Some Medications Contraindicated for Breastfeeding Mothers

Anticoagulants

Dicumarol

Cytotoxic medications

May interfere with cellular metabolism of a breastfeeding infant, causing possible immunosuppression and neutropenia

Unknown effect on growth and unknown association with carcinogenesis

Psychoactive medications

For most psychoactive medications, unknown effect on infants, but because medications and metabolites appear in breast milk and in infant plasma and tissues, possible alteration of short-term and long-term central nervous system function

colic, irritability, feeding problems and sleep disorders, and slow weight gain

Individual medications that are detectable in breast milk and pose theoretical risk

Possible hypothyroidism

Possible idiosyncratic bone marrow suppression

Potential for transfer of high percentage of maternal dose

Possible increase in skin pigmentation

Corticosteroids

With large maternal doses given for weeks or months, can produce high concentrations in milk and may suppress growth and interfere with endogenous corticosteroid production in the infant

Potential for therapeutic serum concentrations in the infant

None described

In vitro mutagens

May stop breastfeeding for 12–24 hours to allow excretion of dose when a mother is given a single dose of 2 g

Safe after the infant is 6 months old

Sulfapyridine

Sulfisoxazole

Caution required if infants have jaundice or G6PD deficiency or are ill, stressed, or premature

Individual medications that are detectable in breast milk and have documented risk

Hypotension, bradycardia, tachypnea

Aminosalicylic acid

Diarrhea

Metabolic acidosis

With large maternal doses and sustained use, may produce plasma concentrations that increase risk of hyperbilirubinemiaG6PD-deficient infants who are < 1 month

Cyanosis, bradycardia

Suppresses lactation

May be hazardous to the mother

Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness

Vomiting, diarrhea, seizures (with doses used in migraine medications)

Withdrawal vaginal bleeding

Iodides

Iodine

Goiter

One third to one half therapeutic blood concentration in infants

Sedation, infantile spasms after weaning, methemoglobinemia

Methemoglobinemia

Sedation, feeding problems

Bloody diarrhea

Hemolysis in infants with G6PD deficiency; safe in others

Drugs of abuse*

Irritability, poor sleeping pattern

Alcohol

With < 1 g/kg daily, decreased milk ejection reflex

With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain in the infant

Heroin

Tremors, restlessness, vomiting, poor feeding

Marijuana

Components detectable in breast milk but effects uncertain

Phencyclidine

Hallucinogen