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Breast feeding and medications

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List of medications and their effect on breast feeding

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

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#-9

  • (1-14C)-Triolein and breast feeding Information in this record refers to the use of (1-14C)-triolein as a diagnostic agent. Breastfeeding does not need to be suspended after administration of (1-14C)-triolein.
  • (14C)-Glycocholic Acid and breast feeding Information in this record refers to the use of (14C)-glycocholic acid as a diagnostic agent. Breastfeeding does not need to be suspended after administration of (14C)-glycocholic acid.

A

  • Abacavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with abacavir during breastfeeding is limited. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Abatacept and breast feeding No information is available on the use of abatacept during breastfeeding. Abatacept is a large genetically engineered fusion protein that interferes with T-cell activation. It has a molecular weight of 92,000. Only small amounts would be expected to enter breastmilk. If abatacept is required by the mother, it is not a reason to discontinue breastfeeding. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Abciximab and breast feeding No information is available on the clinical use of abciximab during breastfeeding. Because abciximab is a large protein molecule with a molecular weight of 47,615, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, abciximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Abemaciclib and breast feeding No information is available on the clinical use of abemaciclib during breastfeeding. Because abemaciclib and its metabolites are over 90% bound to plasma proteins, the amount in milk is likely to be low. However, the manufacturer recommends that breastfeeding be discontinued during abemaciclib therapy and for 3 weeks after the final dose.
  • Acalabrutinib and breast feeding No information is available on the clinical use of acalabrutinib during breastfeeding. Because acalabrutinib is over 97% bound to plasma proteins, and the half-life of the drug and metabolite are less than 7 hours, the amount in milk is likely to be low. However, the protein binding of the active metabolite is not known and the manufacturer recommends that breastfeeding be discontinued during acalabrutinib therapy and for at least 2 weeks after the final dose.
  • Acarbose and breast feeding Because less than 2% of a dose of acarbose is absorbed from the mother's gastrointestinal tract, it is unlikely that any drug reaches the infant through breastmilk.
  • Acebutolol and breast feeding Because of the relatively extensive excretion of acebutolol and its active metabolite diacetolol into breastmilk and their extensive renal excretion, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Acenocoumarol and breast feeding Acenocoumarol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in Canada and other countries. Because of the low levels of acenocoumarol in breastmilk, amounts ingested by the infant are small. No changes in coagulation measurements or adverse reactions in breastfed infants have been reported from maternal acenocoumarol use during lactation. There is a consensus that maternal acenocoumarol therapy during breastfeeding poses little risk to the breastfed infant. No special precautions are necessary.
  • Acesulfame and breast feeding No well-controlled data are available on the extent of passage of acesulfame into breastmilk. However, acesulfame has been found in variable concentrations in the breastmilk of nursing mothers who report consuming artificially sweetened beverages and sweetener packets in the past 24 hours. Even some mothers who reported not consuming artificial sweeteners have small amounts of acesulfame in their breastmilk. Some authors suggest that women may wish to limit the consumption of nonnutritive sweeteners while breastfeeding because their effect on the nursing infants are unknown.
  • Acetaminophen and breast feeding Acetaminophen is a good choice for analgesia, and fever reduction in nursing mothers. Amounts in milk are much less than doses usually given to infants. Adverse effects in breastfed infants appear to be rare.
  • Acetazolamide and breast feeding Limited information indicates that maternal doses of acetazolamide up to 1000 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.
  • Acetohexamide and breast feeding Because no information is available on the use of acetohexamide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Acetylcholine and breast feeding No information is available on the use of acetylcholine ophthalmic drops during breastfeeding. Because of its short half-life, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants.
  • Acetylcysteine and breast feeding No information is available on the use of acetylcysteine during breastfeeding. To avoid infant exposure, nursing mothers may consider pumping and discarding their milk for 30 hours after administration. Acetylcysteine is very minimally absorbed after inhalation, so breastfeeding can be continued and no special precautions are required.
  • Acitretin and breast feeding A maternal acitretin dose of 0.65 mg/kg daily produced low levels in milk in one woman. Because there is no published experience with use of acitretin during breastfeeding, opinions vary on the advisability of breastfeeding during acitretin therapy. Various topical agents that are less likely to be absorbed by the mother may be preferred during breastfeeding, especially while nursing a newborn or preterm infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Aclidinium and breast feeding Although no published data exist on the use of aclidinium during breastfeeding, it produces low maternal serum levels because of rapid hydrolysis to inactive metabolites. The risk to the breastfed infant of maternal aclidinium inhalation is small.
  • Acrivastine and breast feeding Small occasional doses of acrivastine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Acyclovir and breast feeding Even with the highest maternal dosages, the dosage of acyclovir in milk is only about 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. Topical acyclovir applied to small areas of the mother's body away from the breast should pose no risk to the infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Adalimumab and breast feeding Limited information indicates that maternal adalimumab injections produce low levels in breastmilk and do not adversely affect the nursing infant. Because adalimumab is a large protein molecule with a molecular weight of about 148,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Most experts feel that the drug is acceptable to use during nursing. However, until more data become available, adalimumab should be used with caution while nursing a newborn or preterm infant.
  • Adapalene and breast feeding Topical adapalene has not been studied during breastfeeding. Because it is poorly absorbed after topical application, and blood levels are less than 0.25 mcg/L with long-term use, it is probably a low risk to the nursing infant. Do not apply to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Adenovirus Type 4 and Type 7 Vaccine and breast feeding The adenovirus type 4 and type 7 vaccine is indicated only for military personnel between 17 and 50 years of age. No information is available on the use of adenovirus type 4 and type 7 vaccine during breastfeeding or its excretion in human milk. The Centers for Disease Control and Prevention and American Academy of Pediatrics state that in general, vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants. However, the product labeling recommends using caution in nursing mothers, because live virus is shed for 28 days following vaccination.
  • Ado-Trastuzumab Emtansine and breast feeding No information is available on the clinical use of ado-trastuzumab during breastfeeding. Because trastuzumab is a large protein molecule with a molecular weight of 145,531, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. However, ado-trastuzumab emtansine also contains the small molecule cytotoxin, DM1, the manufacturer recommends avoiding breastfeeding during and for 7 months following ado-trastuzumab emtansine therapy.
  • Afatinib and breast feeding No information is available on the clinical use of afatinib during breastfeeding. Because afatinib is about 95% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 37 hours and it might accumulate in the infant. the manufacturer recommends that breastfeeding be discontinued during afatinib therapy and for 2 weeks after the last dose.
  • Aflibercept and breast feeding This record refers to the use of intravitreal aflibercept for macular degeneration. No information is available on the use of aflibercept during breastfeeding. The manufacturer estimates that after intravitreal administration of 2 mg, the mean maximum plasma concentration of free aflibercept is more than 100-fold lower than the concentration of aflibercept required to half-maximally bind systemic vascular endothelial growth factor. Additionally, aflibercept is a large protein molecule with a molecular weight of 115,000, Therefore, the amount in breastmilk is likely to be clinically unimportant after intravitreal injection. However, the manufacturer recommends avoiding the drug during breastfeeding.
  • Agalsidase Alfa and breast feeding Agalsidase alfa is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Because it is a large protein molecule with a molecular weight of about 100,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Six infants who were breastfed for periods up to 12 months by mothers taking agalsidase alfa experienced no adverse effects associated with the drug.
  • Agalsidase Beta and breast feeding No information is available on the clinical use of agalsidase beta during breastfeeding. Because it is a large protein molecule with a molecular weight of about 100,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Six infants who were breastfed for periods up to 12 months by mothers taking the closely related drug agalsidase alfa experienced no adverse effects associated with the drug.
