drug use in pregnancy & lactation · drug use in pregnancy & lactation pharmacy &...

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Department of Pharmaceutical Care

Drug Use in Pregnancy &

Lactation

Pharmacy & Therapeutic Committee- Sep 2018

The following tables summarize safety of drug use in pregnancy and lactation.

Medications of herbal origin are excluded from the list.

Under the column "Drug-Pregnancy Categories", letters A, B, C, D, and X signify the FDA Pregnancy categories.

These five categories indicate the potential of a systemically-absorbed drug to cause birth defects; the key differentiation among the categories rests upon the reliability of documentation and the risk: benefit ratio.

FDA Pregnancy Categories:

A : Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote.

B : Either animal-reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.

C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.

D : There is positive evidence of human fetal risk, but the benefit from use in pregnant women may be acceptable despite the risk (If the drug is needed for life threatening situations or for serious diseases for which safer drugs can not be used or are ineffective).

X : Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.

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For drugs not FDA approved; other classification systems were used to identify the pregnancy categories, whenever possible, the two other systems used are:

1. Micromedex Pregnancy Ratings:

Fetal risk cannot be ruled out

Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during pregnancy.

Fetal risk has been demonstrated

Evidence has demonstrated fetal abnormalities or risks when used during pregnancy or in women of childbearing potential. An alternative to this drug should be prescribed during pregnancy or in women of childbearing potential.

Fetal risk is minimal The weight of an adequate body of evidence suggests this drug poses minimal risk when used in pregnant women or women of childbearing potential.

2. Australian Drug Evaluation Committee (ADEC) Pregnancy Category Definitions

A : Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

B1 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.

B2 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.

B3 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the

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significance of which is considered uncertain in humans.

C : Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

D : Drugs which have caused, are suspected to have caused, or may be expected to cause an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

X : Drugs that have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

Note: For drugs in the B1, B2 and B3 categories, human data are lacking or inadequate and sub-categorization is therefore based on available animal data. The allocation of a B category does not imply greater safety than the C category. Drugs in category D are not absolutely contraindicated in pregnancy (e.g. anticonvulsants). Moreover, in some cases the 'D' category has been assigned on the basis of 'suspicion'.

If there was no data under the previous three categorizations, the drug-pregnancy category is assigned as "N/A"

Data for medication use during breast feeding, are complied from FDA data, WHO data and Micromedex Lactation Ratings:

1. WHO Lactation Ratings:

Avoid breastfeeding

Avoid breastfeeding if possible. May inhibit lactation

Avoid breastfeeding if possible. Monitor infant for side effects

Compatible with breastfeeding

Compatible with breastfeeding. Monitor infant for side effects

WHO documentation states insufficient data

2. Micromedex Lactation Ratings:

Infant risk cannot be ruled out

Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during breastfeeding

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Infant risk has been demonstrated

Evidence and/or expert consensus has demonstrated harmful infant effects when used during breastfeeding. An alternative to this drug should be prescribed or patients should be advised to discontinue breastfeeding.

Infant risk is minimal The weight of an adequate body of evidence and/or expert consensus suggests this drug poses minimal risk to the infant when used during breastfeeding

Milk effects are possible

Evidence suggests this drug may alter milk production or composition. If an alternative to this drug is not prescribed, monitor the infant for adverse effects and/or adequate milk intake

Abbreviations used in the tables:

AAP: American Academy of Pediatrics

APR: Australian Pregnancy Ratings

FDA: U.S. Food and Drug Administration

IU: International Unit

N/A: no data available

MLR: Micromedex Lactation Ratings

MPR: Micromedex Pregnancy Ratings

RDA: Recommended daily allowance

WHO: World Health Organization

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Generic Name Pregnancy Category Breast Feeding Considerations

Abatacept C Excretion in breast milk unknown/not recommended (Possible toxicity)

Abiraterone X Not indicated for use in women

Acarbose B Excretion in breast milk unknown/not recommended

Acetaminophen [Paracetamol] C Excreted in breast milk/use caution

Acetaminophen [Paracetamol] and Codeine

Refer to Individual Agents


Acetaminophen [Paracetamol] and Codeine and Caffeine

C Excreted in breast milk/not recommended

Acetaminophen [Paracetamol] and Tramadol


Acetazolamide C Excreted in breast milk/not recommended

Acetic Acid C Excretion in breast milk unknown/use caution

Acetylcysteine B Excretion in breast milk unknown/use caution

Aciclovir [Acyclovir] (Systemic, Topical)

B Excreted in breast milk/use caution

Activated Charcoal MPR: Fetal risk

cannot be ruled out Excretion in breast milk unknown/use caution

Adalimumab B Excreted in breast milk/use caution

Adapalene C Excretion in breast milk unknown/use caution

Adefovir C Excretion in breast milk unknown/not recommended

Adenosine C Excretion in breast milk unknown/not recommended

Ado-Trastuzumab D Excretion in breast milk unknown/not recommended

Aescin No data available No data available

Aflibercept C Excretion in breast milk unknown/not recommended

Agomelatine (P) ADEC*: B1 MLR: Infant risk cannot be ruled out

Albendazole C Excreted in breast milk/use caution

Albumin C MLR: Infant risk cannot be ruled out

Alendronate C Excretion in breast milk unknown/use caution

Alfacalcidol No data available Excreted in breast milk/not recommended

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Alfuzosin B Excretion in breast milk unknown

Alirocumab No data available Excreted in breast milk/not recommended

Allopurinol C Excreted in breast milk/use caution

Alpha-Lipoic Acid No data available Excretion in breast milk unknown

ALPRAZolam (C) D Excreted in breast milk/not recommended

Alprostadil C (Muse) Not intended for use by lactating women

Alteplase C Excretion in breast milk unknown/use caution

Aluminum Hydroxide B MLR: Infant risk cannot be ruled out

Amantadine C Excreted in breast milk/not recommended

Ambroxol No data available Excreted in breast milk/not recommended

Amethocaine (Tetracaine) C Excretion in breast milk unknown/use caution

Amidotrizoate [Diatrizoate] Meglumine [P]

C Briggs: No human data; probably compatible

Amikacin D Excreted in breast milk/not recommended

Amiloride B Excreted in breast milk/contraindicated

Amino Acids C Excretion in breast milk unknown/use caution

Aminophylline C Excreted in breast milk/not recommended

Amiodarone D Excreted in breast milk/not recommended

Amitriptyline C Excreted in breast milk/not recommended

Amlodipine C Excretion in breast milk unknown/not recommended

Amlodipine and Atorvastatin X Excretion in breast milk unknown/contraindicated

Amlodipine and Olmesartan D Excretion in breast milk unknown/not recommended

Amlodipine and Valsartan D Excretion in breast milk unknown/not recommended

Amlodipine, Valsartan and Hydrochlorothiazide



Ammonium Chloride C Briggs: No human data; probably compatible

Amoxicillin B Excreted in breast milk/use caution

Amoxicillin and Clavulanic Acid B Excreted in breast milk/use caution

Amphotericin-B B Excretion in breast milk unknown/not recommended

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Ampicillin B Excreted in breast milk/use caution

Ampicillin and Sulbactam B Excreted in breast milk/use caution

Anastrozole X Excretion in breast milk unknown/not recommended

Anidulafungin B Excretion in breast milk unknown/use caution

Antihemophilic Factor (Human, Recombinant)

