SAFETY OF COMMONLY USED DRUGS IN NURSING MOTHERS

SAFETY OF COMMONLY USED DRUGS IN NURSING MOTHERS

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.