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National Breastfeeding Week: Medications and Breast Milk

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Jarod Cassidy1 year ago


New and expecting mothers making the decision to breastfeed do understanding that breast milk is an excellent way for their child to receive nutrition and sustain development. They also understand that breast milk can transmit chemicals that are potentially hazardous to their child and adjust their lifestyle accordingly.

However, while it’s easy to remember that the transmission of alcohol and illicit drugs through breast milk can seriously hamper a child’s growth and development, understanding which pharmaceuticals pose a similar threat is much more difficult.

In recognition of National Breastfeeding Week, Thomas J. Henry would like to share a list compiled by Baby Center which categorizes some the most widely used pharmaceuticals based on breastfeeding safety. Please note that even if a medication is considered safe, mothers should consult with their physician if they have any questions or concerns that a medication or combination of medications may pose a hazard to their nursing infant.

Drugs Considered Safe to Take When Breastfeeding

The following medications are considered safe to take in standard doses when breastfeeding:

  • Acetaminophen (Tylenol)
  • Acyclovir and valacyclovir (Zovirax, Valtrex)
  • Antacids (Maalox, Mylanta)
  • Bupivacaine (Marcaine)
  • Cephalosporins (Keflex, Ceclor, Ceftin, Omnicef, Suprax)
  • Clotrimazole (Lotrimin, Mycelex)
  • Contraceptives (progestin-only) – (Micronor, Norplant, Depo-Provera)
  • Corticosteroids (Prednisone)
  • Decongestant nasal sprays (Afrin)
  • Digoxin (Lanoxin)
  • Erythromycin (E-Mycin, Erythrocin)
  • Fexofenadine (Allegra)
  • Fluconazole (Diflucan)
  • Heparin
  • Ibuprofen (Motrin, Advil)
  • Inhalers, bronchodilators, and corticosteroids(Albuterol, Vanceril)
  • Insulin
  • Laxatives, bulk-forming and stool softening(Metamucil, Colace)
  • Lidocaine (Xylocaine)
  • Loratadine (Claritin)
  • Low molecular weight heparins (enoxaparin, dalteparin, tinzaparin) (Lovenox, Fragmin, Innohep)
  • Magnesium sulfate
  • Methyldopa (Aldomet)
  • Methylergonovine (short courses) (Methergine)
  • Metoprolol (Lopressor)
  • Miconazole (Monistat 3)
  • Nifedipine (Adalat, Procardia)
  • Penicillins (Amoxicillin, Dynapen)
  • Propranolol (Inderal)
  • Theophylline (Theo-Dur)
  • Tretinoin (Retin A)
  • Thyroid replacement (Synthroid)
  • Vaccines (except smallpox and yellow fever)
  • Vancomycin (Vancocin)
  • Verapamil (Calan, Isoptin, Verelan)
  • Warfarin (Coumadin) 

Drugs that are Considered Most Likely Safe to Take when Breastfeeding

The medications in this category are considered most likely safe at standard doses. Potential side effects are generally considered mild. In extremely rare cases, the nursing infant may have an allergic reaction.

