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Drug (FDA Fetal Risk Category/Breast-Feeding Compatibility)
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Effect on Lactation and Adverse Effects on Infant
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Abacavir (C/−)
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CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Acarbose (B/−)
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No human lactation data available. Avoid breast feeding until safety data available.
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Acebutolol (B/−)
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AAP recommends to use cautiously due to adverse effects of hypotension, cyanosis, and bradycardia related to b-blockade.
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Acetaminophen (B/+)
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AAP classifies acetaminophen as compatible with breast feeding.
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Acetylcysteine (B/+)
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No human lactation data available. Probably compatible.
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Acitretin (X/CI)
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Because of the teratogenicity of acitretin, a program called PPET (Pregnancy Prevention Is Essential with Treatment) has been developed to educate women of childbearing potential and their healthcare providers about the serious risks associated with acitretin and to help prevent pregnancies from occurring with the use of this drug and for 3 years after its discontinuation.
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Acyclovir (B/+)
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AAP classifies acyclovir as compatible with breast feeding; breast-feeding mothers with herpetic lesions near or on the breast should avoid breast feeding.
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Adalimumab (C/+)
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Excreted into breast milk in low concentrations. Effects on nursing infant unknown.
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Adenosine (C/+)
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IV drug, used in acute care situations, short half-life.
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Ado-trastuzumab emtansine (X/CI)
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No human lactation data available. Due to potential for serious adverse effects, breast feeding not recommended during treatment and for 7 months following the last dose.
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Albendazole (C/+)
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Probably compatible with a single oral dose. Low oral bioavailability suggests excretion into breast milk not clinically significant. Avoid ingestion with high-fat meal.
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Albiglutide (C/−)
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No human lactation data available. Manufacturer recommends a decision be made to continue nursing or discontinue the drug, taking into account the importance of treatment to the mother.
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Albuterol (C/+)
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Monitor nursing infant for agitation and spitting up. Use inhaled form to decrease maternal absorption. Generally considered acceptable in breast-feeding women when used in usual doses.
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Alendronate (C/+)
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Probably compatible. Low plasma concentrations and rapid plasma clearance suggest minimal amounts excreted into breast milk. Consider monitoring the infant’s serum calcium during the first 2 months postpartum.
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Alfentanil (C/−)
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Used epidurally or intravenously during labor or for a short time immediately postpartum would not be expected to cause adverse effects. Opioid therapy should be avoided in breast-feeding mothers due to potential for apnea and sedation in the infant.
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Allopurinol (C/+)
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Allopurinol and its metabolite are excreted into human milk. AAP classifies allopurinol as compatible with breast feeding.
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Almotriptan (C/+)
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No human lactation data available. Low molecular weight of drug suggests excretion into breast milk but effect on nursing infant is unknown.
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Alogliptin (C/−)
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No human lactation data available. Low molecular weight of drug suggests excretion into breast milk, but effect on nursing infant is unknown. Alternative agents are preferred.
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Alprazolam (D/−)
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Excreted into breast milk. Because of the potent effects on neurodevelopment, probable withdrawal, lethargy, and weight loss in infant, use should be avoided during breast feeding.
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Amantadine (C/CI)
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Excreted into breast milk in low concentrations. Not recommended due to potential for urinary retention, vomiting, and skin rash.
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Amikacin (D/−)
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Low concentrations in breast milk because of poor oral absorption. Risk for modification of bowel flora.
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Amiloride (B/+)
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Excreted into breast milk of lactating rats at higher concentrations than in blood. No human lactation data available. Probably compatible.
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Amiodarone (C/−)
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Long half-life, iodine-containing molecule, neonates should be monitored for thyroid disorders and cardiac arrhythmias with in utero exposure.
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Amitriptyline (C/−)
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Milk/plasma ratio of 1.0. AAP classifies amitriptyline effect on breast feeding as unknown but may be of concern.
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Amlodipine (C/+)
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No human lactation data available. Low molecular weight suggests excretion into breast milk. Effects on nursing infant are unknown. Probably compatible.
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Amoxapine (C/−)
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Active metabolites in milk. AAP classifies amoxapine effect on breast feeding as unknown but may be of concern.
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Amoxicillin (B/+)
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Monitor nursing infant for diarrhea, rash, and somnolence. Potential for allergic sensitization and modification of bowel flora. AAP classifies amoxicillin as compatible with breast feeding.
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Amphetamine (C/CI)
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AAP classifies amphetamine as contraindicated during breast feeding. Monitor nursing infant for irritability and poor sleeping pattern.
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Amphotericin B (B/+)
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No human lactation data available. Probably compatible.
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Amphotericin B lipid complex (B/+)
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No human lactation data available. Probably compatible.
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Ampicillin (B/+)
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Monitor nursing infant for diarrhea. Potential for allergic sensitization and modification of bowel flora. AAP classifies ampicillin as compatible with breast feeding.
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Anakinra (B/−)
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No human lactation data available. Recommended to avoid in breast feeding.
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Aripiprazole (C/−)
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Mixed data concerning concentrations in breast milk. Potential for toxicity. The low molecular weight of the drug combined with the prolonged half-life and the active metabolite suggest that 1 or both will be excreted into breast milk. However, the extensive protein binding should limit the excretion. If mother breast feeds while taking drug, observe nursing infant for potent CNS effects, orthostatic hypotension, seizures, dysphasia, nausea, and vomiting. Long-term evaluation is warranted.
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Aspirin (C, D/−)
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May affect platelet function; monitor nursing infant for hemolysis or bleeding. Increased risk with high doses used for rheumatoid arthritis (3–5 g/day). Metabolic acidosis may occur. Theoretical risk of Reye syndrome. AAP recommends to use cautiously due to potential adverse effects.
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Atazanavir (B/CI)
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CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Atenolol (D/−)
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AAP recommends to use cautiously due to adverse effects of hypotension, cyanosis, and bradycardia; suggested to avoid water-soluble, low-protein-bound, renally excreted b-blockers during lactation.
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Atorvastatin (X/CI)
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Some excretion into breast milk is expected; therefore, the potential for adverse effects in nursing infants exists and breast feeding should be avoided.
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Atropine (C/+)
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Mixed data concerning passage into breast milk. AAP classifies atropine as compatible with breast feeding.
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Azathioprine (D/−)
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Theoretical concerns of potential for toxicity with the active metabolites of the drug. May be considered acceptable; monitor complete blood count with differential and liver function tests.
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Azithromycin (B/+)
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Accumulates in breast milk. Macrolide antibiotics may be associated with risk of infantile hypertrophic pyloric stenosis; potential for modification of bowel flora. Recommended agent for various infections.
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Aztreonam (B/+)
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Excreted into breast milk in low amounts, due to acidic nature of the drug and low lipid solubility. Oral absorption is poor, and systemic effects in nursing infants are unlikely. AAP classifies aztreonam as compatible with breast feeding.
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Bacitracin (C/+)
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No human lactation data available. Topical use compatible.
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Baclofen (C/+)
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Limited human lactation data available. AAP classifies baclofen as compatible with breast feeding.
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Beclomethasone (C/+)
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Limited human lactation data available. May be excreted into breast milk. Use of inhaled corticosteroids is considered acceptable during breast feeding.
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Belladonna (C/−)
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No human lactation data available. Due to narrow therapeutic index and viable potency, use should be avoided during lactation.
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Benazepril (C 1st tri; D 2nd, 3rd tri/+)
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Limited human lactation data available. Some excretion into breast milk is expected; not expected to cause adverse effects on nursing infants.
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Benztropine (C/−)
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No human lactation data available. Probably compatible.
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Betamethasone (C, D/+)
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No human lactation data available. Molecular weight suggests excretion into breast milk. Best avoided in favor of a shorter acting and better studied alternative due to potency and low protein binding.
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Bethanechol (C/−)
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Limited human lactation data available. Low molecular weight suggests excretion into breast milk. Abdominal pain and diarrhea reported in nursing infant exposed to bethanechol.
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Bisacodyl (C/+)
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Not absorbed from the gastrointestinal tract; active metabolite is not detectable in breast milk. Probably compatible.
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Bismuth subsalicylate (C/−)
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AAP recommends to use cautiously due to adverse effects because of potential for adverse effects from salicylates. Should be avoided because of systemic absorption.