  • Alatrofloxacin and breast feeding No information is available on the clinical use of alatrofloxacin during breastfeeding. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of alatrofloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available.
  • Albendazole and breast feeding Albendazole and its active metabolite are minimally excreted into breastmilk. An informal consultation group to the World Health Organization concluded that a single oral dose of albendazole can be given to lactating women.
  • Albuterol and breast feeding Although no published data exist on the use of albuterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Alclometasone and breast feeding Alclometasone has not been studied during breastfeeding. Since only extensive application of the most potent of these drugs cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids (e.g., hydrocortisone, triamcinolone) should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Alectinib and breast feeding No information is available on the clinical use of alectinib during breastfeeding. Because alectinib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 33 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during alectinib therapy and for 1 week after the last dose.
  • Alemtuzumab and breast feeding No information is available on the clinical use of alemtuzumab during breastfeeding. Because alemtuzumab is a large protein molecule with a molecular weight of 145,454, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, alemtuzumab should be used with caution or avoided during breastfeeding, especially while nursing a newborn or preterm infant.
  • Alendronate and breast feeding Limited evidence indicates that breastfeeding after cessation of long-term bisphosphonate treatment appears to have no adverse effects on the infant. Because no information is available on the use of alendronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of alendronate by a breastfed infant is unlikely. If the mother receives a bisphosphonate during pregnancy or nursing, some experts recommend monitoring the infant's serum calcium during the first 2 months postpartum.
  • Alfentanil and breast feeding When used epidurally or intravenously during labor or for a short time immediately postpartum, amounts of alfentanil ingested by the neonate are small and would not be expected to cause any adverse effects in breastfed infants. Alfentanil is highly protein bound which should result in less transfer to breastmilk than other opiates; however, because there is no published experience with repeated doses of intravenous alfentanil during established lactation, other agents may be preferred, especially while nursing a newborn or preterm infant. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of alfentanil to a few days with careful monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation.
  • Alglucerase and breast feeding Alglucerase is the placenta-derived form of the enzyme, beta-glucocerebrosidase which is a normal component of human milk. Studies with alclucerase and synthetic forms of the enzyme have found very low levels of the enzyme in breastmilk. Absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. A limited amount of data support the safety of breastfeeding with alglucerase. An international panel of clinicians from 9 centers that treat Gaucher's disease reported that, breastfeeding complications were less frequent in mothers who were treated with alglucerase or imiglucerase (the biosynthetic form of the enzyme) postpartum than in untreated mothers with Gaucher's disease. Consider limiting the duration of breastfeeding to about 6 months to avoid excessive bone loss in the nursing mother.
  • Alglucosidase Alfa and breast feeding Because alglucosidase is a large protein molecule with a molecular weight of about 110,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract Alglucosidase alfa activity was detectable in breastmilk for only 24 hours after a dose in one woman. The investigators recommended withholding breastfeeding for 24 hours after each dose as a precaution until more data are obtained.
  • Alirocumab and breast feeding No information is available on the clinical use of alirocumab during breastfeeding. Because alirocumab is a large protein molecule with a molecular weight of 146,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, alirocumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Allopurinol and breast feeding Limited information indicates that a maternal doses of allopurinol of 300 mg daily provides near-therapeutic dose and plasma levels in an exclusively breastfed infant. If allopurinol is required by the mother, it is not a reason to discontinue breastfeeding, but exclusively breastfed infants should be monitored if this drug is used, including observation for allergic reactions (such as rash) and periodic CBC and differential blood counts. Lesinurad, which is available in the combination product Duzallo, has not been studied in nursing mothers.
  • Almotriptan and breast feeding Because there is no published experience with almotriptan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Alogliptin and breast feeding No information is available on the clinical use of alogliptin during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with alogliptin.
  • Alosetron and breast feeding No information is available on the use of alosetron during breastfeeding. Because of relatively high protein binding and only moderate bioavailability, exposure of the breastfed infant is likely to be low. Until more data are available, alosetron should only be used with careful infant monitoring during breastfeeding.
  • Alprazolam and breast feeding Because of reports of effects in infants, including sedation, alprazolam is probably not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred. After a single dose of alprazolam, there is usually no need to wait to resume breastfeeding.
  • Alteplase and breast feeding Tissue plasminogen activator (tPA), which is identical to alteplase, is a normal component of human colostrum and breastmilk. Levels in milk are highest in colostrum and decrease rapidly during the first week, followed by a sower decrease over time. Because alteplase is a large protein molecule with a molecular weight of about 59,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. No information is available on the clinical use of alteplase during breastfeeding. Until more data become available, alteplase should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Amantadine and breast feeding It is probably best to avoid amantadine during breastfeeding because of its potential negative effect on lactation.
  • Amcinonide and breast feeding Amcinonide has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Amifampridine and breast feeding No information is available on the clinical use of amifampridine during breastfeeding on the presence of amifampridine or the 3-N-acetyl-amifampridine metabolite in breastmilk. If amifampridine is required by the mother, it is not a reason to discontinue breastfeeding, but the infant should be carefully monitored for excessive crying or fussiness, adequate weight gain, and developmental milestones.
  • Amikacin and breast feeding Amikacin is poorly excreted into breastmilk. Newborn infants apparently absorb small amounts of other aminoglycosides, but serum levels with typical three times daily dosages are far below those attained when treating newborn infections and systemic effects of amikacin are unlikely. Older infants would be expected to absorb even less amikacin. Because there is little variability in the milk amikacin levels during multiple daily dose regimens, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Data are not available with single daily dose regimens. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
  • Amiloride and breast feeding No information is available on the use of amiloride during breastfeeding, so an alternate drug may be preferred.
  • Aminophylline and breast feeding An expert panel considers use of aminophylline to be acceptable during breastfeeding. Maternal aminophylline use may occasionally cause stimulation and irritability and fretful sleep in infants. Newborn and especially preterm infants are most likely to be affected because of their slow elimination and low serum protein binding of theophylline. There is no need to avoid aminophylline products; however, keep maternal serum theophylline concentrations in the lower part of the therapeutic range and monitor the infant for signs of theophylline side effects. Infant serum theophylline concentrations can help to determine if signs of agitation are due to theophylline. Avoiding breastfeeding for 2 hours after intravenous or 4 hours after an immediate-release oral aminophylline product can decrease the dose received by the breastfed infant.
  • Aminosalicylic Acid and breast feeding Limited information indicates that maternal aminosalicylic acid therapy produces low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Exclusively breastfed infants should be monitored for rare instances of jaundice, gastrointestinal disturbances, hypokalemia, thrombocytopenia, hemolysis and hypokalemia if this drug is used during lactation.
  • Amisulpride and breast feeding Amisulpride is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Because there is little published experience with amisulpride during breastfeeding and excretion into breastmilk is higher than with other pharmacologically similar drugs, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Some reviewers consider amisulpride to be contraindicated during breastfeeding.
  • Amitriptyline and breast feeding Milk levels of amitriptyline and its metabolites are low. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Amitriptyline use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. However, rare sedation has been reported in a neonate. Other agents with fewer active metabolites may be preferred when large doses are required or while nursing a newborn or preterm infant.
  • Amlodipine and breast feeding Limited information indicates that milk levels of amlodipine are usually low and plasma levels in breastfed infants are undetectable. Maternal use of amlodipine during breastfeeding has not caused any adverse effects in breastfed infants. If amlodipine is required by the mother, it is not a reason to discontinue breastfeeding.
  • Amoxapine and breast feeding Because there is no published experience with amoxapine during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Amoxicillin and Clavulanic Acid and breast feeding Limited information indicates that adverse reactions in infants are uncommon during the use of amoxicillin-clavulanic acid during nursing, with restlessness, diarrhea and rash occurring occasionally. Amoxicillin-clavulanic acid is acceptable in nursing mothers.
