Of the wide range of drugs used to treat respiratory conditions, few have any serious concerns for use in nursing mothers. Inhaled drugs used for respiratory conditions, including nasal sprays, pose little or no risk to the breastfed infant. Oral corticosteroids in dosages used for respiratory conditions do not require any special precautions in nursing mothers. Older antihistamines and pseudoephedrine can cause minor adverse effects in breastfed infants and decrease milk supply, so are best avoided, especially during early postpartum before milk supply is well established. Theophylline can cause stimulation in breastfed infants, so maternal drug levels should be kept low. Omalizumab has relatively extensive use in nursing mothers with no adverse infant effects reported. Other monoclonal antibodies are also unlikely to cause adverse effects, but they have not been studied. Montelukast is the leukotriene receptor antagonist of choice. Roflumilast is a new drug that is currently recommended to avoid in nursing mothers, but further study might indicate that it is acceptable. © Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.