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Bisoprolol (C/−)
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No human lactation data available. AAP recommends to use cautiously due to adverse effects of hypotension, cyanosis, and bradycardia related to b-blockade.
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Botulinum toxin type A (C/+)
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No human lactation data available. Probably compatible. Toxin not expected to appear in circulation and therefore will not appear in breast milk.
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Brompheniramine (C/+)
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Monitor nursing infant for agitation, poor sleeping pattern, and feeding problems. AAP classifies brompheniramine as usually compatible with breast feeding.
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Budesonide (oral/inhaler/nasal) (B, inhaler; C, oral/+)
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Systemic bioavailability of inhaled budesonide is low, so the actual amount in breast milk may also be low. Use of inhaled corticosteroids is considered acceptable during breast feeding.
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Bumetanide (C/+)
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No human lactation data available. Probably compatible. Diuretics may suppress lactation.
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Buprenorphine (C/−)
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Excreted into breast milk. When used to treat opioid addiction, most guidelines allow breast feeding as long as the infant is tolerant to the dose and other contraindications do not exist. Monitor for drowsiness, adequate weight gain, and developmental milestones; observe infants for withdrawal signs if breast feeding is stopped abruptly.
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Bupropion (B/−)
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Excreted into breast milk. Seizures and sleep disturbances have been reported; monitor for changes in sleep, feeding patterns, and behavior. AAP classifies the effect of bupropion on breast feeding as unknown but may be of concern.
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Buspirone (B/−)
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Limited human lactation data available. Buspirone and its metabolites are excreted into the milk of lactating rats. Potential exists for CNS impairment in nursing infant. AAP classifies the effect of buspirone on breast feeding as unknown but may be of concern because of effects on the developing brain that may not be known until later in life.
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Butorphanol (C/+)
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Limited human lactation data available. Excreted into breast milk at levels that are probably not clinically significant. AAP classifies butorphanol as usually compatible with breast feeding. Opioid therapy should be avoided in breast-feeding mothers due to potential for apnea and sedation in the infant.
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Caffeine (C/+)
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Monitor nursing infant for irritability and poor sleeping pattern. AAP classifies caffeine as usually compatible with breast-feeding with moderate intake (2–3 cups/day).
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Calcifediol (C/+)
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Low molecular weight of drug suggests excretion into breast milk but effect on nursing infant is unknown.
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Calcitonin—salmon (C/+)
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Calcitonin is a normal component of human milk; exogenous administration may inhibit lactation.
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Calcitriol (C/+)
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High-dose supplementation in mothers can lead to elevated levels of vitamin D2 in breast milk and subsequently lead to hypercalcemia in breast-fed infants. Caution is advised.
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Canagliflozin (D, −)
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No human lactation data available. Alternative agents are preferred.
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Candesartan (C 1st tri; D 2nd, 3rd tri/+)
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No human lactation data available. Low molecular weight suggests that the drug would be excreted into breast milk. Effects on the nursing infant are unknown.
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Captopril (C 1st tri; D 2nd, 3rd tri/+)
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Excreted into breast milk in low concentrations. Available data showed no effects on nursing infants. AAP classifies captopril as compatible with breast feeding.
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Carbamazepine (D/+)
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Monitor for sedation, poor sucking, and potential for withdrawal. Risk of bone marrow suppression if taken chronically; recommend monitoring complete blood count and liver enzymes. AAP classifies carbamazepine as compatible with breast feeding.
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Carbidopa/levodopa (C/+)
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Excreted into breast milk in low concentrations. Effects on nursing infant unknown.
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Carisoprodol (C/+)
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Limited human lactation data available. Probably compatible. Observe nursing infant for sedation and other behavioral changes.
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Carvedilol (C/−)
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AAP recommends to use cautiously due to adverse effects of hypotension, cyanosis, and bradycardia related to b-blockade.
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Cascara sagrada (C/+)
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Limited human lactation data available. Probably compatible. Observe nursing infant for diarrhea.
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Cefaclor (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cefadroxil (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Cefazolin (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Cefdinir (B/+)
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Probably excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cefepime (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cefixime (B/+)
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Probably excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cefotaxime (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Cefotetan (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cefoxitin (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Ceftazidime (B/+)
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Excreted into breast milk in low concentrations; not absorbed when given orally. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Ceftolozane/tazobactam (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora.
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Ceftriaxone (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding.
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Cefuroxime (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Celecoxib (C 1st, 2nd tri; D 3rd tri/−)
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Excreted into breast milk. Safest course of action is to avoid use during breast feeding.
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Cephalexin (B/+)
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Excreted into breast milk in low concentrations. Potential for allergic sensitization and modification of bowel flora. AAP classifies other cephalosporins as compatible with breast feeding.
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Cetirizine (B/+)
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Manufacturer states drug excreted into breast milk. Effects on nursing infant unknown but observe for sedation, irritability, or jitteriness.
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Chloral hydrate (C/+)
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Monitor nursing infant for sedation and rash. AAP classifies chloral hydrate as compatible with breast feeding.
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Chlordiazepoxide (D/−)
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No human lactation data available. Low molecular weight suggests excretion into breast milk should be expected. Other benzodiazepines have produced adverse effects in nursing infants. Use should be avoided during breast feeding.
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Chlorhexidine (B/+)
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No reports of excretion into breast milk available. Oral rinse is not intended to be swallowed. Rinse nipples if chlorhexidine is used to cleanse them. Probably compatible.
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Chloroquine (C/+)
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Insufficient amounts excreted in breast milk to provide adequate protection against malaria. AAP classifies chloroquine as compatible with breast feeding.
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Chlorothiazide (C/+)
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Diuretics may suppress lactation, especially in the first month. Adverse effects have not been reported, but infant’s electrolytes and platelets should be monitored. AAP classifies chlorothizide as compatible with breast feeding.
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Chlorpheniramine (B/+)
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Effects on nursing infant unknown, but observe for sedation, irritability, or jitteriness. Second-generation antihistamines are preferred.
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Chlorpromazine (C/−)
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Excreted into breast milk in low amounts. Observe nursing infant for sedation. AAP classifies the effect of chlorpromazine on breast feeding as unknown but may be of concern due to potential drowsiness and lethargy in addition to galactorrhea in adults.
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Cholecalciferol (C, D/+)
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Excreted into breast milk in limited amounts. The Committee on Nutrition of the AAP recommends vitamin D supplementation in breast-fed infants if maternal intake is low or exposure to ultraviolet light is insufficient. AAP classifies cholecalciferol as compatible with breast feeding. Monitor serum calcium levels of nursing infant if mother is taking pharmacologic doses of vitamin D.
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Cholestyramine (C/+)
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Nonabsorbable resin. No human lactation data available. Drug binds fat-soluble vitamins, and prolonged use may result in deficiencies of these vitamins in mother and nursing infant.
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Cimetidine (B/+)
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Use with caution. May suppress gastric acidity in infant, inhibit drug metabolism, and cause CNS stimulation. AAP classifies cimetidine as compatible with breast feeding.
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Ciprofloxacin (C/+)
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Data are limited and the amount of drug in breast milk does not appear to represent significant risk to nursing infant. Potential for modification of bowel flora. AAP classifies ciprofloxacin as compatible with breast feeding. However, the manufacturer recommends that mother should wait 48 hours after last dose before breast feeding.
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Citalopram (C/−)
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Doses >20 mg/day or concurrent use of other sedative agents may increase risk of adverse effects to nursing infants. Observe for excessive somnolence, changes in sleep, decreased feeding, and weight loss. Long-term effects on neurobehavioral development are unknown. AAP classifies effect of SSRIs on breast feeding as unknown but may be of concern. However, if required by the mother, it is not a reason to discontinue breast feeding.
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Clarithromycin (C/+)
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Excreted into breast milk. Macrolide antibiotics may be associated with risk of infantile hypertrophic pyloric stenosis; potential for modification of bowel flora, rash, diarrhea, and loss of appetite.
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Clavulanate (B/+)
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No human lactation data available. Molecular weight suggests excretion into breast milk. Effects of lactamase inhibitors on nursing infants are unknown.
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Clindamycin (B/+)
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Excreted into breast milk. Potential for allergic sensitization and modification of bowel flora. Monitor for bloody stools associated with colitis. AAP classifies clindamycin as compatible with breast feeding.
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Clonazepam (D/−)
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Long half-life may cause accumulation in a breast-feeding infant. If chronic use of a benzodiazepine is needed, other shorter acting agents preferred. Monitor nursing infant for decreased feeding and respiratory and CNS depression.
