Articles - Breast Feeding

Drugs and Breast-milk

Contraindicated. These drugs should not be used during lactation. If they are essential to the mother's health, breast-feeding should be discontinued temporarily or permanently.
Amantadine** Cocaine Iodide (including topical forms)
Aminodarone Dipyrone (in Mexican drugs) Metamizol (same as dipyrone)
Antineoplastic agents Gold salts Radiopharmaceuticals (withhold breastfeeding temporarily)
Bromide Indandione anticoagulants (eg, phenindione) Salicylates (large doses)
Potentially Hazardous. Although not generally contraindicated, these agents should be used with caution and avoided if possible, particularly while breast-feeding a newborn.
Acebutolol Doxepin Nicotine/Smoking**
Alcohol (especially large amounts) Ergotamine Nitrofurantoin
Antihistamine/Decongestant combinations** Ethosuximide Phenobarbital (anticonvulsant dose)
Atenolol Fluorescein Piroxicam
Benzodiazepines (lorazepam, oxazepam preferred) Fluoxetine Primidone
Chlorthalidone** Lindane Quinolone antibacterials (norfloxacin preferred)
Clindamycin Lithium Reserpine
Clonidine** Methimazole Sotalol
Contraceptives, estrogen-containing** Nadolol Sulfonamides, long-acting
Cyclosporine Narcotics (in addicts or with therapeutic doses in first 10 days postpartum) Thiazide diuretics, long-acting or high doses**
Diazepam Metronidazole***  
Probably Safe in Usual Doses. Data are insufficient to ensure that these agents have no adverse effects in breast-feeding infants; if these effects occur, they probably are infrequent or mild. There is a potential for rare allergic or idiosyncratic reactions.
ACE inhibitors (eg, enalapril) Decongestants, oral** Propylthioracil
Aminoglycoside antibiotics Ergonovine (short courses)** Quinidine
Anticholinergic agents Fluconazole Salicylates (occasional use)
Anticonvulsants (except ethosuximide and phenobarbital) Histamine H2-receptor antagonists (famotidine preferred) Spironolactone
Antidepressants (except diazepam) Isoniazid Sulfisoxazole
Antihistamines Levothyroxide Terfenadine
Antitubercular agents Metoclopramide (10 to 14 days) Tetracyclines (2 weeks or less)
Azathiopine (immunosuppression following organ transplant) Nonsteroidal anti-inflammatory agents (ibuprofen preferred) Thiazide diuretics, short-acting (low doses)
Barbiturates (except phenobarbital) Oxazepam Tricyclic antidepressants (nortriptyline, desipramine preferred; avoid doxepin)
Butyrophenones (eg, haloperidol) Phenothiazines Verapamil
Safe in Usual Doses. Although the potential for rare allergic or idiosyncratic reactions should be kept in mind, usual doses pose little risk for the breasfed infant.
Acetaminophen Flurbiprofen Metoprolol
Antacids Heparin Miconazole
Caffeine Inhalers, bronchodilators, corticosteroids Pencillins
Cephalosporins Insulin Propranolol
Clotrimazole Labetalol Theophylline
Contraceptives, progestin only Laxatives, bulk-forming and stool softening (eg, psyllium, docusate) Thyroid replacement
Corticosteroids Lidocaine Vaccines
Decongestant nasal sprays Magnesium sulfate Vancomycin
Digoxin Methyldopa Warfarin
Erythromycin Methylergonovine (short courses)  
*Compiled by Philip Anderson, PharmD, Director, Drug Information Service, University of California, San Diego, CA
**Drug also may inhibit lactation.
***In situations where bottle feeding threatens the infant's life, breastfeeding may be undertaken cautiosly.
Sources: Knoben JE, Anderson PO. Handbook of Clinical Drug Data. 7th ed. Hamilton Press; 1993; Anderson P. Drug use during breastfeeding. Clin Pharm. 1991;10:596-624; UCSD Drug Information Service.
Note: The information contained in this table is time-limited. It is current and accurate as of 9/95. For use beyond that date, review and updating may be necessary.
Used with permission.

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