C Excretion in breast milk unknown/use caution

Apixaban B Excretion in breast milk unknown/not recommended

Apomorphine C Excretion in breast milk unknown/not recommended

ARIPiprazole (P) C Excreted in breast milk/not recommended

Ascorbic Acid (Vitamin C) C Excreted in breast milk/use caution

Aspirin (Acetylsalicylic Acid) D Excreted in breast milk/use caution

Atenolol D Excreted in breast milk/use caution

Atenolol and Chlortalidone [Chlorthalidone]

D Excretion in breast milk unknown/use caution

Atomoxetine C Excretion in breast milk unknown/use caution

AtorvaSTATin X Excretion in breast milk unknown/contraindicated

Atosiban No data available Excreted in breast milk/contraindicated

Atropine B/C (Product Specific) Excreted in breast milk/use caution

Axitinib D Excretion in breast milk unknown/not recommended

AzaCITIDine (P) D Excretion in breast milk unknown/contraindicated

AzaTHIOprine D Excreted in breast milk/not recommended

Azelaic Acid B Excretion in breast milk unknown/use caution

Azelastine C Excretion in breast milk unknown/use caution

Azithromycin (Ophthalmic) B Excretion in breast milk unknown/use caution

Azithromycin (Systemic) B Excreted in breast milk/use caution

Bacitracin and Neomycin Refer to Individual Agents Refer to Individual Agents

Baclofen C

Excreted in breast milk/not recommended

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Barium Sulfate (P) MPR: Fetal risk is minimal MLR: Infant risk is minimal (Not absorbed systemically)

BCG C Excretion in breast milk unknown/not recommended

Beclomethasone C Excretion in breast milk unknown/use caution

Bemiparin No data available Excretion in breast milk unknown/not recommended

Bendamustine D Excretion in breast milk unknown/not recommended

Benoxinate (Oxybuprocaine) C Excreted in breast milk/use caution

Benzocaine and Phenazone C Excretion in breast milk unknown/use caution

Benzoyl Peroxide C Excretion in breast milk unknown/use caution

Benzylpenicillin [Penicillin G] (Parenteral/Aqueous)


Benzylpenicillin [Penicillin G] Benzathine


Betahistine ADEC*: B2 Excretion in breast milk unknown/use caution

Betamethasone (Systemic) C Excretion in breast milk unknown/use caution

Betamethasone (Topical) C Excretion in breast milk unknown/use caution

Betamethasone and Clotrimazole (Topical)



Bevacizumab C Excretion in breast milk unknown/not recommended

Bicalutamide X Excretion in breast milk unknown/contraindicated

Bimatoprost C Excretion in breast milk unknown/use caution

Bisacodyl ADEC*: A MLR: Infant risk cannot be ruled out

Bisoprolol C Excretion in breast milk unknown/use caution

Bisoprolol and Hydrochlorothiazide



Bivalirudin B Excretion in breast milk unknown/use caution

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Bleomycin D Excretion in breast milk unknown/not recommended

Bosentan Contraindicated Not recommended

Brimonidine B Excretion in breast milk unknown/not recommended

Brimonidine and Timolol Refer to Individual

Agents Refer to Individual Agents

Bromazepam (C) ADEC*: C Excretion in breast milk unknown/not recommended

Bromhexine ADEC*: A Excreted in breast milk/not recommended

Budesonide C (Capsule, Tablet)/B

(Nasal, Oral Inhalation)

Excreted in breast milk/use caution (capsule, oral inhalation, tablet)

Budesonide (Topical) C Excreted in breast milk/use caution

Budesonide and Formoterol Refer to Individual


Bumetanide C Excretion in breast milk unknown/not recommended

Bupivacaine C Excreted in breast milk/not recommended

Bupreborphine

BuPROPion C Excreted in breast milk/use caution

Cabergoline B Excretion in breast milk unknown/not recommended

Cabozantinib D Excretion in breast milk unknown/not recommended

Calcipotriol [Calcipotriene] and Betamethasone

C Do not apply to the breast if breast-feeding

Calcitonin C Excretion in breast milk unknown/use caution

Calcium Acetate, Carbonate, Chloride, Citrate, Gluconate

MPR: Fetal risk cannot be ruled out

MLR: Infant risk cannot be ruled out

Calcium Dobesilate No data available No data available

Calcium Hydroxylapatite No data available No data available

Calcium Polystyrene Sulphonate C Excretion in breast milk unknown/use caution

Canagliflozin C Excreted in breast milk/use caution

Candesartan

D Excretion in breast milk unknown/not recommended

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Candesartan and Hydrochlorothiazide



Capecitabine D Excretion in breast milk unknown/not recommended

Captopril D Excreted in breast milk/not recommended

Carbachol C Excretion in breast milk unknown/use caution

CarBAMazepine D Excreted in breast milk/not recommended

Carbetocin

Use in pregnancy prior to delivery is contraindicated.

Carbetocin induced contractions are of a longer duration than those observed with oxytocin and are not

stopped by discontinuation of therapy. Improper

use during pregnancy may produce

symptoms similar to those observed with oxytocin overdosage (eg, hyperstimulation

of uterus, uterine rupture).

Excreted in breast milk/use caution

Carbidopa and Levodopa C WHO: Avoid breastfeeding

Carbimazole ADEC*: C AAP: Compatible with breastfeeding

Carbocisteine [Carbocysteine] No data available Excretion in breast milk unknown/not recommended

CARBOplatin D Excretion in breast milk unknown/not recommended

Carboprost Trometamol [Tromethamine]

C Excretion in breast milk unknown

Carvedilol C Excretion in breast milk unknown/not recommended

Caspofungin C Excretion in breast milk unknown/use caution

Cefalexin [Cephalexin] B Excreted in breast milk/use caution

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CeFAZolin B Excreted in breast milk/use caution

Cefdinir B Excretion in breast milk unknown

Cefepime B Excreted in breast milk/use caution

Cefixime B Excretion in breast milk unknown

Cefprozil B Excreted in breast milk/use caution

Ceftazidime B Excreted in breast milk/use caution

Ceftriaxone B Excreted in breast milk/use caution

Cefuroxime B Excreted in breast milk/use caution

Celecoxib C (Prior to 30 weeks

gestation)/D (≥30 weeks gestation)


Cephalexin B Excreted in breast milk/use caution

Certolizumab Use with caution Not excreted in breast milk/use caution

Cetirizine B MLR: Infant risk cannot be ruled out

Cetrorelix X Excretion in breast milk unknown/contraindicated

Cetuximab C Excretion in breast milk unknown/not recommended

Chloral Hydrate No data available Excreted in breast milk/not recommended

Chlorambucil D Excretion in breast milk unknown/not recommended

Chlorhexidine Gluconate B/C (Product Specific) Excretion in breast milk unknown/use caution

Chloroquine C Excreted in breast milk/not recommended

Chlorphenamine [Chlorpheniramine]

C WHO: Avoid breastfeeding

Chlorpromazine ADEC*: C Excreted in breast milk/not recommended

Chlorzoxazone and Paracetamol MPR: Fetal risk

cannot be ruled out MLR: Infant risk cannot be ruled out

Chorionic Gonadotropin (Human, Recombinant)

X Excretion in breast milk unknown/use caution

Ciclesonide C Excretion in breast milk unknown/use caution

CicloSPORINE [CycloSPORINE] (Systemic)