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Clonidine (C/+)
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Excreted in breast milk. Hypotension was not observed in nursing infants, although clonidine was found in the serum of these nursing infants. Long-term significance of this exposure is unknown; other agents may be preferred.
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Clopidogrel (B/+)
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No human lactation data available. Low molecular weight suggests excretion into breast milk. Effects on nursing infants are unknown. Manufacturer recommends a decision be made to continue nursing or discontinue the drug, taking into account the importance of treatment to the mother.
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Clotrimazole (B/+)
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Absorption from skin and vagina is minimal. Unlikely that the levels of this antifungal agent appear in breast milk.
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Clozapine (B/−)
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Concentrated in breast milk. Avoid breast feeding. AAP classifies clozapine as a drug for which the effect on the nursing infant is unknown but may be of concern.
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Cobicistat (C/CI)
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CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Cocaine (C/CI)
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Causes cocaine intoxication in infant from maternal intranasal use (hypertension, tachycardia, mydriasis, and apnea) and from topical use on mother’s nipples (apnea and seizures). AAP classifies cocaine as contraindicated during breast feeding.
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Codeine (C, D/−)
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Codeine and active metabolite, morphine, are present in breast milk; concentrations are dependent on CYD2D6 metabolism. Short term therapy (1–2 days) with close monitoring is compatible, however long term therapy is not compatible with breast feeding. May suppress lactation. Opioid therapy should be avoided in breast-feeding mothers due to potential for apnea and sedation in the infant.
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Colchicine (C/+)
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Excreted into breast milk. No adverse effects on nursing infants have been observed. Waiting 8 hours after dose to breast feed or taking the dose after breast feeding minimizes exposure of nursing infant. AAP classifies colchicine as compatible with breast feeding.
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Cortisone (C, D/+)
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Corticosteroids are excreted in breast milk. Monitor for growth suppression, interference with endogenous production. Unlikely that it poses risk to nursing infant.
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Cromolyn sodium (B/+)
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No human lactation data available. Maternal levels are likely to be low; considered to be compatible with breast feeding.
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Cyclobenzaprine (B/−)
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No reports of excretion into breast milk available. Low molecular weight suggests excretion into breast milk.
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Dactinomycin (D 1st tri; C 2nd, 3rd tri/−)
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No human lactation data available. Despite the high molecular weight, women receiving the drug should avoid breast feeding because of the potential risk of severe adverse effects.
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Dalbavancin (C/−)
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No human lactation data available. Drug has a long half-life and caution should be exercised when used among nursing women.
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Dalteparin (B/+)
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No human lactation data available. Based on the molecular weight and because the drug would be inactivated in the GI tract, the risk to the nursing infant would be negligible.
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Dapagliflozin (C/−)
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No human lactation data available. Avoid breast feeding until safety data available.
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Darbepoetin alfa (C/+)
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No human lactation data available. Passage into breast milk is not expected. Risk to nursing infant appears to be negligible.
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Deferasirox (C/−)
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No human lactation data available. Molecular weight and long elimination half-life suggest excretion into breast milk. Amount of oral absorption in infants unknown; in adults, oral bioavailability is 70%. With the potential to deplete infant’s iron stores, breast feeding should be avoided during therapy.
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Deferoxamine (C/+)
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No human lactation data available. Molecular weight is low enough for some excretion into breast milk to be expected. Effects, if any, on nursing infant are unknown.
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Delafloxacin (C/−)
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No human lactation data available. Avoid breast feeding until safety data available.
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Delavirdine (C/CI)
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No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Desloratadine (C/+)
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No human lactation data available. Desloratadine and loratadine are excreted into breast milk. Probably compatible.
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Dexamethasone (C, D/+)
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No human lactation data available. Excretion into breast milk should be expected. Probably compatible.
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Dextroamphetamine (C/−)
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May cause infant stimulation. Nonmedical use is considered contraindicated in breast feeding.
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Dextromethorphan (C/+)
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No human lactation data available. Low molecular weight suggests excretion into breast milk. Probably compatible. Use alcohol-free preparation.
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Diatrizoate (C/+)
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In 1 study, not detected in breast milk. Probably compatible.
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Diazepam (D/−)
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May cause infant sedation. May accumulate in breast-fed infants.
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Diclofenac (C/D ≥30 weeks’ gestation/+)
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No human lactation data available. Manufacturer states that the drug is excreted into breast milk. Short half-life in adults. Probably compatible.
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Dicloxacillin (B/+)
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No human lactation data. However, other penicillins are excreted into breast milk in low concentrations. Adverse effects rare. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction.
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Didanosine (B/CI)
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No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Digoxin (C/+)
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Excreted into breast milk in small amounts. Monitor nursing infant for spitting up, diarrhea, and heart rate changes. Compatible with breast feeding.
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Dihydroergotamine (X/CI)
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No human lactation data available. Molecular weight and long half-life suggest excretion into breast milk, but high protein binding will limit this. Concern for symptoms of ergotism: vomiting, diarrhea, and convulsions in nursing infants. Breast feeding is contraindicated.
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Diltiazem (C/+)
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Excreted into breast milk. Two nursing infants were not affected. Probably compatible.
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Dimenhydrinate (B/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Probably compatible. Caution: newborns and premature infants have increased sensitivity to antihistamines.
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Diphenhydramine (B/+)
|
Excreted into breast milk, but levels are thought not to be in sufficiently high amounts to affect the nursing infant. Monitor the nursing infant for agitation, poor sleeping pattern, and feeding problems. Probably compatible.
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Diphenoxylate (C/−)
|
Active metabolite probably excreted into breast milk. Potential toxicity.
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Diphtheria and tetanus vaccine (C/+)
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No human lactation data. Probably compatible.
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Dipyridamole (B/+)
|
Excreted into breast milk. Effect unknown on nursing infant. Probably compatible.
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Docusate (calcium, potassium, sodium) (C/+)
|
Probably compatible. Monitor nursing infant for diarrhea.
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Dolasetron (B/+)
|
No human lactation data available. Low molecular weight of drug suggests excretion into breast milk should be expected. Effects on nursing infant are unknown.
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Dolutegravir (B/CI)
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No human lactation data available. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Dornase alfa (B/+)
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No human lactation data available. Inhaled drug does not increase endogenous serum concentration of DNase. Not expected to be excreted into breast milk. Negligible risk to nursing infant.
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Doxycycline (D/+)
|
Excreted into breast milk in low concentrations. Theoretical dental staining and inhibition of bone growth are remote. The bowel flora of nursing infants may be altered and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. AAP classifies doxycycline as compatible with breast feeding.
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Doxylamine (C/−)
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No human lactation data available. Low molecular weight suggests excretion into breast milk should be expected. Effects on nursing infant unknown. Potential effects include sedation, excitement, and irritability. Avoid breast feeding.
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Dulaglutide (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
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Echinacea (C/−)
|
Avoid use during breast feeding.
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Edoxaban (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Efavirenz (C/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Eletriptan (C/+)
|
Excreted into breast milk. Effects of exposure to nursing infants are unknown, but low concentration not thought to be significant. Compatible with breast feeding.
|
|
Empagliflozin (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Emtricitabine (B/CI)
|
No human lactation data available. Molecular weight, low plasma protein binding, and long half-life suggest excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Enalapril (C 1st tri; D 2nd, 3rd tri/+)
|
Enalapril and enalaprilat are excreted into breast milk in small amounts such that risk to nursing infant appears negligible/clinically insignificant. AAP classifies enalapril as compatible with breast feeding.
|
|
Enfuvirtide (B/CI)
|
No human lactation data available. Molecular weight and high plasma protein binding should inhibit but not prevent excretion into breast milk. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Enoxaparin (B/+)
|
No human lactation data available. Based on high molecular weight and probable inactivation by GI tract, the passage of drug into breast milk and its risk to nursing infant is considered negligible.
|
|
Entecavir (C/CI HIV; C/hepatitis B)
|
No human lactation data available. Molecular weight and half-life suggest the drug should be excreted into breast milk. Effects on nursing infants are unknown. Infants of HBsAg-positive or HBeAg-positive mothers should receive HBIG at birth and hepatitis B vaccine soon after birth. Then breast feeding is permitted. Breast feeding is contraindicated in HIV-1 positive mothers in the United States.
