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Using oseltamivir and zanamivir during breastfeeding

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Using oseltamivir and zanamivir during breastfeeding

Oseltamivir and zanamivir can be used during breastfeeding when clinically indicated (1)

  • recommendations apply to full term, healthy infants only

Oseltamivir and zanamivir are used for the prevention and treatment of influenza:

  • oseltamivir is the preferred choice during breastfeeding -infant monitoring is still required
    • limited data suggest that oseltamivir passes into breastmilk in negligible amounts

  • is no published evidence for the use of zanamivir in breastfeeding, however infant exposure is expected to be insignificant

  • zanamivir can be used by any route during breastfeeding when indicated

  • treatment choice should be based on the clinical scenario with safety in breastfeeding a secondary consideration

  • if the breastfed infant also needs direct treatment or prevention for influenza, the recommended dose of oseltamivir or zanamivir for infants should be given directly to the infant
    • is regardless of whether they are also exposed to oseltamivir or zanamivir via breast milk

Breastfeeding with influenza infection

  • breastfeeding should continue as normal
  • is no evidence that influenza can be transmitted via breast milk
  • breast milk contains antibodies and other bioactive factors which can help protect the infant from influenza

Minimising risk of infant infection through close contact

  • in order for breastfeeding to be facilitated it is important that mother and baby stay close together
    • however, consider the following to reduce the risk of the infant becoming infected:
      • wash hands for at least 20 seconds before touching the infant or any expressing equipment
      • avoid coughing or sneezing on the infant while breastfeeding
      • if used, clean breast pumps as recommended by the manufacturer after each use


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