Levocetirizine

Drug Levels and Effects:




Summary of Use during Lactation:


Levocetirizine is the

R

-enantiomer of cetirizine. Small occasional doses of levocetirizine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The British Society for Allergy and Clinical Immunology recommends cetirizine, the racemic form of the drug, at its lowest dose as a preferred choice if anantihistamineis required during breastfeeding.[1]


Drug Levels:


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:


There are no reports of infants breastfed during maternal therapy with levocetirizine. In one telephone follow-up study, mothers reported irritability and colicky symptoms in 10% of infants exposed to variousantihistamines, and drowsiness was reported in 1.6% of infants. None of the reactions required medical attention.[2]


Possible Effects on Lactation:


Antihistaminesin relatively high doses given by injection can decrease basal serum prolactin in nonlactating women and in early postpartum women.[3][4] However, suckling-induced prolactin secretion is not affected byantihistaminepretreatment of postpartum mothers.[3] Whether lower oral doses of levocetirizine have the same effect on serum prolactin or whether the effects on prolactin have any consequences on breastfeeding success have not been studied. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.


Alternate Drugs to Consider:


Desloratadine,Fexofenadine,Loratadine


References:


1. Powell RJ, Du Toit GL, Siddique N et al. BSACI guidelines for the management of chronic urticaria and angio-oedema. Clin Exp Allergy. 2007;37:631-50. PMID:17456211
2. Ito S, Blajchman A, Stephenson M et al. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993;168:1393-9. PMID:8498418
3. Messinis IE, Souvatzoglou A, Fais N, Lolis D. Histamine H1 receptor participation in the control of prolactin secretion in postpartum. J Endocrinol Investig. 1985;8:143-6. PMID:3928731
4. Pontiroli AE, De Castro e Silva E, Mazzoleni F et al. 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. PMID:7228996



Substance Identification:




Substance Name:

Levocetirizine

CAS Registry Number:

130018-77-8

Drug Class:


Antihistamines

Administrative Information:




LactMed Record Number:


702


Last Revision Date:


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