|
|
Ephedrine (C/−)
|
Limited human lactation data available. Observe nursing infant for irritability, excessive crying, and disturbed sleeping patterns. Avoiding breast feeding is recommended.
|
|
Epoetin alfa (C/+)
|
No human lactation data available. Excretion into breast milk is not expected and drug would be digested in GI tract. No risk to nursing infant expected.
|
|
Epoprostenol (B/+)
|
No human lactation data available. Based on its rapid degradation, a physiologic pH, and the GI tract, the amount of drug the nursing infant would be exposed to would not be clinically significant.
|
|
Eprosartan (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Expect excretion into breast milk. Effects on nursing infant are unknown. AAP classifies ACE inhibitors, a similar class of agents, as compatible with breast feeding.
|
|
Ergotamine (X/CI)
|
Causes vomiting, diarrhea, and convulsions in the nursing infant. May hinder lactation. Breast feeding is contraindicated.
|
|
Ertapenem (B/+)
|
Excreted into breast milk in low concentrations. Effects on nursing infant unknown but probably are not clinically significant. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. Probably compatible with breast feeding.
|
|
Erythromycin (B/+)
|
Excreted into breast milk in low concentrations. No reports of adverse effects in nursing infants. The bowel flora of nursing infants may be altered, and there is potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. AAP classifies erythromycin as compatible with breast feeding.
|
|
Escitalopram (C/−)
|
No human lactation data available. Expect excretion into breast milk. Effects on nursing infant unknown. Adverse effects have been seen with similar agent (citalopram), expect similar effects. Closely monitor nursing infants. AAP classifies other SSRIs as drugs for which effect on nursing infants is unknown but may be of concern.
|
|
Eslicarbazepine (C/+)
|
No human lactation data available. Expect excretion into breast milk. Closely monitor nursing infants for common side effects reported in adults.
|
|
Esomeprazole (B/−)
|
No human lactation data available. Expect excretion into breast milk. Effects on nursing infant unknown. Potential for toxic effects: headache, diarrhea and abdominal pain, and suppression of gastric acid secretion. Half-life is short, 1–1.5 hours. Waiting 5–7.5 hours after dose should eliminate 97% of drug from plasma.
|
|
Estrogens, conjugated (X/+)
|
No adverse effects in nursing infants reported. May decrease milk volume and nitrogen and protein content.
|
|
Etelcalcetide (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Ethambutol (C/+)
|
Excreted into breast milk. AAP classifies ethambutol as compatible with breast feeding.
|
|
Ethanol (X/−)
|
Passes freely into breast milk in levels similar to those in maternal serum. Because of risk of toxicity in nursing infant, safest course is to hold breast-feeding for 1–2 hours for each ounce of alcohol consumed.
|
|
Ethinyl estradiol (X/+)
|
No adverse effects in nursing infants reported. Expect trace amount in breast milk. May decrease milk volume and nitrogen and protein content. Monitor weight gain of infant, and use lowest dose.
|
|
Evolocumab (B/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Famciclovir (B/−)
|
No human lactation data available. Expect excretion into breast milk. Avoid breast feeding.
|
|
Famotidine (B/+)
|
Excreted into breast milk but to lesser extent than cimetidine and ranitidine. Effects on nursing infant are unknown. Potential risk for adverse effects; however, AAP classifies cimetidine as compatible with breast feeding. Famotidine may be preferred over other H2 blockers because of lesser amount in breast milk.
|
|
Ferric citrate (B/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Flecainide (C/+)
|
Excreted into breast milk but effects on nursing infant are unknown. Probably not toxic. AAP classifies flecainide as compatible with breast feeding.
|
|
Fluconazole (C for single dose, D/+)
|
Excreted into breast milk. No drug-associated toxicity has been reported. AAP classifies fluconazole as compatible with breast feeding.
|
|
Flucytosine (C/−)
|
No human lactation data available. Because of potential serious adverse effects in nursing infant, breast feeding should be avoided.
|
|
Fluoxetine (C 1st, 2nd tri; D 3rd tri/−)
|
Excreted into breast milk. Long-term effects on neurobehavioral development from exposure to potent serotonin reuptake blocker during period of rapid CNS development have not been adequately studied. Manufacturer recommends breast feeding should be avoided during fluoxetine therapy. AAP indicates that effects on nursing infant are unknown but may be of concern. Maternal benefits may outweigh risks to nursing infant if treating postpartum depression. Colic, irritability, sleep disorders, and poor weight gain may occur.
|
|
Fondaparinux (B/+)
|
No human lactation data available. Excretion into breast milk should be expected. Effects on nursing infants unknown but not thought to be clinically significant.
|
|
Fosamprenavir (C/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Furosemide (C/+)
|
Excreted into breast milk. No reports of adverse effects in a nursing infant. Probably compatible.
|
|
Gabapentin (C/+)
|
No human lactation data available. Probably compatible. Low molecular weight of drug suggests excretion into breast milk but effect on nursing infant is unknown.
|
|
Gadopentetate dimeglumine (MRI contrast) (C/+)
|
Excreted into breast milk in small amounts. Very little is absorbed systemically. AAP classifies gadopentetate dimeglumine as compatible with breast feeding.
|
|
Ganciclovir (D 1st tri; C 2nd, 3rd tri/−)
|
No human lactation data available. Potential for serious toxicity in nursing infant. Avoid breast feeding.
|
|
Gentamicin (C/+)
|
Small amounts excreted into breast milk and absorbed by nursing infants. Observe infant for bloody stools and diarrhea. AAP classifies as compatible with breast feeding.
|
|
Ginkgo biloba (C/−)
|
No human lactation data available. Herbal product that is not standardized and may contain other compounds. Safest course is to avoid breast feeding.
|
|
Ginseng (B/−)
|
No human lactation data available. Herbal product that is not standardized and may contain other compounds. Safest course is to avoid breast feeding.
|
|
Glimepiride (C/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Risk of neonatal hypoglycemia. Breast-feeding women should consider insulin instead.
|
|
Glipizide (C/+)
|
Minimal to nondetectable levels in breast milk. Normal glucose levels in nursing infants.
|
|
Glucosamine (C/+)
|
No human lactation data available. Molecular weight and prolonged plasma protein elimination half-life suggest excretion into breast milk should be expected. Unbound drug is undetectable in plasma; therefore, little if any drug will be excreted into milk. Probably compatible.
|
|
Glutamine (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Glyburide (C/+)
|
Nondetectable levels in breast milk. Normal glucose levels in nursing infants. Probably compatible.
|
|
Guaifenesin (C/+)
|
No human lactation data available. Probably compatible.
|
|
Haemophilus b conjugate vaccine (C/+)
|
Compatible with breast feeding.
|
|
Haloperidol (C/−)
|
Excreted into breast milk. Use may be of concern. Effects on nursing infant unknown. Possible decline in developmental score.
|
|
Heparin (C/+)
|
Not excreted into breast milk.
|
|
Hepatitis A vaccine (C/+)
|
No human lactation data available. Probably compatible.
|
|
Hepatitis B vaccine (C/+)
|
No human lactation data available. Probably compatible.
|
|
Heroin (D/CI)
|
Crosses into breast milk in sufficient amounts to cause addiction in nursing infant. Breast feeding is contraindicated.
|
|
Human papillomavirus vaccine (B/+)
|
Compatible with breast feeding.
|
|
Hydralazine (C/+)
|
Excreted into breast milk. No adverse effects noted in nursing infants. AAP hydralazine classifies as compatible with breast feeding.
|
|
Hydrochlorothiazide (B/+)
|
May suppress lactation, especially in the first month of lactation. Adverse effects have not been reported, but infant’s electrolytes and platelets should be monitored.
|
|
Hydrocodone (C, D/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Observe nursing infant for GI effects, sedation, and changes in feeding patterns.
|
|
Hydrocortisone (C, D/+)
|
No human lactation data available. Unlikely that it poses risk to nursing infant. Compatible with breast feeding.
|
|
Hydromorphone (B, D/+)
|
Excreted into breast milk. Monitor nursing infant for sedation. Milk ejection reflex (letdown) may be inhibited.
|
|
Hydroxychloroquine (C/+)
|
Excreted into breast milk. Slow elimination rate. Breast feeding during daily therapy should be done with caution. Once-weekly doses significantly reduce amount of drug exposure to nursing infant. AAP classifies hydroxychloroquine as compatible with breast feeding. Amount in breast milk is not adequate to provide malaria protection for infant.