  • Amoxicillin and breast feeding Limited information indicates that amoxicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, rash and disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported, but these effects have not been adequately evaluated. Amoxicillin is acceptable in nursing mothers. Amoxicillin powder for suspension reconstituted with breastmilk is absorbed as well as the powder reconstituted with water.
  • Amphetamine and breast feeding In dosages prescribed for medical indications, some evidence indicates that amphetamine does not affect nursing infants adversely. The effect of amphetamine in milk on the neurological development of the infant has not been well studied. Large dosages of amphetamine might interfere with milk production, especially in women whose lactation is not well established. Breastfeeding is generally discouraged in mothers who are actively abusing amphetamines. One expert recommends that amphetamine not be used therapeutically in nursing mothers.
  • Amphotericin B and breast feeding Although no information exists on the milk excretion of amphotericin B, it is highly protein bound, has a large molecular weight, is virtually unabsorbed orally and has been use directly in the mouths of infants; therefore, most reviewers consider it acceptable to use in nursing mothers.
  • Ampicillin and Sulbactam and breast feeding Limited information indicates that ampicillin-sulbactam produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, have been reported with penicillins, but these effects have not been adequately evaluated. Ampicillin-sulbactam is acceptable in nursing mothers.
  • Ampicillin and breast feeding Substantial information indicates that ampicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Ampicillin is acceptable in nursing mothers.
  • Anakinra and breast feeding Anainra is the pharmaceutical name for recombinant human interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra is a normal component of human milk where it may play a role as an anti-inflammatory agent. No data exist on the excretion of anakinra into breastmilk after exogenous administration. Several infants have been breastfed during maternal anakinra therapy with no obvious adverse effects. If anakinra is required by the mother, it is not a reason to discontinue breastfeeding.
  • Antacids and breast feeding Although no published information on the aluminum, calcium or magnesium content of milk during maternal antacid therapy could be found, additional intake of these minerals by a nursing mother is unlikely to surpass that found in other infant foods. In addition, oral absorption of aluminum and magnesium is poor. Because of these factors, reviewers generally consider antacid use during breastfeeding to be acceptable. No special precautions are required.
  • Anthrax Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to the anthrax vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Antihemophilic Factor and breast feeding No information is available on the clinical use of antihemophilic factor (coagulation factor VIII) during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, antihemophilic factor should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Antipyrine and breast feeding Antipyrine is considered unlikely to harm the infant. Because antipyrine is available only in ear drops, it is unlikely to be absorbed by the mother and reach the breastmilk. No special precautions are required during maternal use of antipyrine-containing ear drops.
  • Antivenin Latrodectus Mactans and breast feeding No information is available on the clinical use of antivenin latrodectus mactans during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Antivenin Micrurus Fulvius and breast feeding No information is available on the clinical use of antivenin micrurus fulvius during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Apazone and breast feeding Apazone (azapropazone) is not approved for marketing in the United States by the U.S. Food and Drug Administration. Relatively small amounts of the drug are excreted into breastmilk; however, the toxicity of the drug limits its usefulness in nursing mothers. An alternate drug is preferred, especially while nursing a newborn or preterm infant.
  • Apixaban and breast feeding Because no information is available on the use of apixaban during breastfeeding and the drug is orally absorbable, an alternate drug is preferred while nursing a newborn or preterm infant.
  • Apomorphine and breast feeding No information is available on the use of apomorphine during breastfeeding. Apomorphine inhibits prolactin release in animals and might interfere with establishment of lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Apraclonidine and breast feeding No information is available on the use of apraclonidine during breastfeeding. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Apremilast and breast feeding No information is available on the clinical use of apremilast during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Aripiprazole and breast feeding Limited information indicates that maternal doses of aripiprazole up to 15 mg daily produce low levels in milk, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Aripiprazole can lower serum prolactin in a dose-related manner. Cases of lactation cessation have occurred, but cases of gynecomastia and galactorrhea have also been reported.
  • Armodafinil and breast feeding Armodafinil is the R-enantiomer of modafinil. The amount of armodafinil in one nursing mother was very low. Minimal information from women who breastfed their infant's while using racemic modafinil found no adverse effects in their infants. Until more safety data are available, armodafinil should be used with careful infant monitoring during breastfeeding, or an alternate drug may be preferred.
  • Arsenic Trioxide and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; the manufacturer recommends an abstinence period of 1 week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Artemether and Lumefantrine and breast feeding Artemether and lumefantrine have not been studied in nursing mothers. Estimates of its excretion into breastmilk indicate that amounts in milk are very low. The Centers for Disease Control and Prevention consider the drug combination acceptable for use in mothers nursing an infant weighing at least 5 kg (11 pounds) and it can be given directly to infants weighing 5 kg or more. The safety of the combination in breastfed infants under 5 kg is not known.
  • Articaine and breast feeding No information is available on the use of articaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk, a single dose of articaine injected during breastfeeding is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Asenapine and breast feeding Because no information is available on the use of asenapine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Aspartame and breast feeding Aspartame is not detectable in breastmilk after maternal ingestion because it is rapidly broken down in the mother's body. An extremely large intake of aspartame (equivalent to 17 cans of soda or 100 packets of Equal Sweetener) can slightly increase the amount of phenylalanine in breastmilk. Phenylalanine concentrations in milk return to baseline by 12 hours after a large single dose of aspartame. Although it is prudent to avoid the use of aspartame in women who are nursing an infant with phenylketonuria, amounts that are typically ingested in aspartame-sweetened foods and beverages do not result in any additional risk to breastfed infants with phenylketonuria.
  • Aspirin and breast feeding After aspirin ingestion, salicylic acid is excreted into breastmilk, with higher doses resulting in disproportionately higher milk levels. Long-term, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. Reye's syndrome is associated with aspirin administration to infants with viral infections, but the risk of Reye's syndrome from salicylate in breastmilk is unknown. An alternate drug is preferred over continuous high-dose, aspirin therapy. After daily low-dose aspiring (75 to 325 mg daily), no aspirin is excreted into breastmilk and salicylate levels are low. Daily low-dose aspirin therapy may be considered as an antiplatelet drug for use in breastfeeding women.. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Atenolol and breast feeding Because of atenolol's relatively extensive excretion into breastmilk and its extensive renal excretion, other agents may be preferred while nursing a newborn or preterm infant or with high maternal dosages. Infants older than 3 months of age appear to be at little risk of adverse effects from atenolol in breastmilk. Timing breastfeeding with respect to the time of the atenolol dose appears to be of little benefit in reducing infant atenolol exposure because the time of the peak is unpredictable.
  • Atomoxetine and breast feeding There is no published experience with atomoxetine during breastfeeding, although reports from the manufacturer found no serious advese effects in two breastfed infants. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Atorvastatin and breast feeding The consensus opinion is that women taking a statin should not breastfeed because of a concern with disruption of infant lipid metabolism. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Some evidence indicates that atorvastatin can be taken by nursing mothers with no obvious developmental problems in their infants. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Atovaquone and breast feeding No information is available on the use of atovaquone during breastfeeding. However, the quantity of drug in breast milk is assumed too low to provide adequate protection against malaria for the breastfed infant. A dosage has been established for infants weighing as little as 5 kg, so it is unlikely to adversely affect breastfed infants weighing 5 kg or more.
  • Atracurium and breast feeding No information is available on the use of atracurium during breastfeeding. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Atropine and breast feeding No information is available on the use of atropine during breastfeeding. Long-term use of atropine might reduce milk production or milk letdown, but a single systemic or ophthalmic dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Auranofin and breast feeding Excretion of gold into milk after auranofen has not been studied. Case reports with other gold salts indicate that gold appears in milk in small quantities and at least a little of it is absorbed because it is detectable in the infant's urine. No convincing cases of toxicity have been reported. Opinions of authors of review articles vary from recommending avoidance to allowing use. Monitoring for possible adverse effects in the breastfed infant would seem prudent.
