Safety of Commonly Used Drugs in Nursing Mothers
by Philip O. Anderson, Pharm.D., FASHP

Updated March 2010

Although many medications are safe to use while breastfeeding, most drugs will get into your milk to some degree and may even affect your milk supply. To be safe, check with your child's doctor before taking any kind of medication, even over-the-counter drugs.

The information in our chart was compiled by Philip Anderson, a pharmacist and the editor of LactMed, the U.S. National Library of Medicine's drugs and lactation database. If you have more questions about how a drug you're taking might affect your breast milk or your baby, check the LactMed database online or call the nearest teratogen information service.

Safe 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.
Name of Drug	Brand Name	Use
Acetaminophen	Tylenol	Analgesic
Acyclovir and Valacyclovir	Zovirax, Valtrex	Antiviral for herpes infections
Antacids	Maalox, Mylanta	Used to treat upset stomachs
Bupivacaine	Marcaine	Local anesthetic
Caffeine	Coffee, soft drinks	A stimulant
Cephalosporins	Keflex, Ceclor, Ceftin, Omnicef, Suprax	Antibiotics for lung, ear, skin, urinary tract, throat and bone infections
Clotrimazole	Lotrimin, Mycelex	Used to treat yeast and fungal infections
Contraceptives, Progestin-Only	Micronor, Norplant, Depo-Provera	Used for birth control
Corticosteroids	Prednisone	Used to treat inflammation of joints and other conditions
Decongestant Nasal Sprays	Afrin	Used to treat stuffy noses
Digoxin	Lanoxin	Used to treat heart problems
Erythromycin	E-Mycin, Erythrocin	Used for skin and respiratory infections
Fexofenadine	Allegra	Antihistamine for allergies and hay fever
Fluconazole	Diflucan	Used to treat yeast infections
Heparin & LMW Heparins		Keep blood from clotting
Ibuprofen	Advil, Motrin	Used for pain relief
Inhalers, bronchodilators, and corticosteroids	Albuterol, Vanceril	Used for asthma
Laxatives, bulk-forming and stool softening	Metamucil, Colace	Used to treat constipation
Lidocaine	Xylocaine	A local anesthetic
Loratadine	Claritin	Antihistamine for allergies and hay fever
Low molecular weight heparins (enoxaparin, dalteparin, tinzaparin)	Lovenox, Fragmin, Innohep	Anticoagulants
Magnesium Sulfate		Used to treat preeclampsia and eclampsia
Methyldopa	Aldomet	Used to treat high blood pressure
Methylergonovine (short courses)	Methergine	Used to prevent or control bleeding after childbirth
Metoprolol	Lopressor	A beta-blocker used to treat high blood pressure
Miconazole	Monistat 3	Used to treat yeast infections
Nifedipine	Adalat, Procardia	Used for high blood pressure and Raynaud's syndrome of the nipple
Penicillins	Amoxicillin	Used to treat bacterial infections
Propranolol	Inderal	A beta blocker used to treat heart problems, and high blood pressure
Theophylline	Theo-Dur	Used to treat asthma and bronchitis
Thyroid Replacement	Synthroid	Used to treat thyroid problems
Tretinoin	Retin A	Cream used for acne
Vaccines (except smallpox and yellow fever)
Vancomycin	Vancocin	Antibiotic
Verapamil	Calan, Isoptin, Verelan	Used for high blood pressure
Warfarin	Coumadin	Used to treat or prevent blood clots

Probably Safe in Usual Doses. Little is known about the effects of these drugs on a breastfeeding infant, but if there is an effect, it will probably be mild. In rare cases, a child might have an allergic reaction.
Name of Drug	Brand Name	Use
ACE Inhibitors	Enalapril (Vasotec), Benazepril (Lotensin)	Used to treat high blood pressure
Anticholinergic Agents *	Pro-Banthine	Used to treat intestinal and gall bladder spasms; may reduce milk supply
Anticonvulsants	Depakote, Dilantin, Tegretol (avoid ethosuximide, phenobarbital, and primidone)	Used for seizures and mood disorders
Antihistamines *	Benadryl, Chlor-Trimeton	Used to treat hay fever and allergies. May reduce milk supply and cause infant drowsiness or fussiness
Antituberculars (Isoniazid)	INH	Used to treat tuberculosis
Azathioprine	Imuran	Used to suppress the immune system following organ transplants
Barbiturates (except phenobarbital)	Fiorinal, Fioricet	For sedation and tension headaches
Bupropion	Wellbutrin	For depression
Clindamycin	Cleocin	Used to treat abdominal and vaginal infections
Decongestants, Oral *	Sudafed, Entex PSE	Used to treat congestion associated with colds or allergies; often reduces milk supply
Ergonovine * (short courses)		Used to treat uterine bleeding. May reduce milk supply.
Fluconazole	Diflucan	Antifungal
Gadolinium	Magnevist, Omniscan	Contrast agent for MRI studies
Haloperidol	Haldol	Used to treat psychosis
Histamine H2 Blockers	Cimetidine (Tagamet), ranitidine (Zantac), nizatadine (Axid), and famotidine (Pepcid - preferred)	Used to treat stomach problems
Hydrochlorothiazide (low doses)	HydroDiuril	Diuretic for high blood pressure
Labetalol	Normodyne, Trandate	Used for high blood pressure; caution in preterm infants
Lorazepam	Ativan	Used to treat anxiety
Methimazole	Tapazole	Used for hyperthyroidism; less than 20 mg/day is probably safe
Metoclopramide	Reglan	Used for gastrointestinal problems and to increase milk supply
Midazolam		Sedative used in anesthesia
Naproxen	Naprosyn, Anaprox, Aleve	Used for pain relief; okay if baby is at least 1 month old
Oxazepam	Serax	Used to treat anxiety
Paroxetine	Paxil	Used to treat depression
Phenothiazines	Compazine (anti-nausea), Stelazine, Thorazine (anti-psychotic)
Propofol	Diprivan	Sedative used in anesthesia
Propylthiouracil (PTU)		Used to treat hyperthyroidism
Quinidine		Used to treat heartbeat irregularities
Quinolone antibacterials	Cipro and Levaquin; Noroxin is preferred	Treatment of urinary tract infections
Salicylates (occasional use)	Aspirin	Used for pain relief
Sertraline	Zoloft	Used to treat depression
Spironolactone	Aldactone, Aldactazide	Used to treat high blood pressure
Sumatriptan	Imitrex	Used to treat migraines
Tetracyclines (less than 14 days)	tetracycline, doxycycline	Used to treat acne and urinary tract infections
Trazodone		Used for depression and sleep
Tricyclic Antidepressants (avoid doxepin)	Elavil, Tofranil, Pamelor	Used to treat depression; nortriptyline preferred
Verapamil	Calan, Isoptin, Verelan	Used for high blood pressure