|
|
Hydroxyzine (C/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effects on nursing infant unknown.
|
|
Ibuprofen (B 2nd tri; D 1st, 3rd tri/+)
|
Excreted into breast milk. Amount of drug available to nursing infant is minimal. AAP classifies ibuprofen as compatible with breast feeding.
|
|
Imipenem-cilastatin (C/+)
|
Small amounts excreted into breast milk in amounts comparable to other lactam antibiotics. Effects on nursing infant are unknown.
|
|
Indinavir (C/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Indomethacin (C <30 weeks’ gestation, D ≥30 weeks’ gestation/+)
|
Excreted into breast milk. One case report of seizure in nursing infant. AAP classifies indomethacin as compatible with breast feeding.
|
|
Infliximab (B/+)
|
Excreted into breast milk in trace amount. Compatible with breast feeding.
|
|
Influenza vaccine (B/+)
|
Live attenuated influenza vaccine is not recommended during pregnancy. Maternal vaccination is compatible with breast feeding.
|
|
Iodine (D/+)
|
May cause fetal goiter or hyperthyroidism. APP classifies iodine as compatible with breast feeding.
|
|
Isavuconazonium (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Isoniazid (C/+)
|
Isoniazid and its metabolite are excreted into breast milk. Monitor nursing infant for signs and symptoms of peripheral neuritis or hepatitis. Pyridoxine supplementation should be considered in both mother and infants. AAP classifies isoniazid as compatible with breast feeding.
|
|
Ivacaftor (B/−)
|
No human lactation data available. Molecular weight and long half-life suggest excretion into breast milk should be expected. Effects on nursing infant are unknown. Avoid breast feeding until safety data available.
|
|
Ivermectin (C/+)
|
Excreted into breast milk but no human lactation data available. Low drug levels in milk probably not a risk to nursing infant. AAP classifies ivermectin as compatible with breast feeding.
|
|
Kaolin/pectin (C/+)
|
No effect on nursing infant.
|
|
Ketamine (B/+)
|
Should be undetectable in maternal plasma ~11 hours after dose. Breast feeding after this time should not expose the nursing infant to drug.
|
|
Ketoconazole (C/+)
|
Excreted into breast milk. Effects of exposure to nursing infants are unknown but not thought to be significant. AAP classifies ketoconazole as compatible with breast feeding.
|
|
Ketorolac (C; D if used in 3rd tri or near delivery/+)
|
Excreted into breast milk in amounts that are considered clinically insignificant. AAP classifies ketoralac as compatible with breast feeding.
|
|
Labetalol (C/+)
|
Monitor nursing infant for hypotension and bradycardia. AAP classifies labetalol as compatible with breast feeding.
|
|
Lactulose (B/+)
|
No human lactation data. Probably compatible.
|
|
Lamivudine (C/CI)
|
Excreted into breast milk. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Lamotrigine (C/−)
|
May be of concern. Consider monitoring infant’s serum lamotrigine concentration.
|
|
Lansoprazole (B/−)
|
No human lactation data available. Excretion into breast milk is expected. Potential effects on nursing infant include carcinogenicity (animal data) and suppression of gastric acid secretion. Avoid breast feeding.
|
|
Levetiracetam (C/+)
|
No human lactation data available. Low molecular weight and protein binding suggest excretion into breast milk should be expected. Effects on nursing infant are unknown. AAP classifies levetiracetam as compatible with breast feeding.
|
|
Levofloxacin (C/+)
|
Excreted into breast milk. Effects on nursing infants are unknown. AAP classifies levofloxacin as compatible with breast-feeding.
|
|
Levomilnacipran (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Levothyroxine (A/+)
|
Probably does not interfere with neonatal thyroid screening.
|
|
Lindane (C/+)
|
No human lactation data available. Excreted into breast milk. Small amounts ingested by nursing infant are probably clinically insignificant. Waiting 4 days after discontinuing lotion should prevent exposure to nursing infant.
|
|
Linezolid (C/−)
|
No human lactation data available. Excretion into breast milk is expected. Effects on nursing infant unknown. Potential effects: myelosuppression and reversible thrombocytopenia. Avoid breast feeding.
|
|
Liraglutide (C/−)
|
No human lactation data available. Avoid breast feeding until safety data available.
|
|
Lisinopril (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Excretion into breast milk should be expected. AAP classifies lisinopril as compatible with breast feeding.
|
|
Lithium (D/−)
|
Milk levels average 40% of maternal serum concentration. Monitor nursing infant for cyanosis, hypotonia, bradycardia, and other lithium toxicities.
|
|
Loperamide (B/+)
|
No human lactation data available. AAP classifies loperamide as compatible with breast feeding.
|
|
Lopinavir (C/CI)
|
No human lactation data available. Molecular weight and lipid solubility suggest excretion into breast milk should be expected; however, extensive plasma protein binding should limit this. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Loratadine (B/+)
|
Loratadine and its metabolite are excreted into breast milk. Probably little clinical risk to nursing infant. AAP classifies loratadine as compatible with breast feeding.
|
|
Lorazepam (D/−)
|
Excretion into breast milk in small amount. Monitor nursing infant for sedation, especially if exposure is prolonged.
|
|
Losartan (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Excretion into breast milk is expected. Effects of exposure to nursing infant are unknown. AAP considers losartan compatible with breast feeding.
|
|
Macitentan (X/CI)
|
No human lactation data available. Molecular weight and half-life suggest excretion into breast milk, but high protein binding affinity may limit the amount. Monitor nursing infants for anemia, influenza, and urinary tract infections.
|
|
Measles vaccine (X, C/+)
|
Compatible with breast feeding.
|
|
Meclizine (B/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Probably compatible. Caution: newborns and premature infants have increased sensitivity to antihistamines. Prolonged use may decrease milk supply.
|
|
Medroxyprogesterone (D/+)
|
AAP classifies medroxyprogesterone as compatible with breast feeding.
|
|
Meloxicam (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Molecular weight would suggest excretion into breast milk. Probably compatible.
|
|
Meningococcal vaccine (B/+)
|
No human lactation data available. Probably compatible. ACIP recommends deferring meningococcal B vaccine in breast-feeding women unless the woman is at increased risk for meningococcal disease.
|
|
Meperidine (C, D/+)
|
Monitor nursing infant for sedation. Milk ejection reflex (letdown) may be inhibited. AAP classifies meperidine as compatible with breast feeding.
|
|
Meropenem (B/+)
|
No human lactation data available. Probably compatible. Expect excretion into breast milk. Potential effects on nursing infant are unknown.
|
|
Mesalamine (B/−)
|
Small amount excreted into breast milk. Risk of adverse effect (diarrhea) in nursing infant. AAP classifies mesalamine as a drug that should be used with caution during breast feeding because there is potential for toxicity.
|
|
Metformin (B/+)
|
Excreted into breast milk. Nursing infants had normal blood glucose levels.
|
|
Methadone (C, D/+)
|
Generally compatible with breast feeding. Monitor nursing infant for sedation, depression, and withdrawal on cessation of methadone treatment. AAP classifies methadone as compatible with breast feeding.
|
|
Methamphetamine (C/CI)
|
AAP classifies amphetamines as contraindicated during breast feeding. Monitor nursing infant for irritability and poor sleeping pattern.
|
|
Methimazole (D/+)
|
Potential for interfering with thyroid function. AAP classifies methimazole as compatible with breast feeding.
|
|
Methocarbamol (C/+)
|
Probably compatible. Any amount of drug excreted into breast milk probably not clinically significant.
|
|
Methyldopa (B/C/+)
|
Risk of hemolysis and increased liver enzymes. AAP classifies methyldopa as compatible with breast feeding.
|
|
Methylphenidate (C/−)
|
Excreted into breast milk. Potential toxicity will probably occur in 1st month of life. Observe nursing infant for signs and symptoms of CNS stimulation: decreased appetite, insomnia, and irritability.
|
|
Metoclopramide (B/−)
|
Increases milk production. Effects on nursing infant unknown but may be of concern because it is a dopaminergic-blocking agent.
|
|
Metolazone (B/+)
|
May suppress lactation, especially in the first month of lactation. Probably compatible. Adverse effects have not been reported, but infant’s electrolytes and platelets should be monitored.
