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Staff | Administration

by Philip O. Anderson, PharmD, FASHP, FCSHP
Director, Drug Information Service, University of California San Diego Medical Center
Clinical Professor of Pharmacy, University of California San Diego & University of California San Francisco

Avoid

These drugs should be avoided during lactation if possible.  If they are essential to the mother's health, breastfeeding may have to be discontinued temporarily or permanently.

Amantadine* Amiodarone Antilipemics (excluding resins) Antineoplastic Agents Aspirin (large doses) Bromide

Cocaine Chloramphenicol** Clozapine Dipyrone (dipirona in Mexican drugs) Gold Salts High-dose Iodide (including topical)

Indandione Anticoagulants Metamizol (same as dipyrone) Radiopharmaceuticals  (withhold breastfeeding temporarily) Salicylates (large doses)

Potentially Hazardous

Although not absolutely contraindicated, an alternative drug in the same class should be used from one of the lists below, particularly while breastfeeding an infant of 2 months of age or less.

Acebutolol Alcohol (daily use or large amounts) Atenolol Antihistamine/Decongestant    Combinations* Benzodiazepines, long-acting   (e.g., diazepam) Chlorthalidone* Citalopram Clonidine* Contraceptives, Estrogen-Containing* Doxepin Ergotamine

Ethosuximide Fluorescein, Intravenous Fluoxetine Iodinated Contrast Media  (withhold breastfeeding temporarily) Lamotrigine Lithium (monitor infant serum levels) Metronidazole** Nadolol Narcotics  (especially with meperidine, in   addicts or with high doses in   neonates) Nefazodone Nicotine/Smoking*

Nitrofurantoin Phenobarbital (anticonvulsant doses) Piroxicam Primidone Quinolones (norfloxacin preferred) Reserpine Sotalol Sulfonamides, Long-Acting Thiazide Diuretics, Long-Acting   or in High Doses* Venlafaxine

Probably Acceptable in Usual Doses

There are insufficient data to absolutely ensure that these agents have no adverse effects in breastfeeding infants, but if they occur they are probably infrequent and/or mild.  The potential for rare allergic or idiosyncratic reactions should be kept in mind.

ACE Inhibitors (eg, enalapril) Aminoglycoside Antibiotics Anticholinergic Agents* Anticonvulsants   (except ethosuximide, lamotrigine,    phenobarbital primidone) Antihistamines*   (nonsedating types preferred) Antituberculars Azathioprine   (immunosuppressive doses   following organ transplantation) Barbiturates (except phenobarbital) Bupropion Clindamycin Decongestants, Oral*

Ergonovine (short courses)* Fluvoxamine Gadolinium MRI contrast agents Haloperidol (used alone) H2-Receptor Antagonists Hydrochlorothiazide (low doses) Lorazepam Macrolide antibiotics Methimazole (£20 mg/day) Metoclopramide (£14 days) Midazolam Nonsteroidal Anti-Inflammatory Drugs Oxazepam Paroxetine

Phenothiazines (used alone) Propofol Propylthiouracil Quinidine Salicylates (occasional use) Sertraline Spironolactone Sulfisoxazole Sumatriptan Tetracyclines (£14 days) Trazodone Tricyclic Antidepressants   (nortriptyline, desipramine,   preferred; avoid doxepin)

Little Risk in Usual Doses

Although the potential for rare allergic or idiosyncratic reactions should be kept in mind, usual doses pose little risk for the breastfed infant.

Acetaminophen Acyclovir Antacids Bupivacaine Caffeine Cephalosporins Clotrimazole Contraceptives, Progestin-Only Corticosteroids Decongestant Nasal Sprays Digoxin Fexofenadine Fluconazole

Heparin & LMW Heparins Ibuprofen Inhalers, Bronchodilators   & Corticosteroids Insulin (requirement may drop) Labetalol Laxatives, Bulk-Forming and   Stool Softening (eg, Psyllium,   Docusate) Lidocaine Loratadine Magnesium Sulfate Methyldopa Methylergonovine (short courses)

Metoprolol Miconazole Nifedipine Penicillins Propranolol Theophylline Thyroid Replacement Vaccines (except smallpox) Valacyclovir Vancomycin Verapamil Warfarin

*Drug may also inhibit lactation.

**In situations where bottle feeding poses a grave threat to the infant's life, breastfeeding may be undertaken cautiously.

Sources: (1) Anderson PO et al., eds.(2002) Handbook of Clinical Drug Data, 10th ed. McGraw-Hill; (2) Anderson PO (1991) Drug use during breast-feeding Clin Pharm 10:596-624.  (3) UCSD Drug Information Service 619-543-6971. For health professionals and nursing mothers.

Note: The information contained in this document is time-limited. It is current and accurate as of 4/05