Clemastine (Tavist) During Breastfeeding

My Darling Wife is both breastfeeding our fourth child and allergic to ragweed pollen. She would rather suffer than poison her milk, and she would rather breathe than not breathe . . . So she asked me to find out whether she could take Tavist, and if there is a generic (read: cheaper) version available.

Cliff's Notes: She can, and there is.

The H-E-B 'pharmacy' told her Tavist had been discontinued. I rolled my eyes when my Darling Wife said this, and reminded her they had also said Sudafed had been discontinued. We routinely buy pseudoephedrine at Walgreens and I anticipated finding clemastine tablets with no problem as well.

First, the science. If you search Google, you will find warnings like:

drugs.com "This medication is not recommended if you are breast-feeding"
emedtv.com "You should not take Tavist if you are breastfeeding."
loveyourbaby.com "AVOID - DO NOT USE while breast feeding"
familyeducation.com "should be avoided during pregnancy and while nursing"
drugstore.com "CLEMASTINE FUMARATE IS EXCRETED IN BREAST MILK. DO NOT BREAST-FEED while taking"

. . . and so on. Then you will also find the occasional reference like:
medforallergy.com "The American Academy of Pediatrics considers that clemastine should be given with caution to breast-feeding mothers" which sounds not only less hyperventilation-inducing, but possibly even benign.

I kept digging. It turns out that all the bold, caps-lock warnings are apparently based on ONE case. A breastfeeding mother was taking phenytoin and carbamazepine, both anti-seizure medications, in addition to her Tavist. Her baby started having ugly systemic symptoms after the mother in question took the clemastine, and the symptoms cleared right up when the mother stopped taking the clemastine. Based on this one case, the American Academy of Pediatrics would rather you

. . . consult with your physician before taking this or any over-the-counter or prescription drug, as rare side effects and drug interactions may occur . . .

If you have a family history of crazy diseases, you likely already know you should NOT take clemastine fumarate. If you are otherwise generally healthy, and breastfeeding, and allergic, go ahead and take your Tavist (or, in our case, Wal-Hist) and keep an eye on your baby on the off chance it does have an adverse reaction. Stop taking clemastine if the baby has symptoms. Clemastine is excreted in urine, and you've got rid of most of it in 12 hours and all of it within a day, so any adverse reactions will likely be <1 day duration. Seek emergency care if you're freaking out about what happens to your baby . . . and bear in mind that the odds are (approximately) 1,003,387,209.37 to 1 that you and your baby will probably be just fine.

There, how hard was that?

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For some non-hysterical further reading, see:

"Drugs in Pregnancy and Lactation: a reference guide to fetal and neonatal risk" By Gerald G. Briggs, Roger K. Freeman, Sumner J. Yaffe

and the aforementioned medforallergy.com clemastine fumarate web page (which also has dosing information for children, toddlers, and infants).