Last update: Jan. 15, 2020
Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
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A sympathomimetic with alpha-adrenergic activity. It produces peripheral vasoconstriction and increased blood pressure without stimulating effects on the central nervous system.
Used as a decongestant in topical nasal preparations at low concentrations, associated with other drugs, in oral preparations to treat respiratory colds (Nice 2000, Kanfer 1993) and in eye drops at concentrations of up to 10% as a mydriatic. It is also used subcutaneously or intramuscularly in severe hypotensive states and associated with topical anesthetics.
Since the last update we have not found published data on its excretion in breastmilk.
The low dose of phenylephrine in nasal, ophthalmic and topical preparations makes it unlikely to transfer into breastmilk in significant amounts. It is advised to press on the tear duct after administering eye drops in order to decrease absorption. Low plasma concentrations have been recorded at 10 minutes after ophthalmic administration and practically zero at one hour (AEMPS 2017).
Its pharmacokinetic data: very large volume of distribution and high percentage of protein binding (DrugBank online 2019), make transfer to breastmilk in significant amounts unlikely.
Its low oral bioavailability makes hinders transfer to infant plasma from breastmilk, except in premature infants and the immediate neonatal period when there may be greater intestinal permeability.
Nasal and ophthalmic use is authorized in children under one year of age (Pediamecum 2015) and has been used in premature infants (White 2013).
Avoid excessive or prolonged use when taken orally and use the minimum sufficient dose. A similar molecule, pseudoephedrine, can cause decreased milk production (Aljazaf 2003).
Some authors consider decongestant drugs administered orally and nasally to be non-essential medications, to be avoided in general, not only during breastfeeding, since they expose patients to serious risks (cardiovascular, neurological and intestinal) for the treatment of benign disorders such as nasal obstruction, which usually evolves favourably in a few days without medication (Prescrire 2018).
Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
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