Cinacalcet C Excretion in breast milk unknown/not recommended

Cinnarizine No data available Excretion in breast milk unknown/not recommended

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Ciprofloxacin (Ophthalmic) C Excretion in breast milk unknown/use caution

Ciprofloxacin (Systemic) C Excreted in breast milk/not recommended

Cisatracurium B Excretion in breast milk unknown/use caution

Cisplatin D Excreted in breast milk/not recommended

Citalopram C Excreted in breast milk/consider risk:benefit

Clarithromycin C Excretion in breast milk unknown/use caution

Clindamycin (Systemic, topical) B Excreted in breast milk/not recommended

Clobazam Contraindicated in

the first trimester of pregnancy

Present in breast milk

Clomifene [ClomiPHENE] X Excretion in breast milk unknown/use caution

ClomiPRAMINE C Excreted in breast milk/not recommended

ClonazePAM D Excreted in breast milk/not recommended

CloNIDine C Excreted in breast milk/use caution

Clopidogrel B Excretion in breast milk unknown/not recommended

Clotrimazole C Excretion in breast milk unknown

Cloxacillin B WHO: Compatible with breastfeeding

Colchicine C Excreted in breast milk/use caution

Colecalciferol [Cholecalciferol] MPR: Fetal risk

cannot be ruled out Excreted in breast milk/use caution

Colestyramine [Cholestyramine] Resin

C Not excreted in breast milk/use caution

Colistimethate C Excreted in breast milk/use caution

Cosyntropin C Excretion in breast milk unknown/use caution

Co-Trimoxazole [Sulfamethoxazole and Trimethoprim]

D Excreted in breast milk/use caution

Crotamiton C Excretion in breast milk unknown

Cyanocobalamin (Vitamin B12) C Excreted in breast milk/compatible

Cyclobenzaprine B Excretion in breast milk unknown/use caution

Cyclopentolate C Excretion in breast milk unknown/use caution

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CycloPHOSPHAMIDE D Excreted in breast milk/not recommended

Cyproterone ADEC*: B3 Not intended for use by lactating women

Cyproterone and Ethinylestradiol [Ethinyl Estradiol]

X Excreted in breast milk/not recommended

Cytarabin D Excretion in breast milk unknown/not recommended

Dapagliflozon C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug

Dabigatran C Excretion in breast milk unknown/not recommended

Dapoxetine

not indicated for use in women

not indicated for use in women

Dacarbazine C Excretion in breast milk unknown/not recommended

DACTINomycin D Excretion in breast milk unknown/not recommended

Dalfampridine C Excretion in breast milk unknown/not recommended

Dantrolene C Excreted in breast milk/not recommended

Darbepoetin Alfa C Excretion in breast milk unknown/use caution

Deferasirox C Excretion in breast milk unknown/not recommended

Degarelix X Excretion in breast milk unknown/not recommended

Denosumab D (Xgeva®), X (Prolia®) Excretion in breast milk unknown/not recommended

Desferrioxamine [Deferoxamine] C Excretion in breast milk unknown/use caution

Desflurane B Excretion in breast milk unknown/use caution

Desloratadine C Excreted in breast milk/not recommended

Desmopressin B Excretion in breast milk unknown/use caution

Desogestrel No data available Excreted in breast milk/use caution

Desvenlafaxine C Excreted in breast milk/not recommended

Dexamethasone (Ophthalmic) C Excretion in breast milk unknown/use caution

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Dexamethasone (Systemic) C Excretion in breast milk unknown/not recommended

Dexlanzoprazole No data available Excretion in breast milk unknown/not recommended

Dexmedetomidine C Excretion in breast milk unknown/use caution

Dexpanthenol C Excretion in breast milk unknown/use caution

Dextromethorphan ADEC*: A MLR: Infant risk is minimal

Dextrose C (Injection, Infusion) MLR: Infant risk cannot be ruled out

Dextrose and Sodium Chloride C Refer to Individual Agents

Diazepam (C) D Excreted in breast milk/not recommended

Diclofenac (Ophthalmic) C No data available

Diclofenac (Systemic) C/D ≥30 weeks gestation (Oral)


Diclofenac (Topical)

B (Topical Gel 3%) / C (Topical Gel 1%, Topical Solution, Topical patch) / D (Topical Patch and

Solution ≥30 weeks' gestation)

Excretion in breast milk unknown/not recommended

Dienogest No data available Excretion in breast milk unknown/contraindicated

Digoxin C Excreted in breast milk/use caution

Digoxin Immune Fab C Excretion in breast milk unknown/use caution

Dihydroergotamine X Excreted in breast milk/contraindicated

Diloxanide Furoate Not recommended No data available

Diltiazem C Excreted in breast milk/not recommended

DimenhyDRINATE B Excreted in breast milk/not recommended

Dimethindene No data available No data available

Dimethyl Furmarate C Excretion in breast milk unknown/use caution

Dinoprostone C Excretion in breast milk unknown

DiphenhydrAMINE (Systemic) B Excreted in breast milk/contraindicated

Diphtheria, Pertussis, Tetanus Vaccine

B/C (Product Specific) Excretion in breast milk unknown/use caution

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Dipyridamole B Excreted in breast milk/use caution

Dobutamine B Excretion in breast milk unknown/use caution

DOCEtaxel D Excretion in breast milk unknown/not recommended

Docusate ADEC*: A Excretion in breast milk unknown

Domperidone ADEC*: B2 Excreted in breast milk/not recommended

Donepezil C Excretion in breast milk unknown/use caution

DOPamine C Excretion in breast milk unknown/use caution

Dornase alpha B Infant risk cannot be ruled out

Dorzolamide C Excretion in breast milk unknown/not recommended

Dorzolamide and Timolol Refer to Individual


Doxazosin C Excreted in breast milk/use caution

DOXOrubicin (Conventional) D Excreted in breast milk/not recommended

DOXOrubicin (Liposomal) No data available Excretion in breast milk unknown/not recommended

Doxycycline D Excreted in breast milk/not recommended

Dulaglutide Not recommended Excretion in breast milk unknown/not recommended

Duloxetine C Excreted in breast milk/use caution

Dutasteride X Excretion in breast milk unknown/contraindicated

Dydrogesterone No data available Excretion in breast milk unknown/not recommended

Econazole C Excretion in breast milk unknown/use caution

Eletriptan C Excreted in breast milk/use caution

Empagliflozon C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug

Enalapril D Excreted in breast milk/not recommended

Enalapril and Hydrochlorothiazide Refer to Individual


Enoxaparin B Excretion in breast milk unknown/not recommended

Entecavir (P) C Excretion in breast milk unknown/not recommended

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Epinastine C Excretion in breast milk unknown/use caution

EPINEPHrine (Systemic, Oral Inhalation)


Epirubicin D Excretion in breast milk unknown/not recommended

Eprosartan D Excretion in breast milk unknown/not recommended

Eprosartan/Hydrochlorothiazide D Excreted in breast milk/not recommended

Eptacog Alfa Factor VIIa (Recombinant)

