Class	Drug	Risks to infants during breastfeeding	Effects on milk supply
Intranasal corticosteroids	Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone Mometasone Triamcinolone	Probably safe due to low bioavailability	No effect on milk supply
First-generation oral antihistamines	Chlorpheniramine Diphenhydramine	Probably safe due to low bioavailability; observe for sedation in infants	May reduce milk supply
Second-generation oral antihistamines	Cetirizine Desloratadine Fexofenadine Levocetirizine (Xyzal) Loratadine	Probably safe due to low bioavailability; no sedative effects	May reduce milk supply
Intranasal antihistamine	Azelastine	Probably safe due to low bioavailability; observe for sedation in infants at higher doses	May reduce milk supply at higher doses
Combination intranasal corticosteroid and antihistamine	Azelastine/fluticasone (Dymista) Olopatadine/mometasone (Ryaltris)	Probably safe due to low bioavailability; observe for sedation in infants at higher doses	May reduce milk supply at higher doses
Oral decongestants	Pseudoephedrine	Probably safe due to low bioavailability; observe for agitation in infants	Reduces milk supply through reduced levels of prolactin
Intranasal mast cell stabilizer	Cromolyn	Probably safe due to low bioavailability	No effect on milk supply
Intranasal anticholinergics	Ipratropium (Atrovent)	Probably safe due to low bioavailability	No effect on milk supply
Leukotriene receptor antagonists	Montelukast	Probably safe due to low bioavailability; U.S. Food and Drug Administration boxed warning for use in people younger than 18 years because of mood-related changes and suicidality	Reduces milk supply through reduced levels of prolactin