cetirizine is the active metabolite of hydroxyzine.

A small prospective, comparative study conducted by Motherisk following women exposed to hydroxyzine and 39 to cetirizine 37 in first trimester did not find differences in pregnancy outcomes between the exposed and comparison groups. Fexofenadine is an active metabolite of terfenadine, 9 a second-generation H 1 blocker that is no longer available on the Canadian market owing to clinically significant QT prolongation. Although animal studies failed to show teratogenicity, decreases in pup weight and survival were observed.

There are no human data on fexofenadine 9 ; however, limited data from terfenadine did not find an increased risk of major malformations.

This updated UKMi Q &...

Desloratadine is a major metabolite of loratadine; therefore, data pertaining to safety of loratadine might be extrapolated to desloratadine. Although the data regarding the use of first-generation antihistamines and breastfeeding is limited, only minimal amounts of these drugs have been reported to be secreted in breast milk. None of the reactions required medical attention. Among the second-generation H 1 blockers, data on drug concentration in breast milk are available Non sedating antihistamines breastfeeding in public loratadine, desloratadine, and fexofenadine.

The pharmacokinetics of loratadine and its metabolite desloratadine in breast milk "Non sedating antihistamines breastfeeding in public" studied in 6 lactating women after a single oral dose of 40 mg of loratadine, 19 which is 4 times the current standard therapeutic dose.

The pharmacokinetics of fexofenadine in breast milk were studied in 4 lactating women taking 60 mg of terfenadine every 12 hours. Considering the minimal exposure of a nursing infant to the drugs through breast milk, Non sedating antihistamines breastfeeding in public use of loratadine, desloratadine, or fexofenadine in a standard therapeutic dose is unlikely to result in adverse effects in nursing infants and is considered to be compatible with breastfeeding.

Although seasonal allergy is not a life-threatening medical condition, it can be extremely troublesome for pregnant women and breastfeeding mothers. Based on the current body of evidence, which is large, first-generation H 1 blockers are not associated with an increased risk of major malformations or any other adverse fetal effects.

Although there is less evidence on second-generation H 1 blockers, they have also not been associated with an increased risk of adverse pregnancy outcomes.

In addition, none of the antihistamines is excreted in the breast milk in an appreciable amount so as to have any adverse effects on the breastfeeding infant.

Therefore, pregnant and breastfeeding women can be reassured that they can alleviate their symptoms without posing an increased risk to their fetuses or infants.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in women who are pregnant or breastfeeding? We invite you to submit them to the Motherisk Program by fax at ; they will be addressed in future Motherisk Updates. National Center for Biotechnology InformationU.

I have heard that they...

Journal List Can Fam Physician v. Copyright and License information Disclaimer. This article has been cited by other articles in PMC. First-generation antihistamines Antihistamines targeting histamine—type 1 H 1 receptors are commonly used to treat allergic rhinitis.

Second-generation antihistamines At "Non sedating antihistamines breastfeeding in public," medications from this class of drugs are preferred because they do not cause central nervous system adverse effects eg, drowsiness and because they are available without prescription.

Cetirizine Cetirizine is the active metabolite of hydroxyzine. Fexofenadine Non sedating antihistamines breastfeeding in public is an active metabolite of terfenadine, 9 a second-generation H 1 blocker that is no longer available on the Canadian market owing to clinically significant QT prolongation.

Loratadine and desloratadine Desloratadine is a major metabolite of loratadine; therefore, data pertaining to safety of loratadine might be extrapolated to desloratadine. Antihistamines and breastfeeding Although the data regarding the use of first-generation antihistamines and breastfeeding is limited, only minimal amounts of these drugs have been reported to be secreted in breast milk.

Conclusion Although seasonal allergy is not a life-threatening medical condition, it can be extremely troublesome for pregnant women and breastfeeding mothers. Footnotes Competing interests None declared. Incaudo GA, Takach P.

Attachments

The diagnosis and treatment of allergic rhinitis during pregnancy and lactation. Immunol Allergy Clin North Am. Medications in pregnancy and lactation: Drugs with minimal or unknown human teratogenic effect. Fetal safety of drugs used in the treatment of allergic rhinitis: Pregnancy outcome following first trimester exposure to antihistamines: Prospective controlled study of hydroxyzine and cetirizine in pregnancy.

Ann Allergy Asthma Immunol. Use of antihistamine drugs in early pregnancy and delivery outcome. J Matern Fetal Neonatal Med. Weber-Schoendorfer C, Schaefer C.

The safety of cetirizine during pregnancy. A prospective observational cohort study. Epub May Allegra [product monograph] Laval, QC: Non sedating antihistamines breastfeeding in public Canada Inc; Aerius [product monograph] Montreal, QC: Schering-Plough Canada Inc; Fetal safety of loratadine use in Non sedating antihistamines breastfeeding in public first trimester of pregnancy: J Allergy Clin Immunol.

Pregnancy outcome after gestational exposure to loratadine or antihistamines: Kallen B, Olausson PO. Monitoring of maternal drug use and infant congenital malformations. Does loratadine cause hypospadias? Int J Risk Saf Med. Risk of hypospadias in offspring of women using loratadine during pregnancy: Pseudoephedrine and triprolidine in plasma and breast milk of nursing mothers. Br J Clin Pharmacol.

Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. Excretion of loratadine in human breast milk. Terfenadine pharmacokinetics in breast milk in lactating women. Support Center Support Center.

Please review our privacy policy. that requires an anti-infective agent, a beta-agonist, an antihistamine, or a triptan, Dr. Sachs: As stated in "Non sedating antihistamines breastfeeding in public" report, not all medications are present in breast as drowsiness or sedation, difficulty breastfeeding, breathing difficulties, and decreased tone. Public Information from the FDA and Medscape. I have heard that they might be safer than the newer nonsedating class of drugs. Or have All antihistamines are considered safe to use during breastfeeding.

Second generation antihistamines are also less likely to produce sedation because they have Histamine release; Histamine H1 antagonists, non- sedating; Receptors, histamine H1 . Breastfeeding children and preschoolers The wide availability of second-generation H1 antihistamines in the public health system by.

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