Potentially Hazardous. You should avoid or use these drugs with caution, particularly while breastfeeding a newborn or premature infant.
Name of Drug	Brand Name	Use
Acebutolol	Sectral	A beta blocker used to treat high blood pressure and abnormal heart rhythms.
Atenolol	Tenormin	A beta blocker used to treat high blood pressure and abnormal heart rhythms.
Antihistamine/Decongestant Combinations *	Contac, Dimetapp	Used to treat colds and allergies; may reduce milk supply
Benzodiazepines (lorazepam, oxazepam preferred)	long-acting Librium, Valium, Dalmane	Used to treat anxiety and for sleep (lorazepam, oxazepam preferred)
Chlorthalidone *		Diuretic used to treat high blood pressure; may reduce milk supply
Citalopram	Celexa	Antidepressant; can cause infant drowsiness
Clonidine *	Catapres	Used to treat high blood pressure, may reduce milk supply
Contraceptives, Estrogen-Containing *	Ortho-Novum, Lo-Ovral, Loestrin	Used for birth control; may reduce milk supply
Doxepin	Sinequan	Used to treat depression
Ergotamine	Cafergot	Used to treat migraines
Ethosuximide	Zarontin	Used to treat epilepsy
Fluorescein (IV)		Used to diagnose retinal problems
Fluoxetine	Prozac	Used to treat depression
Iodinated Contrast Media (withhold breastfeeding temporarily)		Used to examine kidneys; withhold breastfeeding temporarily
Lamotrigine	Lamictal	Used for seizures and mood disorders
Lithium (monitor infant serum levels)		Used to treat bipolar disease
Metronidazole	Flagyl	An antibiotic used to treat some intestinal and genital infections
Nadolol	Corgard	A beta blocker used to treat high blood pressure and heart problems
Narcotics, especially meperidine in addicts, or with high doses in neonates	Tylenol #3, Vicodin	Used for pain (one tablet every six hours maximum; watch for drowsiness). Limit to 4 days after milk comes in.
Nefazodone	Serzone	Used for depression
Nicotine*		Smoking can decrease milk supply and toxins in smoke reach the infant
Nitrofurantoin	Macrobid	Used to treat urinary tract infections (safe after the baby is one month old
Phenobarbital (anticonvulsant doses)		Sedative and anticonvulsant
Piroxicam	Feldene	Used to treat arthritis and pain
Primidone	Mysoline	Used to treat seizures
Reserpine		Used to treat hypertension
Sotalol	Betapace	Used to treat heart problems
Thiazide diuretics, long-acting or high doses*	Enduron, Lozol, Renese	edema; high dose may decrease milk supply
Venlafaxine	Effexor	Used to treat depression

Contraindicated. You shouldn't use any of these drugs while breastfeeding. If you must take them for health reasons, you should stop breastfeeding - either temporarily or permanently - depending on how long you need to take them. To keep your milk supply up you can "pump and dump" - that is, use a breast pump and discard what you collect until you're ready to breastfeed again.
Name of Drug	Brand Name	Use
Amantadine *	Symmetrel	Used to treat the flu or Parkinson's disease; may reduce milk supply
Amiodarone	Cordarone	Used to treat heart problems
Antilipemics (excluding resins)	(Lescol, Lipitor, Lopid, Mevacor, Pravacor, Zocor	Used to lower the level of cholesterol in the blood
Antineoplastic Agents		Used to treat cancer
Aspirin (large doses)		Analgesic
Chloramphenicol		Used to treat serious infections
Clozapine	Clozaril	Used to treat schizophrenia
Cocaine
Dipyrone (dipirona in Mexican drugs)		Used for pain and inflammation
Gold Salts	Myochrysine	Used to treat arthritis
Iodide products	Betadine, potassium iodide	Used for douching or as an expectorant
Iodine, Radioactive		Used to diagnose and treat hyperthyroidism
Lipid-lowering drugs	Lescol, Lipitor, Lopid, Mevacor, Pravacor, Zocor	Used to lower the level of fats in the blood
Metamizol (same as dipyrone)		Analgesic/anti-inflammatory. Banned in U.S. but available in Mexico
Salicylates (large doses)	Aspirin	Used to treat arthritis

* Drug may also inhibit lactation.

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