  • Axitinib and breast feeding No information is available on the clinical use of axitinib during breastfeeding. Because axitinib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during axitinib therapy and for 2 weeks after the final dose of therapy.
  • Azacitidine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent azacitidine therapy with an appropriate period of breastfeeding abstinence; the manufacturer recommends an abstinence period of 1 week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Azatadine and breast feeding Small occasional doses of azatadine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Azathioprine and breast feeding Most experts consider breastfeeding during azathioprine to be acceptable. Studies in women with inflammatory bowel disease, systemic lupus erythematosus or transplantation taking doses of azathioprine up to 200 mg daily for immunosuppression have found either low or unmeasurable levels of the active metabolites in milk and infant serum. Some evidence indicates a lack of adverse effects on the health and development of infants exposed to azathioprine during breastfeeding up to 3.5 years of age, but long-term follow-up for effects such as carcinogenesis have not been performed. Mothers with decreased activity of the enzyme that detoxifies azathioprine metabolites may transmit higher levels of drug to their infants in breastmilk. Cases of mild, asymptomatic neutropenia have been reported, so it might be desirable to monitor exclusively breastfed infants with a complete blood count with differential, and liver function tests if azathioprine is used during lactation, although some authors feel that monitoring is unnecessary. Avoiding breastfeeding for 4 hours after a dose should markedly decrease the dose received by the infant in breastmilk.
  • Azelaic Acid and breast feeding Topical azelaic acid has not been studied during breastfeeding. Because only 4% of a dose is absorbed after topical application and it is a chemical that appears in foods and the bloodstream normally, azelaic acid is considered a low risk to the nursing infant. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Azficel-T and breast feeding No information is available on the clinical use of azficel-t during breastfeeding. However, azficel-t is a cellular material made from the patient's own cells, so it would not be expected to cause any adverse effects in breastfed infants.
  • Azilsartan and breast feeding Because no information is available on the use of azilsartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Aztreonam and breast feeding Limited information indicates that aztreonam produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with beta-lactams, but these effects have not been adequately evaluated. Aztreonam is acceptable in nursing mothers.

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B

  • BCG Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to the BCG vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Bacampicillin and breast feeding Limited information indicates that bacampicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Bacampicillin is acceptable in nursing mothers.
  • Bacitracin and breast feeding Because it is poorly absorbed after topical application and oral ingestion, bacitracin is considered a low risk to the nursing infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Therefore, an alternate cream product is preferred for application to the breast.
  • Baclofen and breast feeding Limited information indicates that orally administered baclofen appears in low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor newborn infants for signs of sedation. Low intrathecal doses and topical application produce even lower milk levels and are unlikely to affect the nursing infant.
  • Baloxavir and breast feeding No information is available on the use of baloxavir marboxil during breastfeeding. Because baloxavir is 93% bound to plasma proteins, the amount in milk is likely to be low. However, because no information is available on the use of baloxavir breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Balsalazide and breast feeding Although no information exists on the excretion of balsalazide into breastmilk, it is metabolized to the active drug mesalamine. A few cases of diarrhea have been reported in infants exposed to mesalamine, although the rate is not high. Most experts consider mesalamine derivatives to be safe during breastfeeding. If balsalazide is required by the mother, it is not a reason to discontinue breastfeeding, but observe breastfed infants for diarrhea.
  • Baricitinib and breast feeding No information is available on the use of baricitinib during breastfeeding. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during baricitinib therapy.
  • Barium Sulfate and breast feeding Because barium sulfate is not absorbed after oral or rectal administration, it will not enter the milk, reach the bloodstream of the infant or cause any adverse effects in breastfed infants. No special precautions are required.
  • Basiliximab and breast feeding No information is available on the clinical use of basiliximab during breastfeeding. Because basiliximab is a large protein molecule with a molecular weight of about 144,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, basiliximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during basiliximab therapy.
  • Beclomethasone and breast feeding Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled and oral corticosteroids acceptable to use during breastfeeding.
  • Bedaquiline and breast feeding No information is available on the clinical use of bedaquiline during breastfeeding. Because bedaquiline is more than 99.9% bound to plasma proteins, exposure of the breastfed infant is likely to be low. However, the half-lives of the drug and its main metabolite are over 5 months, so until more safety data become available, bedaquiline should be avoided during breastfeeding.
  • Belatacept and breast feeding No information is available on the use of belatacept during breastfeeding. The manufacturer recommends avoiding nursing if belatacept is given. Because the drug's half-life is 8 to 10 days, it may be more than a month after a dose before the drug is absent from breastmilk.
  • Benazepril and breast feeding Because of the low levels of benazepril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Bendamustine and breast feeding No information is available on the use of bendamustine during breastfeeding. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as bendamustine. The manufacturer recommends that breastfeeding be discontinued during bendamustine therapy. Based on the half-life of the drug and its metabolites, the drug should be eliminated from the milk by 24-48 hours after the last dose.
  • Bendroflumethiazide and breast feeding No information is available on the amount of bendroflumethiazide in breastmilk. Intense diuresis with large doses of bendroflumethiazide can decrease breastmilk production, especially during the neonatal period. Shorter-acting diuretics in low doses are preferred over bendroflumethiazide.
  • Benzalkonium Chloride and breast feeding Topical maternal application of benzalkonium chloride or benzethonium chloride or their presence as a preservative in pharmaceuticals would not be expected to cause any adverse effects in breastfed infants.
  • Benzathine Penicillin G and breast feeding : Limited information indicates benzathine penicillin G produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Benzathine penicillin G is acceptable in nursing mothers.
  • Benznidazole and breast feeding Benznidazole is excreted into milk in dosages much lower than the treatment dosage for infants. Because of the low levels of benznidazole in breastmilk and safety when given directly to infants, its use is acceptable in nursing mothers.
  • Benzocaine and breast feeding Topical benzocaine has not been studied during breastfeeding, but is unlikely to affect her breastfed infant if it is applied away from the breast. Benzocaine should not be applied to the breast or nipple, because the infant may ingest the drug during nursing and it has been associated with severe methemoglobinemia.
  • Benzoyl Peroxide and breast feeding Topical benzoyl peroxide has not been studied during breastfeeding. Because only about 5% is absorbed following topical application, it is considered a low risk to the nursing infant. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Benzthiazide and breast feeding No information is available on the amount of benzthiazide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over benzthiazide.
  • Benztropine and breast feeding No information is available on the use of benztropine during breastfeeding. Long-term use of benztropine might reduce milk production or milk letdown, but a single dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Bepotastine and breast feeding There are no reports of infants breastfed during maternal therapy with bepotastine. Because absorption from the eye is limited, bepotastine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Besifloxacin and breast feeding Maternal use of besifloxacin eye drops presents negligible risk for the nursing infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Betamethasone and breast feeding Betamethasone has not been well studied during breastfeeding after systemic or topical use. Systemic betamethasone is best avoided in favor of one of the shorter-acting and better studied alternatives because of its potency and low protein binding which would favor its passage into milk. Use of betamethasone 3 to 9 days prior to delivery of a preterm infant might decrease postpartum milk production in some women. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply.
  • Betamethasone, Topical and breast feeding Betamethasone ointment appears to have no advantage over lanolin for treating sore nipples during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin; topical betamethasone should be avoided on the nipple. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Bethanechol and breast feeding No information is available on the use of bethanechol during breastfeeding. If it is used during breastfeeding, monitor the infant for signs of cholinergic excess (diarrhea, lacrimation, and excessive salivation or urination), especially in younger, exclusively breastfed infants.
