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| Safety of Commonly Used Drugs in Nursing Mothers
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by Philip O. Anderson, Pharm.D., FASHP
Director, Drug Information Service, University of California San Diego
Medical Center and Clinical Professor of Pharmacy, University of California San Francisco
| Contraindicated.
These drugs should not be used during lactation. If they are essential to the mother's health, breastfeeding should be discontinued temporarily or permanently. |
| Name of Drug |
Brand Name |
Use |
Amantadine *
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Symmetrel, Symadine
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Anti-viral
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Amiodarone
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Cordarone
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Anti-arrhythmic
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Antilipemics (excluding resins)
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(Lipid-lowering drugs) Lescol, Lipitor, Lopid, Mevacor, Pravachol, Zocor
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Use to lower cholesterol
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Antineoplastic Agents
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Cancer drugs
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Treat cancer
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Aspirin (large doses)
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Analgesic
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Bromides
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Sedatives
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Chloramphenicol **
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Chloromycetin
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Antibiotic
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Clozapine
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Clozaril
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Antipsychotic; sedative
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Cocaine
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Crack
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Dipyrone (dipirona in Mexican drugs)
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Banned in US
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Analgesic/anti-inflammatory
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Gold Salts
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Ridaura, Myochrysine, Solganal
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Anti-inflammatory
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Iodide (including topical forms)
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Betadine
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Used to treat minor scrapes and cuts
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| Indandione Anticoagulants |
(eg, Phenindione)
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anticoagulant
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Metamizol (same as dipyrone)
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Metronidazole **
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Flagyl, Metizol, Noritate, Protostat, Trikacide
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Antibiotic
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Radiopharmaceuticals (withhold breastfeeding temporarily)
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Salicylates (large doses)
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Aspirin
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Used to treat arthritis
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| Potentially Hazardous. Although not generally contraindicated, these agents should be used with caution and avoided if possible, particularly while breastfeeding a newborn. |
| Name of Drug |
Brand Name |
Use |
Acebutolol
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Sectral
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Antihypertensive beta blocker
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Alcohol (especially large amounts)
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Atenolol
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Tenormin, Tenoretic
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Antihypertensive beta blocker
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Antihistamine/Decongestant Combinations *
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Used to treat colds and allergies
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Benzodiazepines (lorazepam, oxazepam preferred)
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Used to treat anxiety and for sleep
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Chlorthalidone *
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Hygroton
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Diuretic
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Citalopram
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Celexa
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Antidepressant
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Clindamycin
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Cleocin
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Antibiotic
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Clonidine *
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Catapres
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Antihypertensive
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Contraceptives, Estrogen-Containing *
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Birth control
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Doxepin
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Adapin, Sinequan
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Antidepressant
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Ergotamine
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Cafergot, Wigraine, Ergostat, Ergomar, DHE45
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Anti-migraine
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Ethosuximide
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Zarontin
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Anticonvulsant used for epilepy
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Fluorescein (IV)
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Diagnostic dye
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Fluoxetine
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Prozac
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Anti-depressant
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Iodinated Contrast Media (withhold breastfeeding temporarily)
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Used to examine kidneys
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Lithium
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Antimanic drug in used for bipolar disorders
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Nadolol
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Corgard
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Antihypertensive, antiangina, beta-blocker
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Narcotics (in addicts or with high doses in first 10 days postpartum)
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Used for pain relief
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Nicotine/Smoking *
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Nitrofurantoin
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Furadantin, Macrobid, Macrodantin, Furan
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Urinary tract antibiotic
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Phenobarbital (anticonvulsant doses)
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Barbiturate sedative, anticonvulsant
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Piroxicam
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Feldene
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Nonsteroidal analgesic for arthritis
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Quinolone Antibacterials (Norfloxacin/Noroxin preferred)
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Antibiotic
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Reserpine
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Raudixin, Serpasil
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Antihypertensive
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Sotalol
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Betapace
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Antihypertensive, beta-blocker
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Sulfonamides
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Used to treat infections
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Thiazide Diuretics, Long-Acting or in High Doses *
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Used to treat high blood pressure and to help reduce the amount of water in the body by increasing the flow of urine
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| Venlafaxine |
Effexor
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Antidepressant, SSRI
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| Probably Safe 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. |
| Name of Drug |
Brand Name |
Use |
| ACE Inhibitors (eg, enalapril) |
Benazepril HCL (Lotensin, Lotrel), Bepridil HCL (Vascor, Bepadin), Captopril (Capoten), Enalapril Maleate (Vasotec), Fosinopril (Monopril), Lisinopril (Zestril, Prinivil), Quinapril (Accupril, Accuretic), Ramipril (Altace)
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Antihypertensive
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Acyclovir & Valacyclovir
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Zovirax, Valtrex
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Antiviral for herpes simplex
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Aminoglycoside Antibiotics
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Amikacin (Amikin), Gentamicin (Garamycin), Kanamycin (Kantrex), Netilmicin (Netromycin), Streptomycin, Tobramycin (Nebcin, Tobrex)
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Antibiotics
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Anticholinergic Agents *
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Used to relieve cramps or spasms of the stomach, intestines, and bladder
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Anticonvulsants (AVOID ethosuximide phenobarbital, and primidone)
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Used to control certain types of seizures in the treatment of epilepsy
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Antihistamines * (nonsedating types preferred)
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Used to treat hay fever and allergies. Babies are more susceptible to the side effects of antihistamines, such as unusual excitement or irritability.