|
|
Metoprolol (C/−)
|
Monitor nursing infant for bradycardia and hypotension.
|
|
Metronidazole (D 1st tri; B 2nd, 3rd tri/−)
|
Discontinue during breast feeding. Do not nurse until 12–24 hours after discontinuing to allow excretion of drug.
|
|
Miltefosine (D/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk, but high protein binding may limit amount in milk.
|
|
Minocycline (D/+)
|
Excreted into breast milk in low concentrations. Theoretical dental staining and inhibition of bone growth are remote. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. Compatible with breast feeding.
|
|
Mipomersen (B/−)
|
No human lactation data available. Molecular weight and protein binding suggest excretion into breast milk will be limited. Potential for disruption of infant lipid metabolism. Monitor nursing infant for flulike symptoms and elevated liver transaminases.
|
|
Mirtazapine (C/−)
|
Excreted into breast milk. Monitor infant for potential sedation and weight gain. Long-term effects on neurobehavioral development unknown. AAP classifies other antidepressants as drugs for which effect on nursing infant is unknown but may be of concern.
|
|
Montelukast (B/+)
|
Monitor nursing infant for sedation. Milk ejection reflex (letdown) may be inhibited.
|
|
Morphine (C/−)
|
Excreted into breast milk. Monitor infant for sedation, apnea and bradycardia, and cyanosis. AAP classifies morphine as compatible with breast feeding. Long-term effects on neurobehavioral development are unknown.
|
|
Mumps vaccine (C/+)
|
No human lactation data. Probably compatible.
|
|
Nafcillin (B/+)
|
No human lactation data. Refer to Penicillin.
|
|
Nalbuphine (B/+)
|
Monitor newborn for respiratory depression and bradycardia if used during labor. No human lactation data available. Probably compatible. Expect small amount of drug to be excreted into breast milk. Amounts are clinically insignificant.
|
|
Naloxegol (C/+)
|
No human lactation data available. Molecular weight and protein binding suggest excretion into breast milk is likely. Probably compatible.
|
|
Naloxone (B, C/+)
|
No human lactation data available. Probably compatible.
|
|
Naltrexone (C/+)
|
No human lactation data available. Expect excretion into breast milk. Probably compatible. Effects on nursing infant are unknown. Potential adverse effects of drug: alteration of opioid receptors in the brain; altered levels of some hormones of hypothalamic, pituitary, adrenal, and gonadal origin.
|
|
Naproxen (C/+)
|
Passes into breast milk in very small quantities. Effects on nursing infant are unknown. AAP classifies naproxen as compatible with breast feeding.
|
|
Naratriptan (C/+)
|
No human lactation data available. Excretion into breast milk should be expected. Probably compatible. Effects on nursing infant are unknown.
|
|
Nelfinavir (B/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Netupitant and palonosetron (C/+)
|
No human lactation data available. Molecular weight and protein binding suggest excretion into breast milk is likely. Probably compatible.
|
|
Nevirapine (C/CI)
|
Excreted into breast milk. CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Nicotine (transdermal, others) (D/−)
|
May be of concern. Excessive amounts may cause diarrhea, vomiting, tachycardia, irritability, decreased milk production, and decreased weight gain.
|
|
Nifedipine (C/+)
|
Manufacturer states significant amounts of drug excreted into breast milk. No human lactation data available. AAP classifies nifedipine as compatible with breast feeding.
|
|
Nimodipine (C/+)
|
Excreted in breast milk. Limited data suggest that milk is excreted in likely clinically insignificant amounts. Probably compatible.
|
|
Nitrofurantoin (B/+)
|
Excreted in breast milk in small amounts. Monitor nursing infants with G6PD deficiency for hemolytic anemia. AAP classifies nitrofurantoin as compatible with breast feeding.
|
|
Nortriptyline (C/−)
|
Excreted into breast milk in low concentrations. No adverse effects noted in breast-feeding infants. Long-term effects of chronic exposure to antidepressants in nursing infants are unknown with concern for effects on the infant’s neurobehavioral development. AAP classifies nortriptyline as a drug for which effect on nursing infant is unknown but may be of concern.
|
|
Nystatin (C/+)
|
Poorly absorbed if at all. Excretion into breast milk would not occur.
|
|
Olanzapine (C/−)
|
Sedation has occurred in nursing infants. Decreasing dose may eliminate this problem but may affect control of mother’s disease. Avoid use during breast feeding.
|
|
Olodaterol (C/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk is likely, but low systemic absorption. Probably compatible.
|
|
Olsalazine (C/−)
|
Active metabolite, 5-aminosalicylic acid (mesalamine), is excreted into human milk. Diarrhea reported in nursing infant of mother receiving mesalamine.
|
|
Omeprazole (C/−)
|
Limited human lactation data available. Excretion into breast milk is expected. Effects on nursing infant are unknown. Use during breast feeding should be avoided. Concern for suppression of gastric acid secretion and carcinogenicity observed in animals.
|
|
Ondansetron (B/+)
|
No human lactation data available. Expect excretion into breast milk. Probably compatible. Effects on nursing infant are unknown.
|
|
Oral contraceptives (all classes) (X/+)
|
Causes dose-dependent suppression of lactation. Decreased weight gain, milk production, and nitrogen and protein content of human milk have been associated with this drug. Changes probably only significant in malnourished mothers. Use lowest dose possible. AAP classifies oral contraceptives as compatible with breast feeding.
|
|
Oritavancin (C/+)
|
No human lactation data available. Limited oral bioavailability would suggest low risk of toxicity to nursing infant. Probably compatible.
|
|
Orlistat (X/+)
|
No human lactation data available. Limited systemic bioavailability would suggest that it would not appear in breast milk.
|
|
Oseltamivir (C/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown.
|
|
Oxacillin (B/+)
|
Excreted into breast milk in low concentrations. Adverse effects rare. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction.
|
|
Oxcarbazepine (C/+)
|
One report of use during human lactation. No adverse effects reported. Monitor infant for poor suckling, vomiting, and sedation. AAP classifies carbamazepine as compatible with breast feeding; oxcarbazepine can be also considered compatible.
|
|
Oxycodone (B/−)
|
Monitor nursing infant for drowsiness, sedation, feeding difficulties, or limpness. Withdrawal symptoms may occur when maternal use or breast feeding is discontinued.
|
|
Pamidronate (D/+)
|
No human lactation data available. Molecular weight, prolonged half-life, and lack of metabolism suggest drug will be excreted into breast milk. Considering the bioavailability, the amount absorbed by the nursing infant will be clinically insignificant. Probably compatible.
|
|
Pantoprazole (C/+)
|
Excreted into breast milk in small amounts. Has potential for suppression of gastric acid secretion in nursing infant, but overall risk of toxicities is low.
|
|
Paregoric (C/+)
|
Probably excreted into breast milk. Limited human lactation data available. Probably compatible. Refer to morphine.
|
|
Paroxetine (D, X/−)
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Effect on nursing infant is unknown but may be of concern. Monitor infant for insomnia, lethargy, poor weight gain, and changes in feeding pattern.
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Pasireotide (C/−)
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No human lactation data available. Molecular weight and protein binding suggest excretion in breast milk. Potential adverse reactions include diarrhea, nausea, hyperglycemia, and cholelithiasis. Recommended to avoid breast feeding due to potential toxicity.
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Penicillin G (all forms) (B/+)
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All antibiotics are excreted in breast milk in limited amounts. Monitor nursing infant for rash, diarrhea, and spitting up. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup.
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Pentamidine (C/CI)
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No human lactation data available. Systemic concentrations reached with aerosolized drug are very low. Breast milk levels would be nil.
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Pentobarbital (D/−)
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Excreted into breast milk. Effects on nursing infant are unknown.
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Permethrin (B/+)
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No human lactation data available. Little if any drug expected to be excreted into breast milk. CDC considers permethrin or pyrethrins with piperonyl butoxide treatment of choice for pubic lice during lactation.
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Phenobarbital (D/−)
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Monitor nursing infant for sucking problems, sedation, rashes, and withdrawal. AAP classifies phenobarbital as a drug that has caused major adverse effects in some nursing infants. Use caution if breast feeding.
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Phenytoin (D/+)
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Monitor nursing infant for methemoglobinuria (rare), drowsiness, and decreased suckling. Keep maternal phenytoin in therapeutic range. AAP classifies phenytoin as compatible with breast feeding.