  • Betrixaban and breast feeding Because no information is available on the use of betrixaban during breastfeeding and the drug is orally absorbable, an alternate drug is preferred while nursing a newborn or preterm infant.
  • Bictegravir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of bictegravir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Bimatoprost and breast feeding No information is available on the use of bimatoprost during breastfeeding. Because of its short half-life it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Binimetinib and breast feeding No information is available on the clinical use of binimetinib during breastfeeding. Because binimetinib is 97% bound to plasma proteins, and the half-life of the drugis 3.5 hours, the amount in milk is likely to be low. However, the manufacturer recommends that breastfeeding be discontinued during binimetinib therapy and for at least 3 days after the final dose. For patients taking the combination with encorafenib, the manufacturer recommends that breastfeeding be discontinued during binimetinib therapy and for at least 2 weeks after the final dose.
  • Bisacodyl and breast feeding Bisacodyl is not absorbed from the gastrointestinal tract, and its active metabolite, which is absorbed, is not detectable in breastmilk. Bisacodyl can be taken during breastfeeding and no special precautions are required.
  • Bisoprolol and breast feeding Because there is little published experience with bisoprolol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Bitolterol and breast feeding Although no published data exist on the use of bitolterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Bleomycin and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence. Although no data are available to determine an appropriate period to withhold breastfeeding, the drug's terminal half-life of 4 hours with normal kidney function suggests that withholding breastfeeding for at least 24 hours may be sufficient. This period may be longer in patients with impaired kidney function. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Blinatumomab and breast feeding No information is available on the clinical use of blinatumomab during breastfeeding. Because blinatumomab is a large protein molecule with a molecular weight of about 54,000 the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, blinatumomab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during blinatumomab therapy and for at least 48 hours after treatment.
  • Bosentan and breast feeding There is little published experience with bosentan during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Bosutinib and breast feeding No information is available on the clinical use of bosutinib during breastfeeding. Because bosutinib is 96% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 22 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during bosutinib therapy.
  • Botulin A and breast feeding No data exist on the medical use of botulin A (botulinum toxin, abobotulinumtoxinA, incobotulinumtoxinA, onabotulinumtoxinA, prabotulinumtoxinA) during breastfeeding. However, it is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. One infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant. Since the doses used medically are far lower than those that cause botulism, amounts ingested by the infant, if any, are expected to be small and not cause any adverse effects in breastfed infants. No special precautions are required.
  • Botulin B and breast feeding No data exist on the medical use of botulin B (botulinum toxin, rimabotulinumtoxinB) during breastfeeding. However, rimabotulinumtoxinB is not detectable systemically after intramuscular use, thus excretion into breast milk is considered unlikely. One infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant's blood or stools. Since the doses used medically are far lower than those that cause botulism, amounts ingested by the infant, if any, are expected to be small and not cause any adverse effects in breastfed infants. No special precautions are required.
  • Botulinum Poisoning and breast feeding Breastfeeding is considered to be a risk factor for infant botulism via direct exposure, possibly because of changes in the intestinal flora during weaning. An epidemiologic study in California in 1976-1978 found the age of onset of the disease to be later in breastfed infants (13.8 weeks) than in formula-fed infants (7.6 weeks) and no breastfed infants died from the disease, whereas 8 cases of sudden death from botulism occurred in formula-fed infants. A subsequent study found no difference is severity between breast- and formula-fed infants. Little information is available on the transfer of the botulinum toxin into breastmilk. Mothers suspected of having botulinum poisoning should not breastfeed until they have recovered.
  • Bremelanotide and breast feeding No information is available on the clinical use of bremelanotide during breastfeeding. Because bremelanotide is a cyclic peptide molecule with a molecular weight of 1025, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, bremelanotide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Brentuximab Vedotin and breast feeding No information is available on the clinical use of brentuximab during breastfeeding. Because brentuximab is a large protein molecule with a molecular weight of about 153,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, brentuximab vedotin should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during brentuximab therapy.
  • Bretylium and breast feeding Bretylium is no longer marketed. Because there is little published experience with bretylium during breastfeeding, its high frequency of side effects, and its lack of availability, other agents are preferred.
  • Brexanolone and breast feeding Because of the low amounts of brexanolone in milk and low oral bioavailability, brexanolone would not be expected to cause any adverse effects in breastfed infants. If brexanolone is required by the mother, it is not a reason to discontinue breastfeeding.
  • Brexpiprazole and breast feeding No information is available on the use of brexpiprazole during breastfeeding. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Brigatinib and breast feeding No information is available on the clinical use of brigatinib during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during brigatinib therapy and for 1 week after the final dose.
  • Brinzolamide and breast feeding Because no information is available on the use of brinzolamide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Brivaracetam and breast feeding Because no information is available on use of brivaracetam during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If brivaracetam is required by the mother, it is not necessarily a reason to discontinue breastfeeding, but monitor the infant for drowsiness, agitation, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of drugs. Measurement of infant serum levels may help rule out toxicity if there is a concern.
  • Brompheniramine and breast feeding Small, occasional doses of brompheniramine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
  • Budesonide and breast feeding The amounts of inhaled budesonide excreted into breastmilk are minute and infant exposure is negligible. When taken by mouth, budesonide is only about 9% bioavailable; bioavailability in the infant is likely to be similarly low for any budesonide that enters the breastmilk. Most experts consider oral and inhaled corticosteroids, including budesonide, acceptable to use during breastfeeding.
  • Bumetanide and breast feeding It is unknown if bumetanide is excreted into breastmilk. It should be avoided while breastfeeding a newborn because it may decrease milk flow or completely suppress lactation. Low doses in mothers whose lactation is well established are unlikely to suppress lactation. In general, alternate drugs are preferred.
  • Bupropion and breast feeding Limited information indicates that maternal bupropion doses of up to 300 mg daily produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants. However, there is little reported use in breastfed newborn infants and case reports of a possible seizure in partially breastfed 6-month-olds. If bupropion is required by a nursing mother, it is not a reason to discontinue breastfeeding. However, another drug may be preferred, especially while nursing a newborn or preterm infant. Infants exposed to bupropion and an SSRI through breastfeeding should be closely monitored for vomiting, diarrhea, jitteriness, or sedation and possibly measurement of serum levels to rule out toxicity if there is a concern.
  • Buspirone and breast feeding Limited information indicates that maternal doses of buspirone up to 45 mg daily produce low levels in milk. Because no information is available on the long-term use of buspirone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Busulfan and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence. Although minimal data are available to determine an appropriate period to withhold breastfeeding, the drug's terminal half-live of 2.5 hours suggests that withholding breastfeeding for at least 24 hours may be sufficient. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Butabarbital and breast feeding Because there is little published experience with butabarbital during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Butalbital and breast feeding Butalbital in breastmilk has caused poor feeding and vomiting in one infant. Other agents are preferred, especially while nursing a newborn or preterm infant.
  • Butenafine and breast feeding Topical butenafine has not been studied during breastfeeding. Because it is poorly absorbed after topical application, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Butoconazole and breast feeding Vaginal butoconazole has not been studied during breastfeeding. About 5.5% of a vaginal dose is absorbed and its plasma half-life is 21 to 24 hours. Because there is no published experience with butoconazole during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Butorphanol and breast feeding Limited data indicate that butorphanol is excreted into breastmilk in small amounts. Butorphanol is poorly orally absorbed, so it is unlikely to adversely affect the breastfed infant. However, because there is no published experience with repeated, high, intravenous or intranasal doses of butorphanol during breastfeeding, other agents may be preferred in these situations, especially while nursing a newborn or preterm infant. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. As with other narcotics, once the mother's milk comes in, it is best to limit maternal intake and to supplement analgesia with a nonnarcotic analgesic if necessary for pain control. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Labor pain medication may delay the onset of lactation.

