Pseudoephedrine is a common decongestant medication used to alleviate nasal and sinus congestion often associated with colds, allergies, or hay fever. It functions by narrowing blood vessels in the nasal passages, which helps to reduce swelling and improve airflow. For breastfeeding mothers, understanding its potential effects on the infant and milk supply is important for informed health decisions.
How Pseudoephedrine Affects Infants
Pseudoephedrine passes into breast milk in small amounts after a mother takes it. While its concentration in milk can be higher than in maternal blood, the total amount transferred to the infant is typically low (generally less than 10% of the maternal dose). For most healthy, full-term infants, this low exposure is unlikely to cause harm.
Despite low risk, some infants may experience subtle side effects. Reported side effects in breastfed babies include irritability, increased wakefulness, or sleep disturbances. In one study, irritability was noted in about 20% of infants exposed to pseudoephedrine through breast milk. Parents should monitor their infant for any unusual changes in behavior or sleep patterns if pseudoephedrine is used.
Impact on Milk Production
Pseudoephedrine can reduce a mother’s milk production. This effect is attributed to its alpha-adrenergic agonist properties, which can lead to vasoconstriction and reduce blood flow to the mammary glands. It may also influence prolactin levels, a hormone involved in milk synthesis, though studies show varying significance in reduction.
A single 60 mg dose has been shown to decrease daily milk volume by approximately 24% over 24 hours. This reduction can be more pronounced in mothers in later lactation, such as those breastfeeding infants older than 60 weeks. Mothers with low or borderline milk supply should use pseudoephedrine with caution, as it may further compromise milk production.
Alternative Medications for Cold Symptoms
Several alternatives are more compatible with breastfeeding for managing cold or allergy symptoms. For nasal congestion, saline nasal sprays are a preferred non-pharmacological remedy; they flush out allergens and are not significantly absorbed. Topical decongestant nasal sprays like oxymetazoline can also be used for short periods (typically 3-7 days), as very little is absorbed systemically, minimizing impact on milk supply.
For pain and fever, acetaminophen and ibuprofen are safe choices while breastfeeding. Both transfer into breast milk in very small amounts, unlikely to affect the infant. Certain antihistamines like loratadine and fexofenadine are also recommended due to low levels in breast milk and minimal likelihood of infant side effects or impact on milk production. Cough suppressants like dextromethorphan and expectorants such as guaifenesin are also safe options.
When to Talk to Your Doctor
Consulting a healthcare provider before taking any medication while breastfeeding is sensible. This is especially important if your infant was born prematurely or has existing health conditions, as their ability to process medications might differ. Professional guidance ensures the chosen treatment is appropriate for both you and your baby.
Seek medical advice if you have concerns about your milk supply or notice changes after taking medication. If your symptoms persist or worsen, or if your infant shows signs of adverse reactions, promptly contact your doctor. They can evaluate the situation and recommend the safest course of action.