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Antituberculars (Isoniazid)
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INH, Laniazid
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Used to treat tuberculosis
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Azathioprine (immunosuppression following organ transplantation)
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Imuran
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Used after organ transplants
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Barbiturates (except phenobarbital)
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Sedative, pain reliever
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Decongestants, Oral *
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Used to relieve sinus and nasal congestion, headache of colds, allergy, and hay fever
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Ergonovine *
(short courses)
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Postpartum uterine bleeding
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Fluconazole
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Diflucan
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Antifungal, particularly candida infections
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Gadolinium MRI contrast agents
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Haloperidol
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Haldol
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Antipsychotic
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H2-Receptor Antagonists (Famotidine, preferred)
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Pepcid, Pepcid-AC, Axid-AR
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Used to relieve and/or prevent heartburn, acid indigestion, and sour stomach
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Lorazepam
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Ativan
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Antianxiety sedative
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Methimazole (20 mg/day)
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Tapazole
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Used to treat hyperthyroidism (use 20mg/day or less)
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Metoclopramide (14 days)
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Reglan
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GI stimulant, prolactin stimulant
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Nifedipine
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Adalat; Procardia
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Antihypertensive calcium channel blocker
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Nonsteroidal Anti-Inflammatory Agents (ibuprofen preferred)
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Analgesic
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Oxazepam
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Serax
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Antianxiety drug
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Paroxetine
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Paxil
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Antidepressant, serotonin reuptake inhibitor
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Propylthiouracil
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PTU
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Anti-thyroid
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Quinidine
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Quinaglute, Quinidex
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Antiarrhythmic agent
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Salicylates (occasional use)
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Aspirin
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Analgesic
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Sertraline
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Zoloft
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Antidepressant
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Spironolactone
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Aldactone
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Diruetic
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Sulfisoxazole
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Gantrisin, Azo-Gantrisin
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Sulfonamide antibiotic
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Sumatriptan
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Imitrex
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Anti-migraine medication
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Tetracyclines (#14 days)
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Achromycin, Sumycin, Terramycin
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Antibiotic (use no more than 14 days)
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Trazodone
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Desyrel
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Antidepressant, serotonin reuptake inhibitor
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Tricyclic Antidepressants (avoid doxepin)
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Nortriptyline (Aventyl, Pamelor), Desipramine (Norpramin, Pertofrane), preferred
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used to relieve mental depression
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| Verapamil |
Calan, Isoptin, Covera-HS
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Calcium channel blocker for hypertension
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| 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
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Tempra, Tylenol, Paracetomol
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Analgesic
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Antacids
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Used to relieve heartburn, sour stomach, or acid indigestion
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Bupivacaine
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Marcaine
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Local anesthetic
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Caffeine
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Cephalosporins
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Used in treatment of bacterial infections
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Clotrimazole
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Gyne-Lotrimin, Mycelex, Lotrimin, Fem Care
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Antifungal
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Contraceptives, Progestin-Only
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Corticosteroids
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Decongestant Nasal Sprays
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Digoxin
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Lanoxin
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Cardiac stimulant
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Erythromycin
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Fluconazole
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Diflucan
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Antifungal, particularly candida infection
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Heparin &
LMW Heparins
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Anticoagulant
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Ibuprofen
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Advil, Nuprin, Motrin
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Analgesic
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Inhalers, Bronchodilators, & Corticosteroids
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Insulin (requirement may drop)
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Labetalol
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Trandate, Normodine
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Antihypertensive beta-blocker
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Laxatives, Bulk-Forming and Stool Softening (eg, Psyllium, Docusate)
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Lidocaine
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Xylocaine
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Local anesthetic
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Magnesium Sulfate
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Saline laxative and anticonvulsant
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Methyldopa
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Aldomet
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Antihypertensive
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Methylergonovine (short courses)
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Methergine
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Vasoconstrictor, uterine stimulant
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Metoprolol
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Toprol XL, Lopressor
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Antihypertensive, beta-blocker
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Miconazole
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Monistat IV, Monistat 3, 7
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Antifungal for candida infections
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Penicillins
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Antibiotics
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Propranolol
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Inderal
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Beta-blocker, antihypertensive
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Theophylline
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Bronkodyl; Elixophyllin; Slo-bid; Slo-Phyllin; Theo-24; Theo-Dur; Theolair; Uniphyl
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Used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases
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Thyroid Replacement
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Used to treat thyroid diseases
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Vaccines (all)
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Vancomycin
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Vancocin
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Antibiotic
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| Warfarin |
Coumadin
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Anticoagulant
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* 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 1-900-226-7536. $4 for first minute, $2.50/minute thereafter. For health professionals and nursing mothers.
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