Pseudoephedrine use during breastfeeding
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Pseudoephedrine and Breastfeeding: Effects on Milk Production
Pseudoephedrine, a common decongestant, is known to reduce breast milk production in breastfeeding women. Multiple studies have shown that pseudoephedrine can significantly decrease milk volume, with one controlled study reporting a 24% reduction in daily milk output after a single 60 mg dose compared to placebo. This reduction is likely related to a decrease in prolactin, the hormone responsible for milk production, although the change in prolactin was not always statistically significant 368.
Pseudoephedrine is sometimes used intentionally to manage hyperlactation (excessive milk production) when other methods fail. In such cases, careful dose adjustment under professional supervision has allowed mothers to control milk supply without apparent harm to themselves or their infants .
Infant Exposure to Pseudoephedrine Through Breast Milk
Studies measuring pseudoephedrine levels in breast milk have found that the drug passes into milk in small amounts. The estimated infant dose is about 4–5% of the weight-adjusted maternal dose, which is considered low and unlikely to cause adverse effects in most infants 234. However, infants may still experience mild side effects such as irritability or insomnia, so monitoring is recommended .
Safety and Recommendations for Use During Lactation
Pseudoephedrine is generally considered compatible with breastfeeding by organizations such as the American Academy of Pediatrics, especially when used at the lowest effective dose and for the shortest possible duration 45. Mothers are advised to take the medication after breastfeeding to minimize infant exposure and to avoid combination cold products that may contain other ingredients not recommended during lactation 45.
Despite its compatibility, pseudoephedrine should be used with caution, particularly in mothers struggling to maintain milk supply, as it can inadvertently lead to reduced lactation 568. Non-drug approaches to managing milk supply issues should be tried first, and any use of pseudoephedrine should be discussed with a healthcare provider 16.
Conclusion
Pseudoephedrine can reduce breast milk production and is sometimes used to treat hyperlactation, but it may also cause unwanted decreases in milk supply for mothers who wish to continue breastfeeding. The drug passes into breast milk in small amounts, and while adverse effects in infants are rare, monitoring is advised. Mothers should consult healthcare professionals before using pseudoephedrine while breastfeeding to ensure safe and appropriate use.
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