Is Flonase safe while breastfeeding?

What does the evidence say about Flonase while breastfeeding?

1. Expert opinion considers inhaled, nasal and oral corticosteroids acceptable to use during breastfeeding. Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. 1
2. No effects in breastfed infants have been reported with any corticosteroid, and relevant published information on maternal and infant drug levels for inhaled fluticasone was not found as of the monograph's revision date. 1
3. When inhaled, sprayed in the nose, or applied topically, fluticasone is absorbed into the body in lower amounts than medication taken by mouth, and the amount passing into breast milk after nasal spray use is likely small and not expected to cause side effects. 2
4. Budesonide, a nasal steroid in the same class, provides the measured numbers this class otherwise lacks: inhaled budesonide gives a relative infant dose of 0.3 percent, peak milk concentrations of 168 ng/L after a 200 mcg dose and 335 ng/L after 400 mcg, and infants tested had undetectable serum budesonide. 3
5. For the topical form, only extensive application of the most potent corticosteroids is thought capable of causing systemic effects in the mother, so short-term topical corticosteroid use is unlikely to pose a risk to a breastfed infant through milk. 4

How Flonase changes by nursing stage

• Early weeks. The newborn weeks. Nothing about a nasal steroid is expected to reach your baby in a meaningful amount, since sprayed fluticasone is absorbed into the body in lower amounts than a medication taken by mouth. What is not established is a measured milk level, because none has been published.
• Established nursing. Established feeding, around three months. If you want a number rather than an expectation, budesonide is the corticosteroid with actual milk data: a relative infant dose of 0.3 percent for the inhaled form, with all tested infants showing undetectable serum levels.
• Weaning. Older baby and longer allergy seasons. A nasal steroid works locally over days rather than in a single dose, so it suits a whole season better than a rebound-prone decongestant spray. There is no published information on effects on milk production either way.