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Pirfenidone (C/+)
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No human lactation data available. Molecular weight and protein binding suggest excretion into breast milk is likely. Probably compatible.
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Piroxicam (C/+)
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Excreted into breast milk in amounts that probably do not present a risk to nursing infant. AAP classifies piroxicam as compatible with breast feeding.
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Pneumococcal vaccine (C/+)
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No human lactation data available. Probably compatible.
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Poliovirus inactivated vaccine (C/+)
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No human lactation data available. Probably compatible.
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Pravastatin (X/CI)
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No human lactation data available. Excreted into breast milk. Because of the potential for adverse effects in the nursing infant, avoid use during lactation.
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Prednisolone (C, D/+)
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Trace amounts have been measured in breast milk. Concentration did not pose clinically significant risk to nursing infant. AAP classifies prednisolone as compatible with breast feeding.
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Prednisone (C, D/+)
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Trace amounts have been measured in breast milk. Concentration did not pose clinically significant risk to nursing infant. AAP classifies prednisone as compatible with breast feeding.
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Pregabalin (C/−)
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No human lactation data available. Expect excretion into breast milk. Effects on nursing infants are unknown. Monitor nursing infant for dizziness, somnolence, blurred vision, peripheral edema, myopathy, and decreased platelet count. Avoid use during breast feeding.
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Probenecid (C/+)
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Excreted into breast milk. Toxicity observed probably related to concurrent antibiotic administered. Probably compatible. Observe nursing infant for diarrhea.
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Procainamide (C/+)
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Excreted in and accumulates in milk. AAP classifies procainamide as compatible with breast feeding. Long-term effects of exposure in nursing infants are unknown.
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Prochlorperazine (C/−)
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Other phenothiazines excreted into breast milk, so prochlorperazine excretion expected. Sedation in nursing infant a possible side effect.
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Propranolol (C/−)
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Excreted into breast milk. Monitor nursing infant for hypotension and bradycardia. AAP classifies propranolol as compatible with breast feeding.
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Propylthiouracil (D/+)
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Excreted into breast milk. Monitor thyroid function of infant periodically. AAP classifies propylthiouracil as compatible with breast feeding.
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Prothrombin complex concentrate (C/−)
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No human lactation data available. Manufacturer recommends to only use if clearly needed.
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Pseudoephedrine (C/+)
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Excreted into breast milk. Monitor nursing infant for agitation. AAP classifies pseudoephedrine as compatible with breast feeding.
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Pyrazinamide (C/+)
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Excreted into breast milk in small amounts. Probably compatible. Monitor infant for signs of toxicity such as jaundice, fever, decreased appetite, nausea, vomiting, thrombocytopenia, or rash.
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Pyrimethamine (C/+)
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Excreted into breast milk. AAP classifies pyrimethamine as compatible with breast feeding.
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Quetiapine (C/−)
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Excreted into breast milk. No reports of adverse effects in nursing infants. Long-term effects of this exposure are unknown. Manufacturer recommends avoiding breast feeding.
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Quinidine (C/+)
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Excreted into breast milk. Monitor nursing infant for rash, anemia, and arrhythmias. Risk of optic neuritis with chronic use. AAP classifies quinidine as compatible with breast feeding.
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Quinine (C/+)
|
Excreted into breast milk. No adverse effects reported in nursing infants. G6PD should be ruled out in infants at risk for the disease. AAP classifies quinine as compatible with breast feeding.
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Quinupristin/dalfopristin (B/−)
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No human lactation data available. Large molecular size and weakly acidic nature make it unlikely to be excreted into breast milk. Caution: may alter the bowel flora of nursing infants. There is the potential for the development of resistant strains of VRE. Breast feeding is not recommended.
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Rabies immune globulin (C/+)
|
No human lactation data available. Probably compatible.
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Ranitidine (B/+)
|
Excreted into breast milk. Effects on nursing infant are unknown. Decreases gastric acidity but effect on nursing infant has not been studied. AAP classifies similar agent (cimetidine) as compatible with breast feeding.
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Remifentanil (C/+)
|
No human lactation data available. Expect excretion into breast milk. Very short half-life. Other narcotic agents are classified as compatible with breast feeding by AAP.
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Rifabutin (B/CI)
|
No human lactation data available. Excretion into breast milk expected. Milk may be stained brown-orange color. Effects on nursing infants are unknown, but serious toxicities (leukopenia, neutropenia, rash) are potential adverse effects. Contraindicated if nursing mother is HIV-1 positive.
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Rifampin (C/+)
|
Excreted into breast milk in amounts that pose very little risk to nursing infants. No adverse effects reported. AAP classifies rifampin as compatible with breast feeding.
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Rifapentine (C/+)
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No human lactation data available. Expect excretion into breast milk. May cause red-orange discoloration of breast milk. Effects on nursing infants are unknown. AAP classifies rifampin, a similar agent, as compatible with breast feeding.
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Rifaximin (C/+)
|
No human lactation data available. Expect excretion into breast milk but in very small amounts due to limited systemic absorption. Effects on nursing infants are unknown but probably not clinically significant.
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Riociguat (X/−)
|
No human lactation data available. Expect excretion into breast milk. Effects on nursing infant unknown, but nursing infant should be monitored for diarrhea, vomiting, hypotension, GERD, and constipation.
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Risperidone (C/−)
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Excreted into breast milk. AAP classifies other antipsychotic drugs for which the effects on nursing infants are unknown but may be of concern, especially with long-term use. Could possibly alter short- and long-term CNS function.
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Ritonavir (B/CI)
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No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Rizatriptan (C/+)
|
No human lactation data available. Expect excretion into breast milk. Effects on nursing infants are unknown. Probably compatible.
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Rubella vaccine (C/+)
|
Compatible with breast feeding. ACOG and CDC recommend vaccination of susceptible women in immediate postpartum period.
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Salmeterol (C/+)
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No human lactation data available. Expect excretion into breast milk, but maternal plasma levels after inhaled dose are very low to undetectable. It is unlikely that clinically significant amounts would appear in breast milk. Probably compatible.
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Saquinavir (B/CI)
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No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Scopolamine (C/+)
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No human lactation data available. Excreted into breast milk. AAP classifies scopolamine as compatible with breast feeding.
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Secobarbital (D/+)
|
Excreted into breast milk. Amount and effects on nursing infants are unknown. AAP classifies secobarbital as compatible with breast feeding.
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Senna (C/+)
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Observe nursing infant for diarrhea. AAP classifies senna as compatible with breast feeding.
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Sertraline (C/−)
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AAP classifies sertraline as a drug for which the effect on nursing infant is unknown but may be of concern. Concentrated in human milk.
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Simeprevir (C/−)
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No human lactation data available. Molecular weight and elimination half-life suggest excretion into milk is likely, but high protein binding may limit amount excreted. Monitor nursing infants for rash, myalgia, and dyspnea.
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Simvastatin (X/CI)
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No human lactation data available. Expect excretion into breast milk. Because of the potential for adverse effects in the nursing infant, avoid use during lactation.
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Smallpox vaccine (D, X/CI)
|
CDC recommends breast-feeding women should not routinely be vaccinated; however, if nursing woman is exposed to smallpox or monkeypox, she should be vaccinated and stop breast feeding.
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Sofosbuvir (B, X/+)
|
No human lactation data available. Molecular weight and protein binding suggest it is likely excreted into milk. Potentially toxic if used in combination with ribavirin. Probably compatible otherwise.
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Sotalol (B/−)
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Milk levels 3–5 times maternal serum levels. Could cause bradycardia and hypotension. Long-term effects unknown.
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Spironolactone (C/+)
|
Unknown if spironolactone is excreted into breast milk, but metabolite is found in breast milk—probably insignificant amount. Effects on nursing infants unknown. AAP classifies spironolactone as compatible with breast feeding.
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SSKI (potassium iodide) (D/+)
|
The significance to nursing infant of chronic ingestion of higher levels of iodine unknown. AAP recognizes maternal use of iodides during lactation may affect infant’s thyroid activity by producing elevated iodine levels in breast milk; it classifies as compatible with breast feeding. Consider monitoring infant’s thyroid function.
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St. John’s wort (C/−)
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Unknown if any of the constituents and possible contaminants are excreted into breast milk or if exposure represents risk to nursing infant.
