Sinus issues, such as colds and allergies, often require medication, but the choice becomes complicated when a mother is breastfeeding. Many common over-the-counter treatments contain ingredients that could potentially affect the nursing infant or interfere with milk production. Prioritizing infant safety means mothers must make informed decisions, often selecting less potent or alternative therapies for relief. Understanding how medications are processed and transferred is the first step in safely managing sinus symptoms.
Understanding How Medicines Affect Breast Milk
Nearly all medications present in a mother’s bloodstream transfer into her breast milk, usually in very small amounts. Drug safety during lactation is assessed by considering properties like molecular weight, lipid solubility, and protein binding. Drugs with high molecular weight, high protein binding, or low oral bioavailability are less likely to transfer into milk significantly.
A key metric used to estimate infant exposure is the Relative Infant Dose (RID), which compares the amount of drug the baby receives via milk to the mother’s weight-adjusted dose. An RID below 10% of the maternal dose is generally considered acceptable and low-risk. The infant’s age is also a significant factor, as newborns and premature babies have slower drug metabolism and elimination than older infants.
Over-the-Counter Medications Generally Considered Safe
For pain, fever, and discomfort associated with sinus issues, acetaminophen and ibuprofen are low-risk options. Acetaminophen transfers into breast milk in small amounts, typically less than 1% of the dose. Ibuprofen is also preferred, as very little of the drug enters the milk, and infants are often prescribed it directly at higher doses.
For allergy-related sinus symptoms like sneezing and a runny nose, non-sedating, second-generation antihistamines are the preferred choice. Active ingredients like loratadine and cetirizine are safe because they transfer into breast milk in very low amounts.
To minimize infant exposure, take medication immediately after a feed or before the baby’s longest sleep period. Using the lowest effective dose for the shortest duration necessary is recommended.
Medications That Can Reduce Milk Supply or Cause Concern
Oral decongestants containing pseudoephedrine are advised against due to their potential to reduce milk supply. Pseudoephedrine is a vasoconstrictor; one study showed a single 60 mg dose reduced milk production by approximately 24% over 24 hours. The risk of milk reduction is pronounced in mothers with a marginal supply or those establishing lactation.
Phenylephrine, another common oral decongestant, is also not advised. Its effect on milk supply is less documented than pseudoephedrine’s, and oral phenylephrine may be ineffective due to poor absorption. Both decongestants carry a small risk of causing infant irritability or wakefulness.
Older, sedating antihistamines, such as diphenhydramine, are a concern because they may cause drowsiness in the nursing infant. While diphenhydramine passes into breast milk in small amounts, occasional use is not expected to cause problems. However, prolonged use may lead to infant sedation, poor feeding, or irritability, especially in newborns.
Localized Treatments and Non-Drug Relief
Localized treatments manage sinus symptoms with minimal systemic absorption, making them the safest options during lactation. Saline nasal sprays and nasal rinses, such as Neti pots, are completely safe first-line treatments to flush out nasal passages and reduce congestion. These methods carry no risk of transferring medication to the infant or affecting milk supply.
Topical decongestant sprays, often containing oxymetazoline, are also considered safe because the drug is poorly absorbed into the bloodstream from the nasal passages. This minimal systemic absorption means they do not have the same milk-supply-reducing effect as oral decongestants. Nasal sprays should only be used for a maximum of three days to avoid rebound congestion, which is a worsening of symptoms after the medication wears off.
Non-Drug Relief
Non-drug remedies provide simple and effective relief for sinus pressure and congestion. Inhaling steam from a shower or a bowl of hot water helps to loosen mucus and clear the sinuses. Using a humidifier in the bedroom can keep nasal passages moist, and maintaining adequate hydration by drinking plenty of fluids is beneficial for thinning mucus.