Category Archives: Breastfeeding and Drugs

Breastfeeding and Drugs: Drugs Deemed Safe

Information about what drugs are safe to use during breastfeeding.breastfeeding

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her physician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed safe to take by the American Academy of Pediatrics.

Maternal Medication Usually Compatible With Breastfeeding and any effects on the baby :

Acetaminophen
Acetazolamide
Acitretin
Acyclovir — Drug is concentrated in human milk
Alcohol (ethanol) — With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g/kg daily decreases milk ejection reflex
Allopurinol
Amoxicillin
Antimony
Atropine
Azapropazone (apazone)
Aztreonam
B1 (thiamin)
B6  (pyridoxine)
B12
Baclofen
Barbiturate
Bendroflumethiazide  — Suppresses lactation
Bishydroxycoumarin (dicumarol)
Bromide  — Rash, weakness, absence of cry with maternal intake of 5.4 g/d
Butorphanol
Caffeine — Irritability, poor sleeping pattern, excreted slowly; no effect with moderate intake of caffeinated beverages (2–3 cups per day)
Captopril
Carbamazepine
Carbetocin
Carbimazole — Goiter
Cascara
Cefadroxil
Cefazolin
Cefotaxime
Cefoxitin
Cefprozil
Ceftazidime
Ceftriaxone
Chloral hydrate —  Sleepiness
Chloroform
Chloroquine
Chlorothiazide
Chlorthalidone — Excreted slowly
Cimetidine — Drug is concentrated in human milk
Ciprofloxacin
Cisapride
Cisplatin — Not found in milk
Clindamycin
Clogestone
Codeine
Colchicine
Contraceptive pill with estrogen/progesterone — Rare breast enlargement; decrease in milk production  and protein content (not confirmed in several studies)
Cycloserine
D (vitamin) —  follow up infant’s serum calcium level if mother receives pharmacological doses
Danthron — Increased bowel activity
Dapsone —  sulfonamide detected in infant’s urine 191, 219
Dexbrompheniramine maleate with d-isoephedrine — Crying, poor sleeping patterns, irritability
Diatrizoate
Digoxin
Diltiazem
Dipyrone
Disopyramide
Domperidone
Dyphylline — Drug is concentrated in human milk
Enalapril
Erythromycin — Drug is concentrated in human milk
Estradiol — Withdrawal, vaginal bleeding
Ethambutol
Ethanol (cf. alcohol)
Ethosuximide — drug appears in infant serum
Fentanyl
Fexofenadine
Flecainide
Fleroxacin — One 400-mg dose given to nursing mothers; infants not given breast milk for 48 hours
Fluconazole
Flufenamic acid
Fluorescein
Folic acid
Gadopentetic (Gadolinium)
Gentamicin
Gold salts
Halothane
Hydralazine
Hydrochlorothiazide
Hydroxychloroquine — Drug is concentrated in human milk
Ibuprofen
Indomethacin — Seizure (1 case)
Iodides — May affect thyroid activity; see iodine
Iodine — Goiter
Iodine (povidone-iodine, eg, in a vaginal douche) — Elevated iodine levels in breast milk, odor of iodine on infant’s skin
Iohexol
Iopanoic acid
Isoniazid– acetyl (hepatotoxic) metabolite secreted but no hepatotoxicity reported in infants
Interferon-a
Ivermectin
K1 (vitamin)
Kanamycin
Ketoconazole
Ketorolac
Labetalol
Levonorgestrel
Levothyroxine
Lidocaine
Loperamide
Loratadine
Magnesium sulfate
Medroxyprogesterone
Mefenamic acid
Meperidine
Methadone
Methimazole (active metabolite of carbimazole)
Methohexital
Methyldopa
Methyprylon — Drowsiness
Metoprolol — Drug is concentrated in human milk
Metrizamide
Metrizoate
Mexiletine
Minoxidil
Morphine — infant may have measurable blood concentration
Moxalactam
Nadolol — Drug is concentrated in human milk
Nalidixic acid — Hemolysis in infant with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
Naproxen
Nefopam
Nifedipine
Nitrofurantoin — Hemolysis in infant with G-6-PD deficiency 305
Norethynodrel
Norsteroids
Noscapine
Ofloxacin
Oxprenolol
Phenylbutazone
Phenytoin — Methemoglobinemia (1 case)
Piroxicam
Prednisolone
Prednisone
Procainamide
Progesterone
Propoxyphene
Propranolol
Propylthiouracil
Pseudoephedrine — Drug is concentrated in human milk
Pyridostigmine
Pyrimethamine
Quinidine
Quinine
Riboflavin
Rifampin
Scopolamine
Secobarbital
Senna
Sotalol
Spironolactone
Streptomycin
Sulbactam
Sulfapyridine — Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk
Sulfisoxazole — Caution in infant with jaundice or G-6-PD deficiency and ill, stressed, or premature infant; appears in infant’s milk
Sumatriptan
Suprofen
Terbutaline
Terfenadine
Tetracycline — negligible absorption by infant
Theophylline — Irritability
Thiopental
Thiouracil — drug not used in United States
Ticarcillin
Timolol
Tolbutamide — Possible jaundice
Tolmetin
Trimethoprim/sulfamethoxazole
Triprolidine
Valproic acid
Verapamil
Warfarin
Zolpidem

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Breastfeeding and Drugs: Drugs Deemed Not Safe

Information about what drugs are NOT safe to use during breastfeeding.