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Stavudine (C/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Sucralfate (B/+)
|
Minimal, if any, drug expected to be excreted into breast milk because only small amounts systemically absorbed.
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Sulbactam (B/+)
|
Excretion into breast milk expected. Effects on nursing infants are unknown. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. AAP classifies sulbactam as compatible with breast feeding.
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Sulfamethoxazole (C/−)
|
Excreted into breast milk in low concentrations. Avoid in ill, stressed, or preterm infants and those with hyperbilirubinemia or G6PD deficiency.
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Sulfasalazine (B, D/−)
|
Excreted into breast milk. May cause diarrhea in nursing infants. AAP classifies sulfasalazine as a drug that has been associated with significant effects on some nursing infants and should be given to nursing mother with caution.
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Sulindac (C/−)
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No human lactation data available. Because of prolonged half-life, use safer alternatives such as diclofenac, fenoprofen, flurbiprofen, ibuprofen, ketoprofen, ketorolac, or tolmetin during breast feeding.
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Sumatriptan (C/+)
|
Excreted into breast milk. Absorption from GI tract is inhibited, so amount reaching nursing infant is probably negligible. AAP classifies sumatriptan as compatible with breast feeding.
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Suvorexant (C/+)
|
No human lactation data available. Molecular weight suggests excretion into breast milk, but high protein binding likely limits the amount in milk. Probably compatible.
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Tavaborole (C/+)
|
No human lactation data available. Probably compatible.
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Tedizolid (C/+)
|
No human lactation data available. Molecular weight suggests that excretion into breast milk should be expected, but high protein binding may limit the amount in milk. Probably compatible.
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Telavancin (C/−)
|
No human lactation data available. High fat solubility suggests some excretion into milk. Monitor nursing infant for diarrhea, vomiting, and foamy urine.
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Telmisartan (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Molecular weight suggests that excretion into breast milk should be expected. Effects on nursing infant are unknown. AAP classifies the closely related ACE inhibitors as compatible with breast feeding.
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Temazepam (X/−)
|
Excreted into breast milk. Observe nursing infant for sedation and poor feeding. AAP classifies temazepam as a drug for which the effect on nursing infants is unknown but may be of concern.
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Tenofovir (B/CI)
|
No human lactation data available. Molecular weight suggests excretion into breast milk should be expected. Effect on nursing infant is unknown. CDC recommends HIV-infected mothers in developed countries to not breast feed.
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Terbutaline (C/+)
|
Excreted into breast milk. Monitor nursing infant for agitation and spitting up. Use inhaled form to decrease maternal absorption if available. AAP classifies terbutaline as compatible with breast feeding.
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Tetanus/diphtheria toxoids and acellular pertussis vaccine (B, C/+)
|
No human lactation data available. Compatible with breast feeding.
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Tetracycline (D 1st tri; CI 2nd, 3rd tri/+)
|
Excreted into breast milk in low concentrations. Theoretical dental staining and inhibition of bone growth are remote. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. AAP classifies tetracycline as compatible with breast feeding.
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THC (marijuana) (X/CI)
|
Excreted into breast milk. AAP classifies marijuana as a drug that should not be used during breast feeding.
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Theophylline (C/+)
|
Excreted into breast milk. AAP classifies theophylline as compatible with breast feeding. Monitor nursing infant for irritability.
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Tobramycin (C, D/+)
|
Excreted into breast milk. No adverse effects reported, and because of poor oral absorption, ototoxicity risk is low. The bowel flora of nursing infants may be altered, and there is the potential for interference with the interpretation of an infectious workup. Observe nursing infants for possible allergic reaction. Compatible with breast feeding.
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Topiramate (D/−)
|
Excreted into breast milk. No adverse effects noted in limited number of exposed nursing infants. However, potential for adverse effects: fatigue, somnolence, ataxia, purpura, epistaxis, infections (viral and pneumonia), anorexia, and weight loss. Observe nursing infants for signs of toxicity.
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Tramadol (C/CI)
|
Tramadol and active metabolite, M1 (O-desmethyl tramadol), are present in breast milk; concentrations are dependent on CYP2D6 metabolism. Effects on nursing infants unknown. Opioid therapy should be avoided in breast-feeding mothers due to potential for apnea and sedation in the infant.
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Trazodone (C/−)
|
Excreted in breast milk. AAP classifies trazadone as a drug for which the effects on the nursing infant are unknown but may be of concern.
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Tretinoin (systemic) (CI 1st tri; D 2nd, 3rd tri/+)
|
Vitamin A and probably tretinoin are natural constituents of breast milk. No human lactation data available on amounts excreted into breast milk after doses for treatment of promyelocytic leukemia or risk to nursing infant. Probably compatible.
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Trimethoprim/sulfamethoxazole (D/−)
|
Excreted into breast milk in low concentrations. Considered negligible risk to nursing infant. Monitor for jaundice, hemolysis, and GI disturbance. The bowel flora may be altered. Avoid in ill, stressed, or preterm infants and those with hyperbilirubinemia or G6PD deficiency.
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|
Valacyclovir (B/+)
|
Lack of adverse effects seen with acyclovir, the primary metabolite of valacyclovir. Considered compatible with breast feeding; breast-feeding mothers with herpetic lesions near or on the breast should avoid breast feeding.
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Valganciclovir (C/CI)
|
Active metabolite, ganciclovir, has the potential to cause serious toxicity. CDC recommends HIV-infected mothers in developed countries to not breast feed. Breast feeding contraindicated.
|
|
Valproic acid (D, X for migraine prophylaxis/+)
|
Generally compatible with breast feeding per AAP but carries risk of fatal hepatotoxicity.
|
|
Valsartan (C 1st tri; D 2nd, 3rd tri/+)
|
No human lactation data available. Low molecular weight suggests that the drug would be excreted into breast milk. Effects on nursing infant are unknown.
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|
Vancomycin (B/+)
|
Excreted into breast milk. Effects on nursing infant are unknown, but vancomycin is poorly absorbed from GI tract. Potential for allergic sensitization and modification of bowel flora. AAP classifies cephalosporins as compatible with breast feeding. Compatible with breast feeding.
|
|
Varicella vaccine (D/+)
|
CDC and AAP classify as compatible with breast feeding.
|
|
Vedolizumab (B/−)
|
No human lactation data available. Effect on nursing infant is unknown.
|
|
Velpatasvir (C/−)
|
No human lactation data available. Potentially toxic if used in combination with ribavirin. Effects on nursing infants are unknown.
|
|
Venlafaxine (C/−)
|
Excreted into breast milk. Observe for excessive somnolence, changes in sleep, decreased feeding, and weight loss. Long-term effects on neurobehavioral development are unknown. AAP classifies effect of SNRIs on breast feeding as unknown but may be of concern. However, if required by the mother, it is not a reason to discontinue breast feeding.
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|
Verapamil (C/+)
|
Excreted into breast milk. Limited human lactation data available. AAP classifies verapamil as compatible with breast feeding.
|
|
Voriconazole (D/−)
|
No human lactation data available. Low molecular weight suggests excretion into breast milk. Potential for toxicity in neonatal period. Manufacturer recommends a decision be made to continue nursing or discontinue the drug, taking into account the importance of treatment to the mother.
|
|
Voxilaprevir (C/−)
|
No human lactation data available. Potentially toxic if used in combination with ribavirin. Effects on nursing infants are unknown.
|
|
Warfarin (X/+)
|
Maternal warfarin therapy does not appear to pose a significant risk to normal full-term infants; monitor for bleeding or bruising. American College of Chest Physicians (ACCP) classifies as compatible with breast feeding; other oral anticoagulants are contraindicated in lactating women.
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|
Zanamivir (C/+)
|
No human lactation data available. Low molecular weight and pharmacokinetics of drug suggest it will be excreted into breast milk. Effects on nursing infants are unknown, but risk of harm is low.
|
|
Zidovudine (C/CI)
|
CDC recommends HIV-infected mothers in developed countries to not breast feed.
|
|
Zolmitriptan (C/+)
|
No human lactation data available. Molecular weight and low protein binding suggest drug and its active metabolite will be excreted into breast milk. Effects on nursing infant are unknown.
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|
Zolpidem (C/+)
|
Excreted into breast milk in small amounts, which would indicate few adverse effects, if any, would occur in nursing infant. Observe for increased sedation, lethargy, and changes in feeding habits. AAP classifies zolpidem as compatible with breast feeding.
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