C Excretion in breast milk unknown/not recommended

Eribulin D Excretion in breast milk unknown/not recommended

ERLOtinib D Excretion in breast milk unknown/not recommended

Ertapenem B Excreted in breast milk/use caution

Erythromycin (Ophthalmic) B Excretion in breast milk unknown/use caution

Erythromycin (Systemic) B Excreted in breast milk/use caution

Erythropoietin /Epoetin Alpha C Excretion in breast milk unknown/use caution

Escitalopram C Excreted in breast milk/consider risk: benefit

Esmolol C Excretion in breast milk unknown/not recommended

Esomeprazole C Excreted in breast milk/use caution

Estradiol (Systemic) X Excreted in breast milk/use caution

Estradiol (Systemic) No data available Excreted in breast milk/use caution

Etanercept B Excreted in breast milk/use caution

Ethambutol C Excreted in breast milk/use caution

Ethamsylate No data available No data available

Ethinylestradiol [Ethinyl Estradiol] and Desogestrel


Ethinylestradiol [Ethinyl Estradiol] and Drospirenone


Ethinylestradiol [Ethinyl Estradiol] and Etonogestrel


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Ethinylestradiol [Ethinyl Estradiol] and Norelgestromin


Etomidate C Excretion in breast milk unknown/use caution

Etonogestrel MPR: Fetal risk

cannot be ruled out Excreted in breast milk/use caution

Etoposide D Excretion in breast milk unknown/not recommended

Etoricoxib C (Prior to 30 weeks

gestation)/D (≥30 weeks gestation)

Excretion in breast milk unknown/contraindicated

Everolimus D (Afinitor®)/C

(Zortress®) Excretion in breast milk unknown/not recommended

Evolocumab No data available Excreted in breast milk/not recommended

Exemestane X Excretion in breast milk unknown/not recommended

Exenatide (P) C Excretion in breast milk unknown/use caution

Ezetimibe C Excretion in breast milk unknown/not recommended

Ezetimibe and Simvastatin Refer to Individual Agents Refer to Individual Agents

Factor IX (Human) C No data available

Famciclovir B Excretion in breast milk unknown/not recommended

Fampridine C Excretion in breast milk unknown/not recommended

Fat Emulsion (Plant Based) C Excreted in breast milk/use caution

Febuxostat C Excretion in breast milk unknown/use caution

Felodipine C Excretion in breast milk unknown/not recommended

Fenofibrate and Derivatives C Excretion in breast milk unknown/contraindicated

FentaNYL (N) C Excreted in breast milk/not recommended

Ferric Carboxymaltose C Excreted in breast milk/use caution

Ferrous Sulfate B WHO: Compatible with breastfeeding

Fexofenadine C Excretion in breast milk unknown/use caution

Filgrastim C Excretion in breast milk unknown/use caution

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Finasteride X Excretion in breast milk unknown/contraindicated

Fingolimod C Excretion in breast milk unknown/not recommended

Fluconazole

C (Single dose for vaginal candidiasis)/

D


Fludarabine D Excretion in breast milk unknown/not recommended

Fludrocortisone C Excretion in breast milk unknown/use caution

Flumazenil C Excretion in breast milk unknown/use caution

Flunarizine MPR: Fetal risk

cannot be ruled out Excretion in breast milk unknown/not recommended

Fluorescein C Excreted in breast milk/use caution

FluoroURACIL (P) D Excretion in breast milk unknown/contraindicated

FLUoxetine C Excreted in breast milk/not recommended

Flutamide B Not intended for use by lactating women

Fluticasone (Nasal) C Excretion in breast milk unknown/use caution

Fluticasone (Oral Inhalation) C Excretion in breast milk unknown/use caution

Fluticasone and Salmeterol C Excretion in breast milk unknown/use caution

Fluticasone and Formetrol

Avoid unless benefit outweigh risk

Not recommended

Fluvastatin X Excretion in breast milk unknown/contraindicated

FluvoxaMINE C Excreted in breast milk/consider risk: benefit

Folic Acid A Excreted in breast milk/compatible

Follitropin (Alfa & Beta) X Excretion in breast milk unknown/not recommended

Fondaparinux B Excretion in breast milk unknown/use caution

Fosfomycin B Excreted in breast milk/not recommended

Fosinopril D Excreted in breast milk/not recommended

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Fulvestrant D Excretion in breast milk unknown/not recommended

Furosemide C Excreted in breast milk/use caution

Fusidic Acid (Ophthalmic & Topical)

MPR: Fetal risk cannot be ruled out


Fusidic Acid and Hydrocortisone Refer to Individual


Gabapentin C Excreted in breast milk/use caution

Gadodiamide C Excretion in breast milk unknown/use caution

Gadoterate Meglumine C Excretion in breast milk unknown/use caution

Galantamine C Excretion in breast milk unknown/not recommended

Ganciclovir (Ophthalmic) C Excretion in breast milk unknown/use caution

Ganciclovir (Systemic) C Excretion in breast milk unknown/not recommended

Gatifloxacin (Systemic) C Excretion in breast milk unknown/use caution

GEMcitabine D Excretion in breast milk unknown/not recommended

Gemfibrozil C Excretion in breast milk unknown/not recommended

Gentamicin (Systemic) D Excreted in breast milk/use caution

Glibenclamide [GlyBURIDE] B/C (Product Specific) Not recommended

Glibenclamide [GlyBURIDE] and Metformin



Gliclazide ADEC*: C Excretion in breast milk unknown/contraindicated

Glimepiride C Excretion in breast milk unknown/not recommended

Glucagon B Excretion in breast milk unknown/use caution

Glycerol [Glycerin] C MLR: Infant risk cannot be ruled out

Glycopyrrolate B (Injection)/C (Oral

Solution)

Excretion in breast milk unknown/use caution

Golimumab B Excretion in breast milk unknown/not recommended

of 39



Lactation



Goserelin

X (Endometriosis, Endometrial Thinning); D

(Advanced Breast Cancer)


Granisetron B Excretion in breast milk unknown/use caution

GuaiFENesin C Excretion in breast milk unknown

GuaiFENesin and Dextromethorphan



GuaiFENesin, Dextromethorphan, and Phenylephrine



GuaiFENesin, Pseudoephedrine, and Dextromethorphan



Haloperidol C Excreted in breast milk/not recommended

Heparin C Not excreted in breast milk/use caution

Hepatitis A and Hepatitis B Recombinant Vaccine


Hepatitis A vaccine C Excretion in breast milk unknown/use caution

Hepatitis B Immune Globulin (Human)


Hepatitis B Vaccine (Recombinant)


Human Chorionic Gonadotropin X MLR: Infant risk cannot be ruled out

Hyaluronate and Derivatives MPR: Fetal risk

cannot be ruled out Excretion in breast milk unknown/not recommended

Hyaluronidase C Excretion in breast milk unknown/use caution

HydrALAZINE C Excreted in breast milk/use caution

Hydrochlorothiazide B Excreted in breast milk/not recommended

Hydrochlorothiazide and Spironolactone



Hydrocortisone (Systemic & Topical)

C Excreted in breast milk/use caution

Hydrocortisone, Hydroquinone, and Tretinoin


HYDROmorphone (N) C Excreted in breast milk/not recommended

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Lactation



Hydroquinone C Excretion in breast milk unknown/use caution

Hydroxycarbamide [Hydroxyurea]

D Excreted in breast milk/not recommended

Hydroxychloroquine ADEC*: D Excreted in breast milk/not recommended

Hydroxyprogesterone B Excretion in breast milk unknown/not recommended

Hyoscine Butylbromide [Scopolamine] (Systemic)


