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Medications in Lactation
Aka: Medications in Lactation, Lactation Safe Medications, Contraindicated Drugs in Lactation
- See Also
- Medications in Pregnancy
-
General
- Assess benefit versus risk for medication
- Choose medications safe for Lactation
- Use medications with short half lives
- Take medications just before or after Lactation or before infant's longest sleep time
- Ask women of child-bearing age if they are lactating when prescribing medications
- Pumping and Dumping is not benign (especially in early Lactation)
- Even 1-2 days of Lactation interruption can result in stopping Breast Feeding altogether
- Patient Education
- Lactating women should ask physician or pharmacist before new medication
- Management: Antibiotics considered safe in Lactation
- Penicillin Antibiotics
- Cephalosporin Antibiotics
- Erythromycin (concentrated in human milk, increased risk of Pyloric Stenosis)
- Clindamycin
- Aminoglycosides
- Fluoroquinolones (considered safe by AAP, risk of Arthropathy)
- Sulfa antibiotics
- Avoid in infants with G6PD and in the first month of life due to Hyperbilirubinemia risk
- Management: Analgesics
- Agents considered safe in Lactation
- Acetaminophen (Tylenol)
- Ibuprofen (preferred NSAID over Naproxen)
- Toradol (probably safe, but parenteral dosing has not been studied)
- Agents to use with caution
- Aspirin (AAP recommends use with caution)
- Naproxen (long half-life and case reports of infant adverse effect on LactMed)
- Opioids in general result in infant sedation
- Hydromorphone (Dilaudid)
- Morphine
- Fentanyl
- Agents to avoid in Lactation
- Oxycodone
- Demerol
- Codeine
- Poor Analgesic with variable activity, and generally not recommended as an Analgesic for anyone
- Management: Anticonvulsants in Lactation
- Very low Breast Milk concentrations (highly bound)
- Phenytoin (Dilantin)
- Tiagabine (Gabitril)
- Valproate
- Low to moderate Breast Milk concentrations
- Carbamazepine
- Phenobarbital
- Lamotrigine
- Topiramate (Topamax)
- Zonegran
- Primidone (metabolized in part to phenobarbital)
- Risk of infant sedation
- AAP recommends using with caution
- High Breast Milk concentration (minimally bound)
- Gabapentin
- Levetiracetam (Keppra)
- Ethosuximide (AAP: Compatible with Lactation)
- Management: Antidepressants considered potentially safe in Lactation
- AAP recommends use with caution
- Unknown longterm effect
- Use if benefits outweigh risk
- Preferred agents
- Fluoxetine (risk of colic, irritability, sleep disorders, feeding problems, decreased growth)
- Sertraline
- Paroxetine
- Management: Cardiovascular Medications in Lactation
- Antihypertensives safe in Lactation
- ACE Inhibitors (avoid in first 6 weeks, risk of renal toxicity in Premature Infants)
- Captopril
- Enalapril
- No data on Lisinopril
- Hydrochlorothiazide (may decrease milk production)
- Methyldopa
- Miscellaneous drugs considered safe in Lactation
- Digoxin
- Coumadin
- Heparin (not excreted into Breast Milk)
- Management: Assorted medications considered safe in Lactation
- Magnesium Sulfate
- RhoGAM
- RubellaVaccine
- Oral Contraceptives (avoid until Breast Feeding is established, after 60-90 days)
- CT IV Contrast does not require interruption of Breast Feeding (i.e. pump and dump)
- Only 1% of IV contrast reaches Breast Milk, and only 1% of that is absorbed by the infant
- Newman (2007) Can Fam Physician 53(4): 630–631 [PubMed]
- Antihistamines and Decongestants (use with caution)
- Risk of decreased milk supply
- Management: Herbs and Teas considered safe in Lactation
- Avoid Caffeine more than 2 beverages per day
- Herbs
- Chamomile
- Garlic
- Ginger
- Ginseng
- Valerian
- Teas
- Chicory
- Orange Spice
- Peppermint
- Raspberry
- Red bush tea
- Rose hips
- Management: Contraindicated Drugs in Lactation
- Medications that decrease milk production
- Bromocriptine
- Diuretics
- Chemotherapeutic Medications
- Cyclophosphamide
- Cyclosporine
- Doxorubicin
- Methotrexate
- Gold salts
- Propylthiouracil
- Methimazole
- Radioactive Chemicals used in Nuclear Medicine
- Gallium-67 (in Breast Milk up to 14 days)
- Indium-111 (in Breast Milk up to 20 hours)
- Iodine 131 (in Breast Milk up to 14 days)
- Radioactive Sodium (in Breast Milk up to 96 hours)
- Technetium-99m (in Breast Milk up to 3 days)
- Cardiovascular medications to avoid in Lactation
- Avoid Atenolol and use other Beta Blockers only with caution
- Avoid Acebutolol
- Avoid Amiodarone
- Miscellaneous Medications
- Dextroamphetamine
- Ergotamine
- Lithium
- Metronidazole (esp. if 2 gram dose)
- Chloramphenicol
- Potassium iodide
- Phenindione (Anticoagulant)
- Drugs of Abuse
- Amphetamine
- Cocaine
- Heroin
- Marijuana
- Nicotine
- Phencyclidine
- Resources
- LactMed
- https://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm
- References
- (2000) Harriet Lane Handbook, Mosby, p. 913
- Hale (2006) Medications and Mother's Milk, Hale Publishing
- Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
- Mason and Wheaton in Herbert (2018) EM:Rap 18(11): 8-9
- Middleton (1998) Allergy, Mosby, p. 941
- (1994) Pediatrics 93:137-50 [PubMed]
- Howard (2001) Pediatr Clin North Am 48(2):485-504 [PubMed]