Zyrtec and breastfeeding

March 28, 2006 at 9:10 pm (Allergy News!, Blog & Websites, Products)

I took zyrtec all last year while I was pregnant, so imagine my mild surprise to find my latest refill bearing a warning sticker:

Do Not Use If You Are Breastfeeding


I did some checking and found this:

Home > Is This Safe When Breastfeeding? > Medications

Cold and Allergy Remedies Compatible with Breastfeeding

The common cold will usually run its course within 7 to 14 days. There are many natural remedies and over the counter products that are compatible with breastfeeding.

Natural Remedies


  • Rest. Drink lots of water and take hot baths. Run a humidifier.
  • Take in extra vitamin C from foods, juices or in supplement form.
  • Echinacea is generally recognized to be safe for nursing moms.
  • Garlic eaten raw, cooked, or taken as a supplement can help. Raw is always best, though it's hardest to get down.
  • Homeopathic remedies, are considered safe for nursing moms.
  • OMT is a very gentle form of osteopathic manipulation, which can enhance the immune system, and help keep the fluids draining from the head and neck so bacteria and viruses are less likely to be able to grow. This can help to reduce or even prevent chronic ear and respiratory infections. OMT has been shown to have a dramatic effect on fluid in the ears, and works well on any type of upper respiratory infection.

Head congestion

  • Use a saline nasal spray
  • Steam treatments:
    • Boil a pot of water, remove from the stove and (optional) add a few drops of essential oils (for example: eucalyptus, sage and balsam). Drape a bath towel over your head and breathe deeply for 5 minutes. Do this 2 or 3x a day until symptoms subside.
    • Put two inches of apple cider vinegar in a pan and heat until it begins to steam. Inhale the vapor. If the vapor is too strong, add a little water. Repeat as needed.
  • Essential Oils: Place a drop or two of either eucalyptus or peppermint essential oil on a cotton ball or handkerchief and hold near the nose while breathing deeply.
    • A couple of cautions: Do not use the oil in the nose – it can cause swelling. Do not use peppermint oil or menthol (one of the main components in peppermint oil) or camphor on or near the breast where baby might ingest it, and do not apply directly on the skin of a baby or young child. There have been cases where the direct application of menthol or camphor products (for example, Vicks VapoRub™) to baby's skin resulted in severe breathing difficulties or liver problems (see info on colds and congestion in baby).
  • Cayenne pepper: Sprinkle it on your food, or put a quarter teaspoon in a glass of water and drink.
  • Drink fenugreek tea to relieve head and chest congestion and cough.
  • Massage can help with sinus problems
  • What To Do When You Have Sinus Pain by Allison Ishman

Chest congestion

  • Anise steam treatment: Boil a pot of water, remove from the stove and add about 3 teaspoons of dried anise. Drape a bath towel over your head and breathe deeply for 5 minutes. Do this 3x a day to help keep the chest clear.
  • Drink fenugreek tea to relieve head and chest congestion and cough.

Sore, itchy throat and/or cough

  • Drink strong black tea (use 2 tea bags per cup).
  • Drink hot lemonade with honey. Or make a mixture of one part lemon juice and two parts honey. Sip throughout the day.
  • Drink fenugreek tea to relieve head and chest congestion and cough.
  • Use Zinc gluconate lozenges, but avoid taking large amounts of zinc for more than seven days, because it can interfere with other minerals in the body.
  • Salt water gargle:
    Mix a 1 tablespoon of salt in eight ounces of warm water. Gargle the whole mixture (don't swallow) several times a day.
  • Apple-cider vinegar and water gargle.
    Mix 1-6 teaspoons (1/3 – 2 tablespoons) vinegar in a glass of water; you can mix it as strong as you can stand it. Gargle one mouthful (swallow afterward or spit it out). Repeat twice. Do this every hour, or as needed.
  • Slippery elm bark can help with sore throat and cough. It comes in herbal cough drops and throat lozenges (check the other ingredients!), or you can make a tea. For tea, use 1 to 3 teaspoons of powdered bark per cup, boil and simmer 15 minutes. Up to 3 cups per day.
  • Chamomile tea gargle (you can also drink the tea)
  • Goldenseal tea gargle (use every 2 hours or as needed)

Medications generally regarded as safe

General guidelines

  • Treat only the symptoms you have: avoid a combination medicine when a single one will do the job.
  • Short-acting forms of drugs (6 hours or less) are generally better than the long-acting varieties (but see the info below on the nonsedating antihistamines).
  • Use nasal spray instead of oral medications when possible (see below).
  • Take any medication right AFTER you nurse and only as needed.