Ibandronic Acid [Ibandronate] C Excretion in breast milk unknown/use caution

Ibuprofen C/D ≥30 weeks

gestation Excreted in breast milk/not recommended

Ifosfamide D Excreted in breast milk/not recommended

Imatinib D Excreted in breast milk/not recommended

Imipenem and Cilastatin C Excreted in breast milk/use caution

Imiquimod C Excretion in breast milk unknown/use caution

Immune Globulin C Excretion in breast milk unknown/use caution

Indapamide B Excretion in breast milk unknown/not recommended

Indacaterol maleate / Glycopyrronium bromide


Indometacin [Indomethacin]

C (<30 weeks gestation); C/D (≥30

weeks gestation [manufacturer

specific])


InFLIXimab B Excretion in breast milk unknown/not recommended

Influenza Virus Vaccine (Inactivated)


Insulin Aspart B Briggs: Compatible with breastfeeding

Insulin Aspart Protamine and Insulin Aspart

B Briggs: Compatible with breastfeeding

Insulin Detemir B Briggs: Compatible with breastfeeding

Insulin Degludec C Briggs: Compatible with breastfeeding

Insulin Glargine C Briggs: Compatible with breastfeeding

Insulin Glulisine C Briggs: Compatible with breastfeeding

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Lactation



Insulin Lispro/Insulin Lispro Protamine and Insulin Lispro

B Briggs: Compatible with breastfeeding

Insulin NPH B Briggs: Compatible with breastfeeding

Insulin NPH and Insulin Regular B Briggs: Compatible with breastfeeding

Insulin Regular B Briggs: Compatible with breastfeeding

Interferon Alfa-2a C/X (In combination

with Ribavirin) Excretion in breast milk unknown/not recommended

Interferon Alfa-2b C/X (In combination

with Ribavirin) Excreted in breast milk/not recommended

Interferon Beta-1a C Excreted in breast milk/use caution

Interferon Beta-1b C Excretion in breast milk unknown/not recommended

Iobitridol (P) B Briggs: No human data; probably compatible

Iodine (P) B Briggs: No human data; probably compatible

Iodixanol B Briggs: No human data; probably compatible

Iodoquinol No data available Briggs: No human data; probably compatible

Iohexol B Briggs: No human data; probably compatible

Iopamidol B Briggs: No human data; probably compatible

Iotalamate [Iothalamate] Meglumine [P]

B/C (product dependent)

Excreted in breast milk/bottle feedings are recommended for 24 hours after administration

Ipratopium (Oral Inhalation) B Excretion in breast milk unknown/use caution

Irbesartan D Excretion in breast milk unknown/not recommended

Irbesartan/Hydrochlorthiazide D Excreted in breast milk/not recommended

Irinotecan D Excretion in breast milk unknown/not recommended

Iron Sucrose B Excretion in breast milk unknown/use caution

Isoniazid C Excreted in breast milk/compatible

Isoprenaline /isoproterenol C Excretion in breast milk unknown/use caution

of 39



Lactation



Isosorbide Dinitrate C Excretion in breast milk unknown/use caution Isosorbide mononitrate B/C (Product Specific)

ISOtretinoin X Excretion in breast milk unknown/not recommended

Itraconazole C Excreted in breast milk/not recommended

Ivabradine ADEC*: D Excretion in breast milk unknown/contraindicated

Kaolin and Pectin MPR: Fetal risk is minimal AAP: Compatible with breastfeeding

Ketamine ADEC*: A WHO: Compatible with breastfeeding

Ketoconazole (Topical) C Excretion in breast milk unknown/use caution

Ketorolac (Ophthalmic) C Excretion in breast milk unknown/use caution

Ketotifen (Ophthalmic) C Excretion in breast milk unknown/use caution

Ketotifen (Systemic) C Excreted in breast milk/not recommended

Labetalol C Excreted in breast milk/use caution

Lacosamide C Excretion in breast milk unknown/not recommended

Lactulose B Excretion in breast milk unknown/use caution

LamiVUDine C Excreted in breast milk/contraindicated

LamoTRIgine C Excreted in breast milk/use caution

Lansoprazole B Excretion in breast milk unknown/not recommended

LAPAtinib D Excretion in breast milk unknown/not recommended

Latanoprost C Excretion in breast milk unknown/use caution

Leflunomide X Excretion in breast milk unknown/not recommended

Lercanidipine No data available Excretion in breast milk unknown/contraindicated

Letrozole X Excretion in breast milk unknown/not recommended

Leucovorin Calcium [Calcium Folinate]


Leuprorelin [Leuprolide] X Excretion in breast milk unknown/contraindicated

Levamisole C WHO: Avoid breastfeeding

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Lactation



LevETIRAcetam C Excreted in breast milk/not recommended

LevOCARNitine B Excretion in breast milk unknown/use caution

Levocetirizine B Excretion in breast milk unknown/not recommended

Levodopa, Carbidopa, and Entacapone

C WHO: Avoid breastfeeding

Levofloxacin C Excreted in breast milk/not recommended

Levonorgestrel X Excreted in breast milk/use caution

Levothyroxine A Excreted in breast milk/use caution

Lidocaine (Systemic) B Excreted in breast milk/use caution

Lidocaine (Topical) B Excreted in breast milk/use caution

Lidocaine and Epinephrine B Excreted in breast milk/use caution

Lidocaine and Prilocaine B Excreted in breast milk/use caution

Linagliptin B Excretion in breast milk unknown/use caution

Linezolid C Excreted in breast milk/use caution

Liothyronine A Excreted in breast milk/use caution

Liraglutide X (Saxenda)/C

(Victoza) Excretion in breast milk unknown/not recommended

Lisinopril D Excretion in breast milk unknown/not recommended

Lithium D Excreted in breast milk/not recommended

Loperamide C Excreted in breast milk/not recommended

Loratadine B AAP: Compatible with breastfeeding

Lornoxicam C/D ≥30 weeks

gestation Excretion in breast milk unknown/not recommended

Losartan D Excretion in breast milk unknown/not recommended

Losartan and Hydrochlorothiazide



Loxoprofen C/D ≥30 weeks

gestation No data available

Magnesium Citrate D AAP: Compatible with breastfeeding

Magnesium Oxide D AAP: Compatible with breastfeeding

Magnesium Sulfate D Excreted in breast milk/use caution

Mannitol C Excretion in breast milk unknown/use caution

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Lactation



Measles Virus Vaccine (Live) C Excretion in breast milk unknown/use caution

Measles, Mumps, Rubella Vaccine


Mebendazole C Excretion in breast milk unknown/use caution

Mebeverine No data available Excretion in breast milk unknown/not recommended

Meclizine and Pyridoxine B Excretion in breast milk unknown

MedroxyPROGESTERone X WHO: Compatible with breastfeeding

Mefenamic Acid C Excreted in breast milk/not recommended

Mefloquine B Excreted in breast milk/use caution

Megestrol D (Tablet)/X (Suspension)


Meloxicam C/D ≥30 weeks

gestation Excretion in breast milk unknown/not recommended

Melphalan D Excretion in breast milk unknown/not recommended

Memantine B Excretion in breast milk unknown/use caution

Meningococcal (Groups A / C / Y and W-135) Diphtheria Conjugate Vaccine


Meningococcal Polysaccharide Vaccine (Groups A / C / Y and W-135)


