Some Medications Contraindicated for Breastfeeding Mothers
Drug Class | Examples | General Concerns and Specific Effects in Infants |
|---|---|---|
Anticoagulants | Dicumarol WarfarinWarfarin | May be given cautiously but, in very large doses, may cause hemorrhage (heparin is not excreted in milk)May be given cautiously but, in very large doses, may cause hemorrhage (heparin is not excreted in milk) |
Cytotoxic medications | CyclophosphamideCyclophosphamide CyclosporineCyclosporine DoxorubicinDoxorubicin MethotrexateMethotrexate | 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 | Anxiolytics, including benzodiazepines (alprazolam, diazepam, lorazepam, midazolam, prazepam, quazepam, temazepam) and perphenazineAnxiolytics, including benzodiazepines (alprazolam, diazepam, lorazepam, midazolam, prazepam, quazepam, temazepam) and perphenazine Antidepressants (tricyclics, selective serotonin reuptake inhibitors, bupropion)Antidepressants (tricyclics, selective serotonin reuptake inhibitors, bupropion) Antipsychotics (chlorpromazine, chlorprothixene, clozapine, haloperidol, mesoridazine, trifluoperazine)Antipsychotics (chlorpromazine, chlorprothixene, clozapine, haloperidol, mesoridazine, trifluoperazine) | 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 Fluoxetine: Linked to Fluoxetine: Linked tocolic, irritability, feeding problems and sleep disorders, and slow weight gain Chlorpromazine: Possible drowsiness, lethargy, decline in developmental scoresChlorpromazine: Possible drowsiness, lethargy, decline in developmental scores Haloperidol: Decline in developmental scoresHaloperidol: Decline in developmental scores |
Individual medications that are detectable in breast milk and pose theoretical risk | AmiodaroneAmiodarone | Possible hypothyroidism |
ChloramphenicolChloramphenicol | Possible idiosyncratic bone marrow suppression | |
ClofazimineClofazimine | 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 | |
LamotrigineLamotrigine | Potential for therapeutic serum concentrations in the infant | |
MetoclopramideMetoclopramide | None described | |
MetronidazoleMetronidazole TinidazoleTinidazole | 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 | AcebutololAcebutolol | Hypotension, bradycardia, tachypnea |
Aminosalicylic acid | Diarrhea | |
Aspirin (salicylates)Aspirin (salicylates) | Metabolic acidosis With large maternal doses and sustained use, may produce plasma concentrations that increase risk of hyperbilirubinemia (salicylates compete for albumin-binding sites) and hemolysis only in (salicylates compete for albumin-binding sites) and hemolysis only inG6PD-deficient infants who are < 1 month | |
AtenololAtenolol | Cyanosis, bradycardia | |
BromocriptineBromocriptine | Suppresses lactation May be hazardous to the mother | |
ClemastineClemastine | Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness | |
ErgotamineErgotamine | Vomiting, diarrhea, seizures (with doses used in migraine medications) | |
EstradiolEstradiol | Withdrawal vaginal bleeding | |
Iodides Iodine | Goiter | |
LithiumLithium | One third to one half therapeutic blood concentration in infants | |
PhenobarbitalPhenobarbital | Sedation, infantile spasms after weaning, methemoglobinemia | |
PhenytoinPhenytoin | Methemoglobinemia | |
PrimidonePrimidone | Sedation, feeding problems | |
Sulfasalazine (salicylazosulfapyridine)Sulfasalazine (salicylazosulfapyridine) | Bloody diarrhea | |
Nitrofurantoin, sulfapyridine, sulfisoxazoleNitrofurantoin, sulfapyridine, sulfisoxazole | Hemolysis in infants with G6PD deficiency; safe in others | |
Drugs of abuse* | AmphetamineAmphetamine | 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 | |
CocaineCocaine | Cocaine intoxication: Irritability, vomiting, diarrhea, tremulousness, seizuresCocaine intoxication: Irritability, vomiting, diarrhea, tremulousness, seizures | |
Heroin | Tremors, restlessness, vomiting, poor feeding | |
Marijuana | Components detectable in breast milk but effects uncertain | |
Phencyclidine | Hallucinogen | |
* Effects of smoking are unclear; nicotine is detectable in breast milk, and smoking decreases breast milk production and infant weight gain but may decrease incidence of respiratory illness.* Effects of smoking are unclear; nicotine is detectable in breast milk, and smoking decreases breast milk production and infant weight gain but may decrease incidence of respiratory illness. | ||
Data from Sachs H, Committee on Drugs: The transfer of drugs and other chemicals into human milk: An update on selected topics. Pediatrics 132(3):e796–e809, 2013. doi: 10.1542/peds.2013-1985 | ||