The 2004 edition of Medications and Mothers' Milk by Thomas Hale, PhD has information on many cold medications (including specific guidance on combination products) in the Appendix (p. 874-889). Many of the active ingredients in cold and allergy medications are listed below.

Cough & sore throat meds

  • Sore throat sprays or lozenges are generally considered safe, as are cough drops. Avoid eating excessive amounts of cough drops containing menthol. Large amounts of menthol can reduce milk supply.
  • Many forms of Robitussin, Delsym and Benylin are considered compatible with breastfeeding. Always check the active ingredients, as there are many versions.

Cough Medicines

Name of medication

AAP approved?*

Lactation Risk Category**


Pain meds

Both Advil/Motrin (Ibuprofen) and Tylenol (Acetaminophen) are considered compatible with breastfeeding and are approved by the AAP for use in nursing moms.

Aleve (Naproxen) is also AAP-approved for nursing mothers, but (per Hale) should be used with caution due to its long half-life and its effect on baby's cardiovascular system, kidneys and GI tract; short-term, infrequent or occasional use is not necessarily incompatible with breastfeeding.

Aspirin use is discouraged in children and nursing mothers due to the risk of Reye's syndrome and internal bleeding.

See Pain medications and breastfeeding for more information.


Eye drops

Eye drops designed for cold/allergy symptom relief are considered compatible with breastfeeding.

Nasal sprays or gels

Nasal sprays are generally considered compatible with breastfeeding.

Of the preparations available for treatment of allergic symptoms, the nasal steroids (e.g., Flonase, NasalCrom) are considered to be, by far, some of the most effective and safest to use in breastfeeding moms. Although there is so far no data specifically on these intranasal steroids, it is known that the plasma levels of the drug are extremely low, and thus milk levels would be even lower.

Nasal sprays containing oxymetazoline are probably not a problem, but oxymetazoline is long-acting and thus not the first choice for nursing mothers. A shorter acting alternative is phenylephrine.

Zicam, a homeopathic nasal gel containing ionic zinc gluconate, is generally considered to be compatible with breastfeeding. Zicam contains small amounts of zinc (Zincum Gluconicum) – 266 micrograms per squirt; in one study (Mossad 2003) the daily dosage used was 2.1 mg per day. Zinc is considered compatible with breastfeeding, particularly in small amounts (excessive amounts are not a good idea, for mom's sake rather than baby's). In addition, nasal sprays/gels are generally a better choice for nursing moms as compared to oral medicines. The amount of systemic absorption of nasal sprays/gels is minimal compared to oral ingestion. Although not related to lactation, it should be noted that there are reports of loss of smell resulting from the use of intranasal zinc gluconate (see Jafek BW, Linschoten MR, Murrow BW. Anosmia after intranasal zinc gluconate use. Am J Rhinol. 2004 May-Jun;18(3):137-41).

Nasal Sprays



Mom's use of many forms of Sudafed, Dimetapp and Actifed are considered to be safe for the breastfed baby, but always check the active ingredients, as there are many versions of these medications.

Sudafed (pseudoephedrine, a decongestant) and Actifed (pseudoephedrine plus triprolidine, an antihistamine) are reported safe for baby, and both pseudoephedrine and triprolidine are approved by the AAP for use in nursing moms and pass into breastmilk in minimal amounts.