Menotrophins [Menotropins] X Excretion in breast milk unknown/not recommended

Mepivacaine and Adrenaline C Excretion in breast milk unknown/use caution

Mepolizumab Fetal risk cannot be

ruled out Infant risk cannot be ruled out

Mercaptopurine D Excretion in breast milk unknown/not recommended

Meropenem B Excreted in breast milk/use caution

Mesalazine [Mesalamine] B/C (Product Specific) Excreted in breast milk/use caution

Mesna B Excretion in breast milk unknown/not recommended

MetFORMIN B Excreted in breast milk/not recommended

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Lactation



Methadone (N) C Excreted in breast milk/not recommended

Methocarbamol C Excretion in breast milk unknown/use caution

Methotrexate X (Psoriasis,

Rheumatoid arthritis) Excreted in breast milk/contraindicated

Methoxy Polyethylene Glycol-Epoetin Beta (P)


Methyldopa B/C (Injectable) Excreted in breast milk/use caution

Methylene Blue X WHO: Avoid breastfeeding

Methylergometrine [Methylergonovine]


Methylphenidate (C) C Excreted in breast milk/use caution

MethylPREDNISolone C Excreted in breast milk/use caution

Metoclopramide B Excreted in breast milk/use caution

Metolazone B Excreted in breast milk/not recommended

Metoprolol C Excreted in breast milk/use caution

MetroNIDAZOLE (Systemic) B Excreted in breast milk/not recommended

MetroNIDAZOLE (Topical) B Excreted in breast milk/not recommended

Miconazole (Oral) C Excretion in breast milk unknown/use caution

Miconazole (Topical) No data available Excretion in breast milk unknown/use caution

Micronized Purified Flavonoid Fraction (MPFF)

No data available Excretion in breast milk unknown/not recommended

Midazolam (C) D Excreted in breast milk/use caution

Midodrine C Excretion in breast milk unknown/use caution

Milrinone C Excretion in breast milk unknown/use caution

Minoxidil (Sytemic) C Excreted in breast milk/not recommended

Mirtazapine C Excreted in breast milk/use caution

Misoprostol X Excreted in breast milk/use caution

MitoMYcin (Systemic) X Excretion in breast milk unknown/not recommended

MitoXANtrone D Excreted in breast milk/not recommended

Modafinil C Excretion in breast milk unknown/use caution

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Lactation



Mometasone (Nasal) C Excretion in breast milk unknown/use caution Mometasone (Topical) C

Montelukast B Excretion in breast milk unknown/use caution

Morphine (N) C Excreted in breast milk/use caution (AAP rates compatible)

Moxifloxacin (Ophthalmic) C Excretion in breast milk unknown/use caution

Moxifloxacin (Systemic) C Excretion in breast milk unknown/not recommended

Moxonidine No data available Excreted in breast milk/Contraindicated

Mupirocin B Excretion in breast milk unknown/use caution

Mycophenolate D Excretion in breast milk unknown/not recommended

Naloxone B/C (Product Specific) Excretion in breast milk unknown/use caution

Naphazoline and Pheniramine C Excretion in breast milk unknown/use caution

Naproxen C Excreted in breast milk/not recommended

Natalizumab C Excreted in breast milk/use caution

Nebivolol C Excretion in breast milk unknown/not recommended

Neomycin D Excretion in breast milk unknown/not recommended

Neostigmine C Excretion in breast milk unknown/use caution

Netupitant and Palonosetron C Discontinue breastfeeding or to discontinue the drug

NIFEdipine C Excreted in breast milk/not recommended

NiMODipine C Excreted in breast milk/not recommended

Nintedanib D Excreted in breast milk/not recommended

Nitrofurantoin B (Contraindicated at

term) Excreted in breast milk/not recommended (infants <1 month)

Nitroglycerin B/C (Product Specific) Excretion in breast milk unknown/use caution

Nivolumab (P) MPR: Fetal risk has been demonstrated

MLR: Infant risk cannot be ruled out

Norepinephrine C Excretion in breast milk unknown/use caution

of 39



Lactation



Norethisterone X Excreted in breast milk/use caution

Norfloxacin C Excretion in breast milk unknown/not recommended

Nystatin (Oral, Topical) C Excretion in breast milk unknown/use caution

Ocrelizumab

An effective contraception should

be used during therapy and for 6

months after the last infusion.

Contraindicated

Octreotide B Excreted in breast milk/use caution

Oestrogens [Estrogens] (Conjugated/Equine, Systemic)

X Excreted in breast milk/use caution

Ofloxacin (Ophthalmic) C Excretion in breast milk unknown/not recommended

Ofloxacin (Systemic) C Excreted in breast milk/not recommended

OLANZapine C Excreted in breast milk/not recommended

Olmesartan D Excretion in breast milk unknown/not recommended

Olmesartan/Hydrochlorothiazide D Excreted in breast milk/not recommended

Olopatadine (Ophthalmic) C Excretion in breast milk unknown/use caution

Omalizumab (P) No data available No data available

Ombitasvir/Paritaprevir/Ritonavir (P)

B Excretion in breast milk unknown/not recommended

Omega-3 Fatty Acids C Excreted in breast milk/use caution

Omeprazole C Excreted in breast milk/use caution

Omeprazole and Sodium Bicarbonate



OnabotulinumtoxinA [Botulinum Toxin Type A]


Ondansetron B Excretion in breast milk unknown/use caution

Orlistat X Excretion in breast milk unknown/use caution

Oseltamivir C Excreted in breast milk/use caution

Oxaliplatin D Excretion in breast milk unknown/not recommended

of 39



Lactation



OXcarbazepine C Excreted in breast milk/not recommended

Oxybutynin B Excretion in breast milk unknown/use caution

OxyCODONE B/C (Product Specific) Excreted in breast milk/not recommended

OxyCODONE and Paracetamol [Acetaminophen]



Oxymorphone (N) C Excretion in breast milk unknown/use caution

Oxytocin C (Product Specific) Excretion in breast milk unknown/use caution

PACLItaxel (Conventional) D Excreted in breast milk/not recommended

PACLitaxel (Protein Bound) D Excreted in breast milk/not recommended

Palivizumab C No data available

Pancrelipase C Excretion in breast milk unknown/use caution

Panitumumab C Excretion in breast milk unknown/not recommended

Pantoprazole B Excreted in breast milk/not recommended

Papaverine C Excretion in breast milk unknown/use caution

Papillomavirus (Types 16, 18) Vaccine (Human, Recombinant)

B Excretion in breast milk unknown/use caution

Papillomavirus (Types 6, 11, 16, 18) Vaccine (Human, Recombinant)


Paricalcitol C Excretion in breast milk unknown/not recommended

PARoxetine D/X (Product Specific) Excreted in breast milk/use caution

PAZOPanib D Excretion in breast milk unknown/not recommended

Pegfilgrastim C Excretion in breast milk unknown/use caution

Peginterferon Alfa-2a/2b C/X (In combination

with Ribavirin) Excretion in breast milk unknown/not recommended

Peginterferon beta 1 A C Excretion in breast milk unknown/use caution

PEMEtrexed D Excretion in breast milk unknown/not recommended

of 39



Lactation



PenicillAMINE D Excretion in breast milk unknown/contraindicated

Pentoxifylline C Excreted in breast milk/not recommended

Perampanel Contraindicated Excretion in breast milk unknown/use caution

Perindopril D Excretion in breast milk unknown/use caution

Perindopril and Amlodipine D Refer to Individual Agents

PERTuzumab D Excretion in breast milk unknown/not recommended

Pethidine [Meperidine] (N) C Excreted in breast milk/not recommended

PHENobarbitone [PHENobarbital] (C)

