Is Levocetirizine Safe in Breastfeeding

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

Second generation antihistamine drug derived from piperazine with a minimal sedative effect and low toxicity even at higher dose. On latest update no published data about breastfeeding were found. However, it is the R-enantiomer of cetirizine which is considered to be safe while breastfeeding. No short or long-term side effects were found in an infant with a mother who was treated with Cetirizine in the first month post delivery for pemphigus (Westermann 2012). Because of a high plasma protein binding capacity, excretion into breast milk seems to be unlikely. The British Society of Immunology and Allergy rates Cetirizine as compatible with breastfeeding (Powell 2007).

Levocetirizine is the -enantiomer of cetirizine. Small occasional doses of levocetirizine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The British Society for Allergy and Clinical Immunology recommends cetirizine, the racemic form of the drug, at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.[1]

Relevant published information on levocetirizine was not found as of the revision date. In one telephone follow-up study, mothers reported irritability and colicky symptoms in 10% of infants exposed to various antihistamines, and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[2]

Antihistamines in relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women.[3][4] However, suckling-induced prolactin secretion is not affected by antihistamine pretreatment of postpartum mothers.[3] Whether lower oral doses of levocetirizine have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.