Last update May 6, 2022
Sympathomimetic, stereoisomer of ephedrine, used as a nasal decongestant. Oral administration up to 4 times a day. Marketed on multiple pharmaceutical compounds as a constituent of antitussives, mucolytics, expectorants and nasal decongestants (Nice 2000). Simple formulations (one active ingredient per drug) are preferable even more while breastfeeding.
It is excreted into breast milk in a clinically non-significant amount (Aljazaf 2003, Nice 2000, Kanfer 1993, Findlay 1984) without major problems having been reported in infants whose mothers had received this medication. (Soussan 2014, Aljazaf 2003, Ito 1993)
Two infants out of ten appeared with mild irritability that did not require medical care (Ito 1993) with only 4 cases related to maternal pseudoephedrine intake having been declared to the French Pharmaceutical Surveillance Database in 26 years. (Soasan 2014)
According to one author, it may decrease the milk production, hence a high intake of fluids is recommended to the mother (Nice 2000). Pseudoephedrine produced a variable and non-significant decrease on prolactin levels along with a variable decrease (between 3% and 59%, on average 25%, and a median 15%) on milk production in 8 women whose infants were beyond neonatal period (Aljazaf 2003). Based on the latter single work (Aljazaf 2003), it has been speculated with the use of pseudoephedrine to treat hypergalactia, galactorrhea and to inhibit milk production. (Johnson 2020, Trimeloni 2016, Eglash 2014)
Nor-pseudoephedrine was found in the urine of infants whose mothers had consumed a stimulant plant called Catha edulis, qat o cat. (Kristiansson 1987)
Although not recommended during lactation by some authors (Amir 2011, Rubin 1986), others think it is compatible. (Nice 2000, Mitchell 1999, Ghaeli 1993, Ito 1993, Findlay 1984)
The American Academy of Pediatrics considers it to be a medication usually compatible with breastfeeding. (AAP 2001)
It is suggested the use of a lowest effective dose as possible avoiding a long-term use. Monitor milk production, especially if associated with use of Triprolidine (see specific info) during the neonatal period.
Some authors consider oral and nasal decongestant drugs dispensable drugs, to be avoided in general, not only during lactation, since they expose patients to serious risks (cardiovascular, neurological and intestinal) to treat a benign alteration such as nasal obstruction , which usually evolves favorably in a few days without medication. (Prescribed 2018)
Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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