Safety of Levocetirizine and Montelukast During Breastfeeding

Drug Safety Profile

• The American Academy of Pediatrics and other medical societies suggest that montelukast has extremely low excretion into breast milk, with only about 1% of the maternal dose passing into milk, and extensive metabolism and plasma protein binding further limit infant exposure 1, 2
• Expert consensus, as reported in Rhinology, states that the benefits of breastfeeding overwhelm the risk of exposure to montelukast 1, 2

Alternative Treatment Options

• The European Respiratory Society and other guideline societies may prefer cetirizine and loratadine as alternatives to levocetirizine due to more accumulated safety data 3

Evidence Quality and Recommendations

• The evidence quality is stronger for montelukast, with multiple guidelines and research studies, compared to levocetirizine, which has primarily one high-quality 2024 study, though both are acceptable 1, 2, 3