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C

  • C1 Esterase Inhibitor and breast feeding C1 esterase inhibitor [human] is a serine proteinase inhibitor derived from human plasma that is used in treating hereditary angioedema. Breastmilk levels of C1 esterase inhibitor have not been measured after exogenous administration in humans. Because of its large molecular weight, amounts in milk are expected to be small. Any C1 esterase inhibitor in breastmilk is probably destroyed in the infant's gastrointestinal tract and not absorbed, except perhaps in neonates. Various international consensus panels state that human plasma-derived C1 esterase inhibitor is considered to be the therapy of choice for both treatment and prophylaxis of maternal hereditary angioedema during lactation.
  • Cabbage and breast feeding Cabbage (Brassica oleracea) leaves have been applied topically to the breasts to treat breast engorgement. Some investigators cut out a hole in the leaves to keep the nipples dry. Leaves have been applied frozen, refrigerated or at room temperature. Various studies found cabbage leaves beneficial for reducing breast engorgement and pain regardless of temperature. However, a meta-analysis concluded that there is no good evidence that topical cabbage leaves were better than no treatment, because engorgement tends to improve over time regardless of treatment. The authors felt that the intervention was cheap, unlikely to cause harm and might be soothing for the mother. Unrestricted nursing of the infant may be an important factor in reducing engorgement. Some low-quality evidence indicates that maternal cabbage ingestion might cause colic in their breastfed infants.
  • Cabergoline and breast feeding Cabergoline is usually not used during breastfeeding because it suppresses lactation. The U.S. Food and Drug Administration considers cabergoline to be not indicated to suppress lactation because the similar drug bromocriptine has caused hypertension, stroke, seizures and psychosis when used for this purpose. Cabergoline's use in other conditions has caused side effects similar to other dopamine agonists, such as bromocriptine. Whether rare cases of severe adverse effects occur with cabergoline as with bromocriptine cannot be determined because of the small number of postpartum patients treated in clinical trials to date. However, limited experience from clinical trials indicates that a single oral dose of 1 mg of cabergoline causes fewer side effects (usually headache, dizziness and nausea) than 14 days of bromocriptine and is at least as effective when used to suppress unwanted lactation. Some experts recommend cabergoline as a safer alternative to bromocriptine for lactation suppression, but others do not. The disadvantage of cabergoline is that it has a half-life of about 68 hours, which means that any adverse effects will persist for a prolonged period of time. Women treated with cabergoline for pituitary adenomas who become pregnant can breastfed their infants with no apparent risk of recurrence. A treatment scheme has been reported for mothers with hypergalactia that uses low doses of cabergoline to decrease milk supply.
  • Cabozantinib and breast feeding No information is available on the clinical use of cabozantinib during breastfeeding. Because cabozantinib is more than 97% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life ranges from 55 to 99 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during cabozantinib therapy and for 4 months after the last dose.
  • Caffeine and breast feeding Caffeine appears in breastmilk rapidly after maternal ingestion. Insufficient high-quality data are available to make good evidence-based recommendations on safe maternal caffeine consumption. Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily. Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. A maternal intake limit of 300 to 500 mg daily might be a safe level of intake for most mothers. However, preterm and younger newborn infants metabolize caffeine very slowly and may have serum levels of caffeine and other active caffeine metabolites similar to their mothers' levels, so a lower intake level preferable in the mothers of these infants. Other sources of caffeine, such as cola and energy drinks, yerba mate or guarana, will have similar dose-related effects on the breastfed infant. Coffee intake of more than 450 mL daily may decrease breastmilk iron concentrations and result in mild iron deficiency anemia in some breastfed infants.
  • Calcipotriene and breast feeding No information is available on the use of calcipotriene during breastfeeding. Because it is poorly absorbed after topical application, calcipotriene is probably a low risk to the nursing infant and is generally considered acceptable during breastfeeding, even to the nipple area. Avoid application of the combination product containing betamethasone (Enstilar) to the breast. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Calcitonin and breast feeding Little information is available on the clinical use of calcitonin during breastfeeding; however, calcitonin is a normal component of human milk where may play a role in development of enteric neurons in the breastfed infant. Because it is a large peptide, absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. If calcitonin is required by the mother, it is not a necessarily reason to discontinue breastfeeding Calcitonin therapy is sometimes used to treat symptomatic postpartum osteoporosis, which is often treated in part by stopping lactation to reduce calcium loss. There is no evidence that exogenous calcitonin decreases serum prolactin or lactation in nursing mothers.
  • Calcitriol and breast feeding Calcitriol is the normal physiologically active form of vitamin D, 1,25-dihydroxyvitamin D. Limited data indicate that its use in nursing mothers in appropriately adjusted doses does not affect the breastfed infant. If calcitriol is required by the mother, it is not a reason to discontinue breastfeeding. Calcitriol and calcium dosage requirements are usually reduced during lactation in women with hypoparathyroidism. The American Academy of Pediatrics recommends the administration of a minimum of 400 IU of vitamin D daily to all infants, children and adolescents.
  • Canagliflozin and breast feeding No information is available on the clinical use of canagliflozin during breastfeeding. Canagliflozin is is an uncharged molecule that is 99% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. The manufacturer does not recommend canagliflozin during breastfeeding because of a theoretical risk to the infant's developing kidney. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Candesartan and breast feeding Because no information is available on the use of candesartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Cannabidiol and breast feeding Cannabidiol is a component of cannabis. Cannabidiol has not been studied in nursing women taking the pharmaceutical product, but it has been detected in the breastmilk of some mothers who used cannabis products. Because no published information is available with cannabidiol use as an antiepileptic during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Capecitabine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; the manufacturer recommends an abstinence period of 2 weeks. Capecitabine is metabolized to fluorouracil. Limited information indicates that a maternal continuous intravenous fluorouracil infusion at a dose of 200 mg/square meter daily produces undetectable levels in milk. If capecitabine use is undertaken, monitoring of the infant's complete blood count and differential is advisable. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Caplacizumab and breast feeding No information is available on the clinical use of caplacizumab during breastfeeding. Because caplacizumab is a large protein molecule with a molecular weight of about 28,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, caplacizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Capreomycin and breast feeding Developmental problems have been reported in two infants exposed to capreomycin in breastmilk; however, their mothers were also exposed to several drugs during pregnancy and during breastfeeding, so the problems cannot necessarily be attributed to capreomycin. Because capreomycin is not orally absorbed it is unlikely to adversely affect the breastfed infant.
  • Captopril and breast feeding Because of the low levels of captopril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Carbachol and breast feeding No information is available on the use of carbachol ophthalmic drops during breastfeeding. Because of its short half-life, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants.
  • Carbamide Peroxide and breast feeding Carbamide (urea) peroxide has not been studied during breastfeeding. It is unlikely that carbamide peroxide found in ear drops or teeth whiteners is absorbed into the bloodstream. However, if any carbamide peroxide were absorbed, it would be broken down to urea and hydrogen peroxide, both of which are found normally in human milk. If carbamide peroxide is used by the mother according to directions, it is not a reason to discontinue breastfeeding and no special precautions are required.
  • Carbenicillin Indanyl Disodium and breast feeding Limited information indicates that carbenicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Carbenicillin indanyl disodium is acceptable in nursing mothers.
  • Carbinoxamine and breast feeding Small occasional doses of carbinoxamine are probably acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Carbon- 11 and breast feeding Information in this record refers to the use of carbon 11 radiopharmaceuticals as diagnostic agents. The International Commission on Radiological Protection also recommends that breastfeeding need not be interrupted after administration of radiopharmaceuticals containing carbon-11.
