I am a breastfeeding mother and i want to know if it is safe to use Promethazine? Is Promethazine safe for nursing mother and child? Does Promethazine extracts into breast milk? Does Promethazine has any long term or short term side effects on infants? Can Promethazine influence milk supply or can Promethazine decrease milk supply in lactating mothers?

Promethazine lactation summary

Promethazine usage has low risk in breastfeeding
  • DrLact safety Score for Promethazine is 3 out of 8 which is considered Low Risk as per our analyses.
  • A safety Score of 3 indicates that usage of Promethazine may cause some minor side effects in breastfed baby.
  • Our study of different scientific research indicates that Promethazine may cause moderate to no side effects in lactating mother.
  • Most of scientific studies and research papers declaring usage of Promethazine low risk in breastfeeding are based on normal dosage and may not hold true for higher dosage.
  • While using Promethazine We suggest monitoring child for possible reactions. It is also important to understand that side effects vary largely based on age of breastfed child and time of medication in addition to dosage.
  • Score calculated using the DrLact safety Version 1.2 model, this score ranges from 0 to 8 and measures overall safety of drug in lactation. Scores are primarily calculated using publicly available case studies, research papers, other scientific journals and publically available data.

Answer by Dr. Ru: About Promethazine usage in lactation

1st-generation-antihistamine and phenothiazine-type drug with a strong sedative effect. At latest update relevant published data on excretion into breast milk were not found. It may decrease prolactin levels and interfere with milk production during the first few weeks after birth (Pontiroli 1981, Messinis 1985).Pharmacokinetic data (high volume of distribution and high plasma protein-binding capacity) would render it unlikely a significant passage into the breastmilk.In addition, a low oral bioavailability would hinder a further passage to infant’s plasma through the ingested breastmilk, except on premature infants and immediate neonatal period when there may be an increased intestinal permeability.There are doubts about any association with Sudden Infant Death Syndrome (SIDS) (Kahn 1982, Stanton 1983). It may be considered compatible with breastfeeding on isolated doses such as those used for pre-surgical medication or traveler's dizziness (WHO 2002). Avoid a repeated use as it may cause drowsiness in the infant.Avoid using it in the immediate neonatal period (first 4 to 6 weeks after birth) and in case of prematurity. If used, follow-up the infant for drowsiness and feeding issues. It is not recommended bed-sharing when taking this medication (UNICEF 2006, ABM 2008, Landa 2012, UNICEF 2013).

Answer by DrLact: About Promethazine usage in lactation

Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation. Because promethazine can lower basal prolactin secretion, promethazine might interfere with the establishment of lactation if given during labor, before lactation is well established or with a sympathomimetic such as pseudoephedrine. An antiemetic without potent histamine blocking action is preferred in nursing mothers.

Promethazine Possible Effects in Breastfeeding

Possible Effects on Lactation: Unlike most phenothiazines, promethazine usually causes a reduction in basal prolactin secretion in nonnursing women.[1][2] In one small study, women given promethazine with meperidine and secobarbital during labor, had the time to lactogenesis II prolonged by 14 hours. Women given meperidine or secobarbital without promethazine had lactogenesis II prolonged 7 hours compared to unmedicated women, but the difference was not statistically significant.[3] The effect of postpartum promethazine is not known, but it might interfere with the establishment of lactation if given in the early postpartum period.

Alternate Drugs

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