brand logo

Am Fam Physician. 2002;65(5):979-980

Women commonly stop breastfeeding because of medication use and advice from a physician, according to a report from the American Academy of Pediatrics (AAP). The AAP states that this advice may not be warranted. Most drugs likely to be Prescribed to a nursing mother should have no effect on milk supply or on the infant's well being. The report, titled “The Transfer of Drugs and Other Chemicals into Human Milk,” appears in the September 2001 issue ofPediatrics. It includes discussions of nicotine, psychotropic drugs, silicone breast implants, and other drug therapies.

The current AAP statement is intended to update the list of agents transferred into breast milk and describe possible effects on the infant or lactation, if any are known (Tables 1 and 2).

Before prescribing drugs to lactating women, the AAP recommends that the following should be considered:

Acetaminophen
Acetazolamide
Acitretin*
Acyclovir†
Allopurinol*
Amoxicillin
Antimony*
Atropine
Azapropazone (apazone)*
Aztreonam
B1(thiamin)
B6 (pyridoxine)
B12
Baclofen
Bishydroxycoumarin (dicumarol)
Butorphanol
Captopril
Carbamazepine
Carbetocin
Cascara
Cefadroxil
Cefazolin
Cefotaxime
Cefoxitin
Cefprozil*
Ceftazidime
Ceftriaxone
Chloroform
Chloroquine
Chlorothiazide
Cimetidine†
Ciprofloxacin
Cisapride
Clindamycin
Clogestone
Codeine
Colchicine*
Cycloserine
Diatrizoate
Digoxin
Diltiazem
Dipyrone
Disopyramide
Domperidone
Dyphylline†
Enalapril*
Erythromycin†
Ethambutol
Fentanyl*
Fexofenadine
Flecainide*
Fluconazole
Flufenamic acid
Fluorescein*
Folic acid
Gadopentetic
(Gadolinium)
Gentamicin
Gold salts
Halothane
Hydralazine
Hydrochlorothiazide*
Hydroxychloroquine†
Ibuprofen
Iohexol
Iopanoic acid
Interferon-α*
Ivermectin
K1(vitamin)
Kanamycin
Ketoconazole
Ketorolac*
Labetalol
Levonorgestrel*
Levothyroxine
Lidocaine
Loperamide*
Loratadine
Magnesium sulfate
Medroxyprogesterone
Mefenamic acid
Meperidine
Methadone
Methimazole (active metabolite of carbimazole)
Methohexital
Methyldopa
Metoprolol†
Metrizamide
Metrizoate
Mexiletine
Minoxidil
Moxalactam
Nadolol†
Naproxen*
Nefopam
Nifedipine*
Norethynodrel
Norsteroids
Noscapine
Ofloxacin
Oxprenolol
Phenylbutazone
Piroxicam
Prednisolone
Prednisone
Procainamide
Progesterone
Propoxyphene
Propranolol
Propylthiouracil
Pseudoephedrine†
Pyridostigmine
Pyrimethamine
Quinidine
Quinine
Riboflavin
Rifampin
Scopolamine*
Secobarbital
Senna
Sotalol*
Spironolactone
Streptomycin
Sulbactam
Sumatriptan
Suprofen
Terbutaline
Terfenadine
Thiopental
Ticarcillin
Timolol
Tolmetin
Trimethoprim/sulfamethoxazole
Triprolidine
Valproic acid
Verapamil
Warfarin
Zolpidem

  • Is drug therapy necessary? If drugs are required, the safest drug should be chosen.

  • If there is a possibility of risk to the infant, consideration should be given to measurement of blood concentrations of the drug in the nursing infant.

  • Drug exposure to the nursing infant may be minimized by having the mother take the medication just after breastfeeding the infant or just before the infant is ready for a lengthy sleep period.

DrugReported signs or symptoms
Alcohol (ethanol)With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain; maternal ingestion of 1 g per kg daily decreases milk ejection reflex
Aspirin (salicylates)†Metabolic acidosis (one case)
Atenolol†Cyanosis; bradycardia
BarbiturateShould be given with caution; blood concentration in the infant may be of clinical importance
BendroflumethiazideSuppresses lactation
BromideRash, weakness, absence of cry with maternal intake of 5.4 g per day
CaffeineIrritability, poor sleeping pattern, excreted slowly; no effect with moderate intake of caffeinated beverages (2 to 3 cups per day)
CarbimazoleGoiter
Chloral hydrateSleepiness
ChlorthalidoneExcreted slowly
CisplatinNot found in milk
Contraceptive pill with estrogen/ progesteroneRare breast enlargement; decrease in milk production and protein content (not confirmed in several studies)
D (vitamin)Follow up infant's serum calcium level if mother receives pharmacologic doses
DanthronIncreased bowel activity
DapsoneSulfonamide detected in infant's urine
Dexbrompheniramine maleate with d-isoephedrineCrying, poor sleeping patterns, irritability
EstradiolWithdrawal, vaginal bleeding
EthosuximideDrug appears in infant serum
FleroxacinOne 400-mg dose given to nursing mothers; infants not given breast milk for 48 hours
IndomethacinSeizure (one case)
IodidesMay affect thyroid activity; see iodine
IodineGoiter
Iodine (povidone-iodine, e.g., in a vaginal douche)Elevated iodine levels in breast milk, odor of iodine on infant's skin
IsoniazidAcetyl (hepatotoxic) metabolite secreted but no hepatotoxicity reported in infants
Lithium†One third to one half therapeutic blood concentration in infants
MethyprylonDrowsiness
MorphineInfant may have measurable blood concentration
Nalidixic acidHemolysis in infant with glucose-6-phosphate dehydrogenase (G6PD) deficiency
NitrofurantoinHemolysis in infant with G6PD deficiency
Phenobarbital†Sedation; infantile spasms after weaning from milk containing phenobarbital, methemoglobinemia (one case)
PhenytoinMethemoglobinemia (one case)
SulfapyridineCaution in infant with jaundice or G6PD deficiency and ill, stressed, or premature infant
SulfisoxazoleCaution in infant with jaundice or G6PD deficiency and ill, stressed, or premature infant
TetracyclineNegligible absorption by infant
TheophyllineIrritability
ThiouracilDrug not used in the United States
TolbutamidePossible jaundice

Physicians who encounter adverse effects in infants who have been receiving drug-contaminated breast milk are urged to document these events with the U.S. Food and Drug Administration (http://www.fda.gov/medwatch/index.html). This report should include the generic and brand names of the drug, the maternal dose and mode of administration, the concentration of the drug in milk and maternal and infant blood in relation to the time of ingestion, the method used for laboratory identification, the age of the infant, and the adverse effects.

If a pharmacologic or chemical agent does not appear in the tables, it does not mean that it is not transferred into breast milk or that it does not have an effect on the infant; it only indicates that there were no reports found in the literature.

Continue Reading


More in AFP

Copyright © 2002 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See https://www.aafp.org/about/this-site/permissions.html for copyright questions and/or permission requests.