  • Carboplatin and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as carboplatin. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence, but the duration of abstinence is not clear. In one case, carboplatin was still detectable in milk 13 days after a dose of 2.9 mg/kg. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Carfilzomib and breast feeding No information is available on the clinical use of carfilzomib during breastfeeding. Because carfilzomib is 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during carfilzomib therapy.
  • Cariprazine and breast feeding No information is available on the use of cariprazine during breastfeeding. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Carisoprodol and breast feeding If carisoprodol is required by the mother, it is not necessarily a reason to discontinue breastfeeding. Slight sedation has occurred in a breastfed newborn infant who was exposed during pregnancy and lactation; sedation might be more pronounced in newborns who are exposed for the first time during nursing. Other agents may be preferred, especially while nursing a newborn or preterm infant, or when other drugs that can cause sedation are used simultaneously.
  • Carmustine and breast feeding No information is available on the use of carmustine during breastfeeding. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as carmustine. The manufacturer recommends that breastfeeding be discontinued during carmustine therapy and for 1 month after the last dose.
  • Carrot and breast feeding Carrots (Daucus carota) contain alpha- and beta-carotene. A poultice of raw carrots applied to the breast has been used to treat uncomplicated breast engorgement during breastfeeding; however, as with topical cabbage leaves, evidence of efficacy is lacking because engorgement tends to improve over time regardless of treatment. Both beta-carotene and carrot flavor are transmitted into breastmilk. Carrot intake can improve maternal and breastmilk beta-carotene and vitamin A status, but excessive maternal intake of carrots can lead to a harmless, reversible discoloration of the breastfed infant's skin. Exposure to carrot flavor in breastmilk can improve the future acceptance of carrots by the infant.
  • Carvedilol and breast feeding Based on its physicochemical properties, carvedilol appears to present a low-risk to the breastfed infant. Because there is no published experience with carvedilol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Caspofungin and breast feeding No information is available on the clinical use of caspofungin during breastfeeding. Caspofungin is indicated for use in infants over 3 months of age and it is poorly absorbed orally, so it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. However, no published experience exists with caspofungin during breastfeeding, therefore an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Cefaclor and breast feeding Limited information indicates that maternal cefaclor produces low levels in milk which are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefaclor is acceptable in nursing mothers.
  • Cefadroxil and breast feeding Limited information indicates that cefadroxil produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefadroxil is acceptable in nursing mothers.
  • Cefazolin and breast feeding Limited information indicates cefazolin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefazolin is acceptable in nursing mothers.
  • Cefdinir and breast feeding Although no information is available on the use of cefdinir during breastfeeding, cephalosporins are generally not be expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefdinir is acceptable in nursing mothers.
  • Cefditoren and breast feeding Although no information is available on the use of cefditoren during breastfeeding, cephalosporins are generally not be expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefditoren is acceptable in nursing mothers.
  • Cefepime and breast feeding Although no information is available on the use of cefepime during breastfeeding, the levels in breastmilk appear to be low and cephalosporins are generally not be expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefepime is acceptable in nursing mothers.
  • Cefixime and breast feeding Although no information is available on the use of cefixime during breastfeeding, cephalosporins are generally not be expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefixime is acceptable in nursing mothers.
  • Cefoperazone and breast feeding Limited information indicates cefoperazone produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefoperazone is acceptable in nursing mothers.
  • Cefotaxime and breast feeding Limited information indicates that cefotaxime produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefotaxime is acceptable in nursing mothers.
  • Cefotetan and breast feeding A moderate amount of information indicates that cefotetan produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefotetan is acceptable in nursing mothers.
  • Cefoxitin and breast feeding Substantial information indicates that cefoxitin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefoxitin is acceptable in nursing mothers.
  • Cefpodoxime and breast feeding Limited information indicates that cefpodoxime produces low levels in milk and is not be expected to cause any adverse effects in breastfed infants.. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefpodoxime is acceptable in nursing mothers.
  • Cefprozil and breast feeding Limited information indicates that cefprozil produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefprozil is acceptable in nursing mothers.
  • Ceftaroline and breast feeding Although no information is available on the use of ceftaroline during breastfeeding, cephalosporins are generally not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftaroline is acceptable in nursing mothers.
  • Ceftazidime and Avibactam and breast feeding Limited information indicates that ceftazidime produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Avibactam has not been studied in nursing mothers. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftazidime-avibactam is acceptable in nursing mothers.
  • Ceftazidime and breast feeding Limited information indicates that ceftazidime produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftazidime and is acceptable in nursing mothers.
  • Ceftibuten and breast feeding Limited information indicates that ceftibuten produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftibuten is acceptable in nursing mothers.
  • Ceftizoxime and breast feeding Limited information indicates that ceftizoxime produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftizoxime is acceptable in nursing mothers.
  • Ceftolozane and Tazobactam and breast feeding No information is available on the clinical use of ceftolozane-tazobactam during breastfeeding. No serious adverse effects have been reported for other cephalosporin antibiotics during breastfeeding. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftolozane-tazobactam is acceptable in nursing mothers.
  • Ceftriaxone and breast feeding Limited information indicates that ceftriaxones produce low levels in milk which are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Ceftriaxone is acceptable in nursing mothers.
  • Cefuroxime and breast feeding Limited information indicates that cefuroxime produces low levels in milk that are not expected to cause severe adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. Cefuroxime is acceptable in nursing mothers.
  • Celecoxib and breast feeding Because of the low levels of celecoxib in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Cellulose and Citric Acid and breast feeding No data are available on cellulose and citric acid use during breastfeeding. However, the drug is not absorbed from the gastrointestinal tract, so it cannot enter the breastmilk. Cellulose and citric acid is acceptable to use during breastfeeding.
  • Cenegermin and breast feeding Because cenegermin is a large protein molecule with a molecular weight of 13,266, and absorption from the eye is limited, the amount in milk is likely to be very low and oral absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue. Ophthalmic cenegermin is not expected to cause any adverse effects in breastfed infants.
  • Centruroides (Scorpion) Immune F(ab\')2 and breast feeding No information is available on the clinical use of centruroides (scorpion) immune f(ab')2 (equine) during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Cephalexin and breast feeding Limited information indicates that maternal cephalexin produces low levels in milk that are usually not expected to cause adverse effects in breastfed infants. Cephalexin is an alternative for the treatment of mastitis. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. A rare case of a severe allergic reaction occurred in an infant previously exposed to intravenous cefazolin whose mother began taking cephalexin whie breastfeeding. Cephalexin is acceptable in nursing mothers.
  • Cephradine and breast feeding Limited information indicates cephradine produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with cephalosporins, but these effects have not been adequately evaluated. cephradine is acceptable in nursing mothers.
  • Ceritinib and breast feeding No information is available on the clinical use of ceritinib during breastfeeding. Because ceritinib is 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during ceritinib therapy and for 2 weeks after the final dose.
  • Certolizumab Pegol and breast feeding Certolizumab is excreted into breastmilk in some, but not all, women in small amounts. Absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Most experts consider certolizumab to be probably safe during breastfeeding. The European Medicines Agency has deemed certolizumab pegol acceptable to use during breastfeeding.
  • Cetuximab and breast feeding No information is available on the clinical use of cetuximab during breastfeeding. Because cetuximab is a large protein molecule with a molecular weight of 145,782, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, cetuximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during cetuximab therapy and for 2 months after the last dose.
  • Chelonitoxin Poisoning and breast feeding Chelonitoxism is caused by eating sea turtle meat contaminated with chelonitoxins, which are thought to accumulate from the environment without affecting the turtle. Initially, gastrointestinal symptoms occur, followed by neurologic, hepatic and renal toxicity. Breastfed infants have been affected by maternal poisoning, including some deaths. Mothers suspected of having chelonitoxin poisoning should not breastfeed until they have recovered.
