Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 10/11/2025

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