Safety of Commonly Used Drugs in Nursing Mothers
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