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Promethazine in breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

A review notes (1):

  • choice of anti-emetic will depend on the individual clinical situation and the indication which includes general nausea and vomiting, motion sickness, or after chemotherapy or surgery.
    • treatment choice should primarily be directed at controlling symptoms, with safety in breastfeeding a secondary consideration
      • therefore, recommending the preferred choice anti-emetic is not always possible
      • non-pharmacological measures could be tried first, if appropriate.
  • where possible, use the lowest effective dose of an anti-emetic and use short-term
  • most of the anti-emetics can cause drowsiness
    • NICE advises avoiding sharing a bed with an infant when sedating medication has been used, due to the increased risk of sudden unexpected death in infancy

With respect to specific anti-emetics (1):

  • cyclizine
    • for short-term use, can be used with caution during breastfeeding, but monitoring is required
    • monitor the infant for drowsiness, poor feeding (including not waking to feed) and urinary retention
    • repeated use may pose a risk of infant sedation
  • hyoscine hydrobromide
    • for occasional short-term use, can be used with caution during breastfeeding, but precautionary monitoring is required
    • monitor the infant for drowsiness, irritability, dry mouth (which may cause difficulty feeding), dry eyes, urinary retention and constipation
    • there is a small risk that repeated use may interfere with milk production, although there is no published evidence to support this
    • is used in infants over 1 month old and is the preferred medicine for motion sickness during breastfeeding
  • metoclopramide
    • for short-term use, can be used with caution during breastfeeding for nausea, but monitoring is required
    • assessment does not cover the use of metoclopramide for poor breast milk supply
    • monitor the infant for sedation, gastrointestinal disturbances, difficulty feeding, irritability, and extrapyramidal symptoms such as tremor, or sudden or jerky movements
    • there is a moderate amount of published evidence of use during breastfeeding which shows very small to moderate amounts in breast milk
    • dose should not exceed 30mg daily for a maximum of five days
    • avoid in people with a history of depression
  • prochlorperazine
    • used for occasional doses and short-term, can be used with caution during breastfeeding, but monitoring is required
    • monitor infants for sedation, irritability, poor feeding, dry mouth, adequate weight gain, and extrapyramidal symptoms, such as tremor and sudden jerky movements
    • is no published evidence of use during breastfeeding
      • its properties make it highly unlikely that significant quantities will pass into breast milk
      • also has low oral bioavailability, therefore any that does pass into breast milk is unlikely to be absorbed by the infant in significant quantities.
    • repeated use may pose a risk of infant sedation and may affect lactation
  • promethazine
    • used for occasional doses and short-term, can be used with caution during breastfeeding, but monitoring is required
    • monitor infant for sedation or irritability, not waking to feed/poor feeding, dry mouth, adequate weight gain, extrapyramidal symptoms, such as tremor and sudden jerky movements
    • highly unlikely that significant quantities will pass into breast milk
      • also has low oral bioavailability; therefore any that does pass into breast milk is unlikely to be absorbed by the infant in significant quantities.
    • repeated use may pose a risk of infant sedation and may interfere with lactation
  • ondansetron
    • can be used with caution during breastfeeding, but monitoring is required
    • monitor infant for sedation, irritability, diarrhoea or constipation and urinary retention
    • there is no published evidence of use during breastfeeding
      • its properties make it unlikely that it will be excreted in breast milk in significant quantities
      • no problems have been reported in breastfed infants (1)

Reference:

  1. NHS Specialist Pharmacy Service (March 26th 2024). Treating nausea during breastfeeding

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