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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*

Fluoxetine — Colic, irritability, feeding and sleep disorders, slow weight gain
Chlorpromazine — Galactorrhea in mother; drowsiness and lethargy in infant; decline in developmental scores
Haloperidol — Decline in developmental scores
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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