Promethazine and Breastfeeding

Summary of use during 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.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

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.

Alternative drugs to consider

Prochlorperazine

References

1. MessinisIE SouvatzoglouA FaisN Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Invest 1985 8 143 6 3928731 PubMed
2. PontiroliAE De Castro e SilvaE MazzoleniF The effect of histamine and H1 and H2 receptors on prolactin and luteinizing hormone release in humans: Sex differences and the role of stress. J Clin Endocrinol Metab 1981 52 924 8 7228996 PubMed
3. HildebrandtHM Maternal perception of lactogenesis time: A clinical report. J Hum Lact 1999 15 317 23 10776182 PubMed