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E
Breast-Feeding and Medication Use
General Considerations
Lactation
Category Risk Rationale
" Most medications are safe to use while breast-feeding;
however, the woman should always check with the pedi-
of use in
atrician, physician, or lactation specialist before taking
many breast-
any medications, including over-the-counter and herbal
feeding
products.
women
" Inform the woman that she has the right to seek a second has not
demonstrated
opinion if the physician does not perform a thoughtful
risk to the
risk-versus-benefit assessment before prescribing med-
infant.
ications or advising against breast-feeding.
" Most medications pass from the woman s bloodstream L2 Safer Limited clinical
research
into the breast milk. However, the amount is usually
has not
very small and unlikely to harm the baby.
demonstrated
" A preterm or other special needs neonate is more sus-
an increase
ceptible to the adverse effects of medications in breast
in adverse
milk. A woman who is taking medications and whose
effects in the
baby is in the neonatal intensive care unit or special care
infant.
nursery should consult with the pediatrician or neo-
L3 Moderately There is possible
natologist before feeding her breast milk to the baby.
safe risk to
" If the woman is taking a prescribed medication, she
the infant;
should take the medication just after breast-feeding. This
however,
practice helps ensure that the lowest possible dose of
the risks are
medication reaches the baby through the breast milk.
minimal or
" Some medications can cause changes in the amount of
nonthreatening
milk the woman produces. Teach the woman to report
in nature. These
any changes in milk production.
medications
should be
given only
Lactation Risk Categories (LRC)
when the
potential
Lactation
benefit
Category Risk Rationale
outweighs
the risk to the
L1 Safest Clinical research
infant.
or long-term
observation
(continued)
appendix
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Appendix E 783
" Sulfonamides should not be used during the neonatal
Lactation
stage (the first month of life). (LRC: L3)
Category Risk Rationale
L4 Possibly There is positive
Antihypertensives
hazardous evidence
" A high degree of caution is advised when antihyper-
of risk to
tensives are used during breast-feeding.
the infant;
however, in " Some beta blockers can be used.
life-threatening
" Hydralazine and methyldopa are considered to be safe.
situations or
(LRC: L2)
for serious
" ACE inhibitors are not recommended in the early post-
diseases, the
partum period.
benefit might
outweigh the
Sedatives and Hypnotics
risk.
L5 Contraindicated The risk of using
" Neonatal withdrawal can occur when antianxiety med-
the medication
ications, such as lorazepam, are taken. Fortunately with-
clearly out-
drawal is generally mild.
weighs any
" Phenothiazines, such as Phenergan and Thorazine, may
possible benefit
lead to sleep apnea and increase the risk for sudden
from breast-
infant death syndrome.
feeding.
Antidepressants
" The risk to the baby often is higher if the woman is
Potential Effects of Selected
depressed and remains untreated, rather than taking the
Medication Categories on
medication.
" The older tricyclics are considered to be safe; however
the Breast-Fed Infant
they cause many bothersome side effects, such as weight
Narcotic Analgesics
gain and dry mouth, which may lead to noncompliance
on the part of the woman.
" Codeine and hydrocodone appear to be safe in moder-
" The selective serotonin uptake inhibitors (SSRIs) also
ate doses. Rarely the neonate may experience sedation
are considered to be safe and have a lower side effect pro-
and/or apnea. (LRC: L3)
file, which makes them more palatable to the woman.
" Meperidine (Demerol) can lead to sedation of the neo-
(LRC: L2 and L3)
nate. (LRC: L3)
" Low to moderate doses of morphine appear to be safe.
(LRC: L2) Mood Stabilizers
" Trace-to-negligible amounts of fentanyl are found in
(Antimanic Medication)
human milk. (LRC: L2)
" Lithium is found in breast milk and is best not used in
the breast-feeding woman. (LRC: L4)
Non-narcotic Analgesics and NSAIDs
" Valproic acid (Depakote) seems to be a more appro-
" Acetaminophen and ibuprofen are approved for use.
priate choice for the woman with bipolar disorder. The
(LRC: L1)
infant will need periodic lab studies to check platelets
" Naproxen may cause neonatal hemorrhage and anemia
and liver function.
if used for prolonged periods. (LRC: L3 for short-term
use and L4 for long-term use)
Corticosteroids
" The newer COX2 inhibitors, such as celecoxib (Cele-
" Corticosteroids do not pass into the milk in large
brex), appear to be safe for use. (LRC: L2)
quantities.
Antibiotics " Inhaled steroids are safe to use because they don t accu-
mulate in the bloodstream.
" Levels in breast milk are usually very low.
" The penicillins and cephalosporins are generally con-
Thyroid Medication
sidered safe to use. (LRC: L1 and L2)
" Tetracyclines can be safely used for short periods but are " Thyroid medications, such as levothyroxine (Synthroid),
not suitable for long-term therapy (e.g., for treatment of can be taken while breast-feeding.
acne). (LRC: L2) " Most are in LRC category L1.
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784 Appendix E
" Iodides
Medications That Usually
" Methotrexate and immunosuppressants
Are Contraindicated for
" Lithium
the Breast-Feeding Woman
" Radiopharmaceuticals
" Ribavirin
" Amiodarone
" Tetracycline (prolonged use more than 3 weeks)
" Antineoplastic agents
" Pseudoephedrine (found in many over-the-counter
" Chloramphenicol
medications)
" Doxepin
" Ergotamine and other ergot derivatives
Material in this Appendix was adapted from information found on the American Academy of
Pediatrics website (www.aap.org) and from Riordan, J. (2005). Breastfeeding and human
lactation (3rd ed.). Boston: Jones and Bartlett Publishers: Hale, T. W. (2004). Medications
and mother s milk (11th ed.). Amarillo, TX: Pharmasoft Publishing.