B/D (Product Specific) Excreted in breast milk/use caution

Phenoxymethylpenicillin [Penicillin V] Potassium

B MLR: Infant risk cannot be ruled out

Phentermine (C) X Excretion in breast milk unknown/contraindicated

Phenylephrine (Ophthalmic, Systemic)


Phenytoin D Excreted in breast milk/not recommended

Phytomenadione [Phytonadione; Vitamin K]


Pilocarpine C Excretion in breast milk unknown/not recommended

Pimecrolimus C Excretion in breast milk unknown/not recommended

Pinaverium

Animal reproduction studies and information from human pregnancies is not available. The presence of bromine in the formulation poses a theoretical risk of causing neurologic effects (sedation, hypotony) to newborns if pinaverium is used late in pregnancy, though no such cases have been reported


of 39



Lactation



Pioglitazone C Excretion in breast milk unknown/not recommended

Piperacillin and Tazobactam B Excreted in breast milk/use caution

Piracetam Not recommended Excreted in breast milk/Not recommended

Pirfenidone C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug

Piribedil Not recommended Excretion in breast milk unknown/use caution

Pizotifen No data available Excretion in breast milk unknown/not recommended

Pneumococcal Conjugate Vaccine (13-Valent)


Pneumococcal Polysaccharide Vaccine (23-Valent)

C

Excretion in breast milk unknown/use caution

Policresulen

It may be used during pregnancy and breast feeding only if strictly

indicated. There have not been

any studies of the risks associated with use during pregnancy

in humans, but animal studies have

not yield any evidence of fetal

malformation. It is not known whether the active substance

passes into milk.

It may be used during pregnancy and breast feeding only if strictly indicated. There have not been any studies of the risks associated with use during pregnancy in humans, but animal studies have not yield any evidence of fetal malformation. It is not known whether the active substance passes into milk.

Polidocanol C Excretion in breast milk unknown/not recommended

Poliovirus Vaccine (Live/Trivalent/Oral)

C MLR: Infant risk cannot be ruled out

of 39



Lactation



Polyethylene Glycol 3350 C Excretion in breast milk unknown/use caution

Potassium Acetate C MLR: Infant risk cannot be ruled out

Potassium Chloride C Excreted in breast milk/not recommended

Potassium Iodide and Iodine D (Potassium Iodide) Excreted in breast milk/use caution (AAP rates compatible)

Potassium Phosphate C Excreted in breast milk/use caution (AAP rates compatible)

Povidone-Iodine (Ophthalmic) C Excretion in breast milk unknown/not recommended

Povidone-Iodine (Topical) No data available Excreted in breast milk/use caution

Pralidoxime (PAM) C Excretion in breast milk unknown/use caution

Pramipexole C Excretion in breast milk unknown/not recommended

PrednisoLONE (Ophthalmic) C Excretion in breast milk unknown/use caution

PrednisoLONE (Systemic) C/D (Product Specific) Excreted in breast milk/use caution

Pregabalin C Excretion in breast milk unknown/not recommended

Primidone D Excreted in breast milk/not recommended

Procainamide C Excreted in breast milk/not recommended

Prochlorperazine ADEC*: C Excretion in breast milk unknown

Progesterone B (Oral) Excreted in breast milk/use caution

Promethazine C Excretion in breast milk unknown/not recommended

Propofol B Excreted in breast milk/not recommended

Propranolol C Excreted in breast milk/use caution

Propylthiouracil D Excreted in breast milk/use caution

Protamine C Excretion in breast milk unknown/use caution

Protirelin C Excretion in breast milk unknown/use caution

Pseudoephedrine ADEC*: B2 Excreted in breast milk/use caution (AAP rates compatible)

Psyllium Safe (Not absorbed

systematically) AAP: Compatible with breastfeeding

Pylera (Bismuth, Metronidazole, Tetracycline)

Contraindicated Excreted in breast milk/not recommended

Pyrazinamide C Excreted in breast milk/use caution

of 39



Lactation



Pyridostigmine B/C (Product Specific) Excreted in breast milk/use caution

Pyridoxine (Vitamin B6) A Excreted in breast milk/compatible

QUEtiapine C Excreted in breast milk/not recommended

QuiNINE C Excreted in breast milk/use caution (AAP rates compatible)

RABEprazole C Excretion in breast milk unknown/use caution

Rabies Vaccine C Excretion in breast milk unknown

Raloxifene X Excretion in breast milk unknown/contraindicated

Ramipril D Excretion in breast milk unknown/not recommended

Ranibizumab C Excretion in breast milk unknown/use caution

Ranitidine B Excreted in breast milk/use caution

Rasburicase C Excretion in breast milk unknown/not recommended

Regorafenib (P) D Excretion in breast milk unknown/contraindicated

Remifentanil (N) C Excretion in breast milk unknown/use caution

Repaglinide C Excretion in breast milk unknown/not recommended

Rho(D) Immune Globulin C Excretion in breast milk unknown/use caution

Ribavirin X Excretion in breast milk unknown/not recommended

Riboflavin, Ophthalmic No data available No data available

Rifampin C Excreted in breast milk/not recommended

Rifampin and Isoniazid Refer to Individual


Rimexolone C Excretion in breast milk unknown/not recommended

RisperiDONE C Excreted in breast milk/not recommended

RiTUXimab C Excretion in breast milk unknown/not recommended

Rivaroxaban C Excretion in breast milk unknown/not recommended

Rivastigmine B Excretion in breast milk unknown/not recommended

of 39



Lactation



RIZAtriptan (P) C Excretion in breast milk unknown/use caution

Rocuronium C MLR: Infant risk cannot be ruled out

Rosuvastatin X Excretion in breast milk unknown/contraindicated

Rotavirus Vaccine C AAP: Compatible with breastfeeding

Rotigotine C Excretion in breast milk unknown/use caution

Salbutamol /Albuterol C Excretion in breast milk unknown/not recommended

Salicylic Acid C Not recommended

Saxagliptin B Excretion in breast milk unknown/use caution

Saxagliptin and MetFORMIN Refer to Individual


Secukinumab B Infant risk cannot be ruled out

Selegiline C Excretion in breast milk unknown/not recommended

Senna C AltMedDex®; Micromedex®: Compatible

Sertaconazole C Excretion in breast milk unknown/use caution

Sertraline C Excreted in breast milk/use caution

Sevelamer C MLR: Infant risk is minimal

Sevoflurane B MLR: Infant risk cannot be ruled out (for 24 hours after anesthesia)

Sildenafil B Excretion in breast milk unknown/use caution

Silver Sulfadiazine B Excretion in breast milk unknown/not recommended

Silymarin No data available No data available

Simeticone [Simethicone] Safe (Not absorbed

systematically) AAP: Compatible with breastfeeding

Simvastatin X Excretion in breast milk unknown/contraindicated

SitaGLIPtin B Excretion in breast milk unknown/use caution

Sitagliptin and Metformin Refer to Individual


Sodium Acetate C Excreted in breast milk/compatible

Sodium Bicarbonate C Excreted in breast milk/compatible

of 39



Lactation



Sodium Chloride C Excreted in breast milk/use caution

Sodium Cromoglicate [Cromolyn] (Ophthalmic)