  • ACE inhibitors – Enalapril (Vasotec), Benazepril (Lotensin)
  • Anticholinergic agents (Pro-Banthine)
  • Anticonvulsants – Depakote, Dilantin, Tegretol (avoid ethosuximide, phenobarbital, and primidone)
  • Antihistamines, First-generation – (Benadryl, Chlor-Trimeton)
  • Antituberculars (INH)
  • Azathioprine (low doses) – (Imuran)
  • Barbiturates (except phenobarbital) – Fiorinal, Fioricet
  • Bupropion (Wellbutrin)
  • Clindamycin (Cleocin)
  • Oral decongestants (Sudafed, Entex PSE)
  • Ergonovine (short course)
  • Fluconazole (Diflucan)
  • Gadolinium (Magnevist, Omniscan)
  • Histamine H2 blockers – Cimetidine (Tagamet), ranitidine (Zantac), nizatadine (Axid), and famotidine (Pepcid – preferred)
  • Labetalol (Normodyne, Trandate)
  • Hydrochlorothiazide (low doses) – (HydroDiuril)
  • Lorazepam (Ativan)
  • Methimazole (apazole)
  • Metoclopramide (Reglan)
  • Midazolam
  • Naproxen (Naprosyn, Anaprox, Aleve)
  • Omeprazole (Prilosec)
  • Oxazepam (Serax)
  • Paroxetine (Paxil)
  • Propofol (Diprivan)
  • Quinidine
  • Quinolone antibacterials (Cipro and Levaquin; Noroxin is preferred)
  • Salicylates (occasional use) – (aspirin)
  • Sertraline (Zoloft)
  • Spironolactone (Aldactone, Aldactazide)
  • Sumatriptan (Imitrex)
  • Tetracyclines < 14 days – (tetracycline, doxycycline)
  • Trazodone
  • Tricyclic antidepressants (avoid doxepin) -(Elavil, Tofranil, Pamelor)
  • Verapamil (Calan, Isoptin, Verelan)
Drugs that May Be Dangerous to Nursing Infants

Breastfeeding mothers should use caution when taking the following medications as they may cause serious side effects and adverse events in newborns, especially premature infants. New and expecting mothers taking these medications should consult with their healthcare provider to determine the best course of action.

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Antihistamine/decongestant combinations(Contac, Dimetapp)
  • Benzodiazepines, Long-Acting (Librium, Valium, Dalmane)
  • Chlorthalidone
  • Citalopram (Celexa)
  • Clonidine (Catapres)
  • Contraceptives (estrogen-containing) – (Ortho-Novum, Lo-Ovral, Loestrin)
  • Doxepin (Sinequan)
  • Egotamine (Cafergot)
  • Escitalopram (Lexapro)
  • Ethosuximide (Zarontin)
  • Fluorescein IV
  • Fluoxetine (Prozac, Serafem)
  • Iodinated contrast media
  • Lamotrigine (Lamictal)
  • Lithium (monitor infant serum levels) – (Lithobid)
  • Metronidazole (Flagyl)
  • Nadolol (Corgard)
  • Narcotics, especially meperidine in addicts and high doses with newborns (Tylenol #3, Vicodin)
  • Nefazodone (Serzone)
  • Nicotine
  • Nitrofurantoin (Macrobid)
  • Phenobarbital, anticonvulsant doses
  • Piroxicam (Feldene)
  • Primidone (Mysoline)
  • Reserpine
  • Sotalol (Betapace)
  • Thiazide diuretics, long-acting or high doses (Aquatensin, Enduron, Lozol, Renese)
  • Venlafaxine (Effexor)
Drugs that Are Unsafe to Take when Breastfeeding

The following drugs are not safe for breastfeeding mothers. New and expecting mothers taking these medicaitons should ask their physician if there are safer, alternative treatments. In the event that there is not a safer alternative, you may be advised to temporarily discontinue treatment. Mothers are urged to consult with their healthcare providers if they are on these medications.

  • Amantadine (Symmetrel)
  • Amiodarone (Cordarone
  • Antilipemics (excluding resins) – Lescol, Lipitor, Lopid, Mevacor, Pravacor, Zocor)
  • Antineoplastic agents
  • Aspirin (large doses)
  • Cocaine
  • Chlorampenicol
  • Clozapine (Clozaril)
  • Dipyrone (dipirona in Mexican drugs)
  • Gold Salts (Myochrysine
  • Iodide products (Betadine, potassium iodide)
  • Iodine, radioactive
  • Lipid-lowering drugs (Lescol, Lipitor, Lopid, Mevacor, Pravacor, Zocor)
  • Metamizole (Dipyrone)
  • Salicyclates, large doses (Aspirin)




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