Milk supply: Pseudoephedrine (Sudafed) may reduce milk supply. Thomas Hale Ph. D., a renowned breastfeeding pharmacologist (Breastfeeding Pharmacology), has recently said that he recommends using caution with Sudafed or any product containing pseudoephedrine:

"Preliminary studies from our laboratories suggest that in some mothers, a significant reduction in milk volume and prolactin levels may result following exposure to pseudoephedrine. While the amount of pseudoephedrine in milk is not clinically relevant, the reduction in milk supply is concerning." (Medications' and Mothers' Milk by Thomas Hale, PhD, 2002 edition, p. 605.)

Dr. Hale was speaking of this study, which is now complete: Aljazaf K, et. al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 Jul;56(1):18-24.

If you do take pseudoephedrine and notice a drop in milk supply (many moms do not, but recent research shows that it can decrease milk supply by as much as 30%), simply stop the medication and take measures to increase milk supply – the problem should resolve fairly quickly.

Be very cautious about taking pseudoephedrine on a regular basis, as it has the potential to permanently decrease your milk supply. Regular use of pseudoephedrine (120 mg/day) has been used to decrease milk production in moms with overproduction, where the usual methods to regulate milk production were not working.


Name of medication

AAP approved?*

Lactation Risk Category**

*  Per the AAP Policy Statement The Transfer of Drugs and Other Chemicals Into Human Milk, revised September 2001.
** Per Medications' and Mothers' Milk by Thomas Hale, PhD (2002 edition)



Mom's use of Benadryl and Chlor-Trimeton are generally regarded to be compatible with breastfeeding, but always double-check the active ingredients. Monitor your infant for possible drowsiness if you use an antihistamine. The non-sedating antihistamines (below) are generally preferred and are less likely to sedate baby.

The ingredients of Claritin, Claritin-D, Allegra, Allegra-D, Actifed (the decongestant pseudoephedrine plus triprolidine) and Seldane have been approved by the AAP for use by nursing moms. Loratadine (Claritin) has been studied and the amount of loratadine that passes into breastmilk is extremely low. Claritin-D and Allegra-D have pseudoephedrine added (which is AAP approved, but see above about possible effect on milk supply). Dr. Hale has said that he prefers the nonsedating antihistamines (even though they are long-acting) over the sedating allergy medications.

Zyrtec is also generally considered to be compatible with breastfeeding. It is commonly used by nursing moms, although its levels in milk are not known. Hale rates Zyrtec in the lactation risk catagory L2 (safer).

Clarinex (desloratadine): Desloratadine is another name for descarboethoxyloratadine, which is the main metabolite (breakdown product) of Claritin (loratadine). Per one study (Hilbert J, Radwanski E, Affrime MB et al. Excretion of loratadine in human breast milk. J Clin Pharmacol.1988:28:234-9), 0.019% of the descarboethoxyloratadine was transferred into breastmilk. Since Claritin (and thus its active metabolites, too) is considered safe for nursing moms (it's AAP approved, in fact), Clarinex should not be a problem either.

Milk supply: A common concern is that antihistamines might lower milk supply but, per Dr. Thomas Hale, there is no current research supporting this belief. If you feel that your supply has decreased, it could simply be a byproduct of decreased nursing frequency or dehydration due to your illness.

If you feel that a medication is the cause of a sudden drop in milk supply, then stop taking (or decrease your use of) the medication – if the med is indeed the cause, then supply should increase again soon after you stop taking it. When using an antihistamine, it can be helpful to step up your fluid intake quite a bit. As with any medication, take it only as needed, and discontinue use as soon as you can.




Page last modified: 05/24/2005
Written: 12/11/1998


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Thank you, kellymom.com




  1. Crystle said,

    Thank you so much for this. Here it is 2am, I really need something for my allergies and my allergist gave me Zyrtec. I have been searching everywhere for some information, because do you think I remembered to bring it up to our pedi at our visit last week?
    I am happy with your results, and I am taking a pill and off to bed. Thank you again!

  2. ann said,

    are there any medicines to stop the production of breastmilk? i just breastfed my baby for 2 weeks and i stopped beastfeeding because the baby is away from me and i had to work.

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