Sodium Phosphate C Excreted in breast milk/compatible

Sodium Polystyrene Sulfonate C Excretion in breast milk unknown/use caution

Sodium Stibogluconate X Excretion in breast milk unknown/contraindicated

Sofosbuvir/Ledipasvir (P) B MLR: Infant risk cannot be ruled out

Solifenacin C Excretion in breast milk unknown/not recommended

Somatropin B/C (Depending upon

manufacturer) Excretion in breast milk unknown/use caution

SORAfenib D Excretion in breast milk unknown/not recommended

Sotalol B Excreted in breast milk/not recommended

Spironolactone C Excreted in breast milk/not recommended

Streptomycin D Excreted in breast milk/not recommended

Sucralfate B Excretion in breast milk unknown/use caution

SUFentanil (N) C Excretion in breast milk unknown/use caution

Sugammadex No data available Excretion in breast milk unknown

SulfADIAZINE C Excreted in breast milk/contraindicated

SulfaSALAzine B Excreted in breast milk/use caution

Sulpiride Not recommended Excreted in breast milk/not recommended

SUMAtriptan C Excreted in breast milk/not recommended

SUNItinib D Excretion in breast milk unknown/not recommended

Suxamethonium [Succinylcholine]


TACrolimus (Systemic, Topical) C Excreted in breast milk/not recommended

Tadalafil B Excretion in breast milk unknown/use caution

Tafacitinib C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug

Talc (Sterile) B Excretion in breast milk unknown

of 39



Lactation



Tamoxifen D Excretion in breast milk unknown/not recommended

Tamsulosin B MLR: Infant risk cannot be ruled out

Teicoplanin Not recommended Excretion in breast milk unknown/use caution

Telaprevir B/X (in combination

with ribavirin) Excretion in breast milk unknown/not recommended

Telmisartan D Excretion in breast milk unknown/not recommended

Telmisartan and Hydrochlorothiazide



TEMOzolomide D Excretion in breast milk unknown/not recommended

Temsirolimus D Excretion in breast milk unknown/not recommended

Tenofovir B Excreted in breast milk/contraindicated

Terbinafine (Systemic) B Excreted in breast milk/not recommended

Teriflunomide X Excretion in breast milk unknown/not recommended

Teriparatide C Excretion in breast milk unknown/not recommended

Testosterone X Excreted in breast milk/contraindicated

Tetanus Toxoid (Adsorbed) C Excretion in breast milk unknown/use caution

Tetracaine [Amethocaine] C Excretion in breast milk unknown/use caution

Tetracosactide [Tetracosactrin, Cosyntropin]


Tetrastarch C Excretion in breast milk unknown/use caution

Thalidomide X Excretion in breast milk unknown/not recommended

Theophylline C Excreted in breast milk/compatible

Thiamine A Excreted in breast milk/use caution

Thyrotropin Alfa C Excretion in breast milk unknown/use caution

Tibolone X Excretion in breast milk unknown/contraindicated

Ticagrelor C MLR: Infant risk cannot be ruled out

of 39



Lactation



Tigecycline D Excretion in breast milk unknown/use caution

Timolol C Excreted in breast milk/consider risk: benefit

Tinidazole C Excreted in breast milk/contraindicated

Tinzaparin B Excretion in breast milk unknown/use caution

Tiotropium C Excretion in breast milk unknown/use caution

Tirofiban B Excretion in breast milk unknown/not recommended

TiZANidine C Excretion in breast milk unknown

Tobramycin (Ophthalmic) B Not recommended

Tobramycin and Dexamethasone (Ophthalmic)


Tocilizumab C Excretion in breast milk unknown/not recommended

Tofacitinib Not recommended Excretion in breast milk unknown/not recommended

Tolterodine C Excretion in breast milk unknown/not recommended

Topiramate D Excreted in breast milk/use caution

Topotecan D Excretion in breast milk unknown/not recommended

Trace Elements Refer to Individual


TraMADol (C) C Excreted in breast milk/not recommended

Tranexamic Acid B Excreted in breast milk/use caution

Trastuzumab D Excretion in breast milk unknown/not recommended

Travoprost C Excretion in breast milk unknown/use caution

Tretinoin (Topical) D Excretion in breast milk unknown/use caution

Triamcinolone (Systemic) C Excreted in breast milk/use caution

Triamcinolone (Topical) C Excretion in breast milk unknown/use caution

Trihexyphenidyl C Excretion in breast milk unknown/use caution

Trimetazidine No data available Excretion in breast milk unknown/not recommended

of 39



Lactation



Trimethoprim C Excreted in breast milk/use caution

Triprolidine ADEC*: A MLR: Infant risk is minimal

Triptorelin (LHRH) X Excretion in breast milk unknown/not indicated for use in women

Tropicamide C Excretion in breast milk unknown/use caution

Trospium C Excretion in breast milk unknown/use caution

Trypan Blue C Excretion in breast milk unknown/use caution

Tuberculin Test C No data available

Typhoid Vaccine C Excretion in breast milk unknown/use caution

Umeclindium bromide and Vilanterol


Urea B/C (Product Specific) Excretion in breast milk unknown/use caution

Ursodiol B Excretion in breast milk unknown/use caution

Ustekinmab B Excretion in breast milk unknown/use caution

ValACIclovir [ValACYclovir] B Excreted in breast milk/use caution

ValGANciclovir C Excretion in breast milk unknown/not recommended

Valproic Acid and Derivatives X (Migraine

prophylaxis)/D (All other indications)


Valsartan D Excretion in breast milk unknown/not recommended

Valsartan and Hydrochlorothiazide



Valsartan and Sacubitril Discontinue as soon

as possible once pregnancy is detected


Vancomycin B (Oral)/C (Injection) Excreted in breast milk/not recommended

Varenicline C Excretion in breast milk unknown/not recommended

Varicella Zoster Vaccine MPR: Fetal risk

cannot be ruled out Excretion in breast milk unknown/use caution

Vasopressin C Excretion in breast milk unknown/use caution

of 39



Lactation



Vedolizumab B Infant risk cannot be ruled out

Venlafaxine C Excreted in breast milk/not recommended

Verapamil C Excreted in breast milk/not recommended

Vigabatrin C Excreted in breast milk/not recommended

VILDAgliptin Not recommended Excretion in breast milk unknown/not recommended

VILDAgliptin and MetFORMIN Refer to Individual


VinBLAStine D Excretion in breast milk unknown/not recommended

VinCRIStine D Excretion in breast milk unknown/not recommended

Vinorelbine D Excretion in breast milk unknown/not recommended

Vitamin B - Complex A Excreted in breast milk/use caution (AAP rates compatible)

Vitamin E A MLR: Infant risk cannot be ruled out

Voriconazole D Excretion in breast milk unknown/not recommended

Vortioxetine C Data not available

Warfarin D (Mechanical Heart

Valves)/X (Other Indications)

Not excreted in breast milk/use caution

Xylometazoline C MLR: Infant risk cannot be ruled out

Zaleplon C Excreted in breast milk/not recommended

Zinc Sulfate C Excreted in breast milk/compatible

Zoledronic acid D Excretion in breast milk unknown/not recommended

Zolpidem (C) C Excreted in breast milk/use caution

drug use in pregnancy & lactation · drug use in pregnancy & lactation pharmacy &...

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