A common reason for the cessation of breastfeeding is the use of medication by the nursing mother and advice by her breastfeedingphysician to stop nursing.  Of course, if you don’t have to take drugs, whether they are over the counter, or prescription, it is always for the best.

This information is important not only to protect nursing infants from untoward effects of maternal medication but also to allow effective pharmacological treatment of breastfeeding mothers.

Below is a list of drugs deemed NOT safe to take by the American Academy of Pediatrics.

Cytotoxic Drugs That May Interfere With Cellular Metabolism of the Nursing Infant:

Cyclophosphamide  — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
Cyclosporine —  Possible immune suppression; unknown effect on growth or association with carcinogenesis
Doxorubicin* — Possible immune suppression; unknown effect on growth or association with carcinogenesis
Methotrexate — Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia
* Drug is concentrated in human milk.

Drugs of Abuse for Which Adverse Effects on the Infant During Breastfeeding Have Been Reported*

Amphetamine† — Irritability, poor sleeping pattern
Cocaine — Cocaine intoxication: — irritability, vomiting, diarrhea, tremulousness, seizures
Heroin — Tremors, restlessness, vomiting, poor feeding
Marijuana — Only 1 report in literature; no effect mentioned; very long –half-life for some components
Phencyclidine — Potent hallucinogen
* The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother.
† Drug is concentrated in human milk.

Radioactive Compounds That Require Temporary Cessation of Breastfeeding*

Copper 64 (64Cu) — Radioactivity in milk present at 50 h
Gallium 67 (67Ga) — Radioactivity in milk present for 2 wk
Indium 111 (111In) — Very small amount present at 20 h
Iodine 123 (123I) — Radioactivity in milk present up to 36 h
Iodine 125 (125I) — Radioactivity in milk present for 12 d 42
Iodine 131 (131I) —  Radioactivity in milk present 2–14 d, depending on study
Iodine131 — If used for treatment of thyroid cancer, high radioactivity may prolong exposure to infant
Radioactive sodium — Radioactivity in milk present 96 h
Technetium 99m (99mTc), 99mTc
macroaggregates, 99mTc O4 — Radioactivity in milk present 15 h to 3 d
* Consult nuclear medicine physician before performing diagnostic study so that radionuclide that has the shortest excretion time in breast milk can be used. Before study, the mother should pump her breast and store enough milk in the freezer for feeding the infant; after study, the mother should pump her breast to maintain milk production but discard all milk pumped for the required time that radioactivity is present in milk. Milk samples can be screened by radiology departments for radioactivity before resumption of nursing.

Drugs for Which the Effect on Nursing Infants Is Unknown but May Be of Concern*

Anti-anxiety:
Alprazolam
Diazepam
Lorazepam
Midazolam
Perphenazine
Prazepam†
Quazepam
Temazepam
Antidepressants:
Amitriptyline
Amoxapine
Bupropion
Clomipramine
Desipramine
Dothiepin
Doxepin
Fluoxetine — Colic, irritability, feeding and sleep disorders, slow weight gain
Fluvoxamine
Imipramine
Nortriptyline
Paroxetine
Sertraline†
Trazodone
Antipsychotic:
Chlorpromazine — Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores
Chlorprothixene
Clozapine†
Haloperidol — Decline in developmental scores
Mesoridazine
Trifluoperazine
OTHERS:
Amiodarone — Possible hypothyroidism
Chloramphenicol — Possible idiosyncratic bone marrow suppression
Clofazimine — Potential for transfer of high percentage of maternal dose; possible increase in skin pigmentation
Lamotrigine —  Potential therapeutic serum concentrations in infant
Metoclopramide† — dopaminergic blocking agent
Metronidazole — In vitro mutagen; may discontinue breastfeeding for 12–24 h to allow excretion of dose when single-dose therapy given to mother
Tinidazole  — See metronidazole
* Psychotropic drugs, the compounds listed under anti-anxiety, antidepressant, and antipsychotic categories, are of special concern when given to nursing mothers for long periods. Although there are very few case reports of adverse effects in breastfeeding infants, these drugs do appear in human milk and, thus, could conceivably alter short-term and long-term central nervous system function.
† Drug is concentrated in human milk relative to simultaneous maternal plasma concentrations.

Drugs That Have Been Associated With Significant Effects on Some Nursing Infants and Should Be Given to Nursing Mothers With Caution*

Acebutolol — Hypotension; bradycardia; tachypnea
5-Aminosalicylic acid — Diarrhea (1 case) ,  Aspirin; Reye’s Syndrome
Atenolol — Cyanosis; bradycardia
Bromocriptine — Suppresses lactation; may be hazardous to the mother
Aspirin — (salicylates) Metabolic acidosis (1 case),  Reye’s Syndrome
Clemastine — Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness (1 case)
Ergotamine — Vomiting, diarrhea, convulsions (doses used in migraine medications)
Lithium — One-third to one-half therapeutic blood concentration in infants
Phenindione — Anticoagulant: increased prothrombin and partial thromboplastin time in 1 infant; not used in United States
Phenobarbital — Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (1 case)
Primidone — Sedation, feeding problems
Sulfasalazine (salicylazosulfapyridine) — Bloody diarrhea (1 case), Reye’s Syndrome
* Blood concentration in the infant may be of clinical importance

 

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