Mothers who are breastfeeding often call my office to find out if a particular drug is safe to take. The truth is that every drug that a mom takes gets excreted in the breast milk to some extent. The issue is how much and is it a problem. The National Library of Medicine (NLM) has one of the best, most reliable websites for finding information on drugs and lactation (LactMed). Drugs are searchable by drug name (generic or trade name) and by pharmacologic category. I’ve listed the most common medications I get calls about, but check out the website for more information (e.g., drug levels in breast milk, effects on the infant, drug alternatives, the AAP category).
Note: “Safe” is a relative term. It is better not to expose an infant to a drug, but sometimes it is inevitable. The following drugs, based on the literature, have little to no reported effects on infants. Please talk with your doctor before taking any medication. The following can often be taken, but use caution (and, again, consult your doctor):
- B1 (thiamin)
- B6 (pyridoxine)
- Bishydroxycoumarin (dicumarol)
- Contraceptive pills (Note: Combination pills with estrogen and progesterone can decrease milk production and protein content of milk.)
- Folic Acid
- Levothyroxine (Note: If you are taking any thyroid medications, you need to tell your pediatrician as this may affect the infant’s thyroid levels.)
- Loratadine (Note: Antihistamines and allergy medications may decrease your milk supply; use cautiously.)
- Pseudoephedrine (Note: Antihistamines and allergy medications may decrease your milk supply; use cautiously.)
- Valproic Acid
- Cytotoxic drugs: Cyclophosamide, Cyclosporine, Doxorubicin, Methotrexate
- Drugs of Abuse: Cocaine, Amphetamine, Heroin, Marijuana, Phencyclidine
- Radioactive Compounds: Copper 64, Gallium 67, Indium 111, Iodine 123, Iodine 125, Iodine 131, Radioactive sodium, Technetium 99m
- Antidepressants: Fluoxetine (Note: All antidepressants need to be chosen carefully because the long-term effects of many are not well understood. Discuss carefully with your doctor before starting.)
- Antipsychotics: Haloperidol, Chlorpromazine (Note: All antipsychotics need to be chosen carefully because the long-term effects of many are not well understood. Discuss carefully with your doctor before starting.)
- Others: Amiodarone, Acebutolol, Asprin (salicylates), Atenolol, Bromocriptine, Chloramphenicol, Clemastine, Clofazimine, Ergotamine, Lithium, Metronidazole, Phenindione, Phenobarbital, Primidone, Sulfasalazine, Tinidazole. Lamotrigine
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