  • Chloral Hydrate and breast feeding Short-term or occasional use of chloral hydrate during breastfeeding is unlikely to adversely affect the breastfed infant, especially if the infant is older than 2 months. Because the active metabolite of chloral hydrate has a long half-life, other sedative-hypnotics are preferred for long-term use during breastfeeding, especially while nursing a neonate or preterm infant. Monitor the infant for excessive drowsiness.
  • Chloramphenicol and breast feeding Adverse reactions such as vomiting, excessive intestinal gas and falling asleep at the breast have been reported in breastfed infants whose mothers were taking oral chloramphenicol. Milk concentrations are not sufficient to induce "gray baby" syndrome, but since chloramphenicol-induced aplastic anemia is not dose-related, this might occur, but has not been reported. An alternate drug is preferred to chloramphenicol during breastfeeding, especially while nursing a newborn or preterm infant. If the mother must receive chloramphenicol during nursing, monitor the infant for gastrointestinal disturbances and adequacy of nursing. Monitoring of the infant's complete blood count and differential is advisable. In some cases, discontinuation of breastfeeding might be preferred.
  • Chlordiazepoxide and breast feeding No information is available on the use of chlordiazepoxide during breastfeeding. Because the drug and metabolites could accumulate in the breastfed infant, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Chlorhexidine and breast feeding Chlorhexidine has been used vaginally or topically on the abdomen or perineum prior to delivery to prevent infection. No toxicity has been reported in breastfed infants and it has clearly less toxicity compared to povidone-iodine in these situations. Topical application of chlorhexidine to the breast before and after nursing did not appear to adversely affect the breastfed infants in one study. Use of chlorhexidine oral rinse by a nursing mother is unlikely to adversely affect her infant.
  • Chloroprocaine and breast feeding No information is available on the use of chloroprocaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk and the extremely short half-life of chloroprocaine, it is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Chloroquine and breast feeding Very small amounts of chloroquine are excreted in breast milk; when given once weekly, the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. United Kingdom malaria treatment guidelines recommend that weekly chloroquine 500 mg be given until breastfeeding is completed and primaquine can be given. Breastfeeding infants should receive the recommended dosages of chloroquine for malaria prophylaxis. In HIV-infected women, elevated viral HIV loads in milk were decreased after treatment with chloroquine to a greater extent than other women who were treated with the combination of sulfadoxine and pyrimethamine. Because no information is available on the daily use of chloroquine during breastfeeding, hydroxychloroquine or another agent may be preferred in this situation, especially while nursing a newborn or preterm infant.
  • Chlorothiazide and breast feeding Low-dose chlorothiazide appears to be acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production.
  • Chlorpheniramine and breast feeding Small (2 to 4 mg), occasional doses of chlorpheniramine are acceptable during breastfeeding. Larger doses or more prolonged use might cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as spseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives, though.
  • Chlorpromazine and breast feeding Chlorpromazine is detectable in the milk of some mothers during therapy, but levels appear not to correlate well with the maternal dose or serum level. Some breastfed infants become drowsy during maternal chlorpromazine therapy. Very limited long-term follow-up data indicate no adverse developmental effects when the drug is used alone. However, using it in combination with haloperidol can negatively affect development. Monitor the infant for excessive drowsiness during breastfeeding and for developmental milestones, especially if other antipsychotics are used concurrently.
  • Chlorpropamide and breast feeding Limited data indicate that amounts of chlorpropamide in breastmilk are unlikely to affect a breastfed infant. Short-acting drugs are generally preferred while breastfeeding a neonate to avoid drug accumulation. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Chlorthalidone and breast feeding Although amounts of chlorthalidone in milk are not great, its slow clearance may lead to accumulation in the infant, especially while nursing a newborn or preterm infant. It may also suppress lactation. An alternate drug may be preferred.
  • Chocolate and breast feeding Chocolate contains small amounts of caffeine and larger amounts of the closely related compound, theobromine. It also contains anandamide and two related compounds that stimulate cannabinoid receptors, tryptophan, and polyphenols. All of these compounds are detectable in breastmilk in small amounts. Low intake of chocolate by a nursing mother is not problematic, but extreme amounts can affect the infant.
  • Cholera Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to cholera vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Cholestyramine and breast feeding Cholestyramine is a nonabsorbable resin. Because it does not enter the mother's bloodstream, it will not reach the infant via breastmilk. It is acceptable for use during lactation.
  • Choline Magnesium Salicylate and breast feeding Choline magnesium salicylate has not been studied during breastfeeding, but choline magnesium salicylate results in salicylic acid in the blood. Salicylic acid and aspirin have been studied during breastfeeding. The excretion of salicylate into breastmilk increases disproportionately as the maternal dosage increases. Long-term, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. Reye's syndrome is associated with aspirin administration to infants with viral infections, but the risk of Reye's syndrome from salicylate in breastmilk is unknown. An alternate drug is preferred over choline magnesium salicylate.
  • Ciclesonide and breast feeding Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled corticosteroids acceptable to use during breastfeeding.
  • Ciclopirox and breast feeding Topical ciclopirox has not been studied during breastfeeding. Because only about 1.3% is absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Ciguatera Poisoning and breast feeding Ciguatera toxin is created in tropical reef-dwelling fish that ingest toxins from algal blooms produced by the dinoflagellate Gambierdiscus toxicus. The main toxin appears to be ciguatoxin, although maitotoxin has also been implicated. Ciguatera can present initially with gastrointestinal or neurological symptoms, such as paresthesias of the extremities and around the mouth. Although the fatality rate is low, neurologic effects can last for weeks. Mothers suspected of having ciguatera poisoning should not breastfeed until they have recovered.
  • Cilostazol and breast feeding Because no information is available on the use of cilostazol during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Cimetidine and breast feeding Limited information indicates that maternal cimetidine results in infant dosages much less than those given directly to neonates. Cimetidine would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. However, because of its potential for causing hepatic enzyme inhibition, other drugs might be preferred.
  • Cinnarizine and breast feeding Cinnarizine is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. No information is available on the use of cinnarizine during breastfeeding. Expert opinion recommends that cinnarizine not be used in migraine prophylaxis. An alternate drug is preferred, especially while nursing a newborn or preterm infant.
  • Cisapride and breast feeding Cisapride was removed from the market in the United States by the U.S. Food and Drug Administration because of cardiac toxicity. Because of the low levels of cisapride in breastmilk, its use is acceptable in nursing mothers if it is required.
  • Cisatracurium and breast feeding No information is available on the use of cisatracurium during breastfeeding. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Cisplatin and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as cisplatin. Excretion of platinum into milk occurs, but results from 3 cases are inconsistent. The exact form and toxicity of platinum excreted into breastmilk are also not known. The nursing infant would receive any platinum compounds orally rather than intravenously and oral absorption of oral platinum compounds by infants is not known. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Citalopram and breast feeding Infants receive citalopram in breastmilk and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to a year. Infants exposed in utero can have withdrawal effects postpartum despite breastfeeding and continued maternal citalopram use. If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding. Otherwise, agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. The breastfed infant should be monitored for behavioral side effects such as sedation or fussiness. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state. These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.
  • Citriodiol and breast feeding No published information is available on the clinical use of citriodiol (para-menthanediol; oil of lemon eucalyptus) during breastfeeding. However, the Centers for Disease Control and Prevention and U.S. Environmental Protection Agency consider citriodiol to be safe and effective during breastfeeding when used as directed. It should be used by breastfeeding women to avoid exposure to mosquito-borne viruses. Avoid application directly to the nipple and other areas where the infant might directly ingest the product.
  • Cladribine and breast feeding Because there is no published experience with cladribine during breastfeeding, it should be avoided during breastfeeding, especially while nursing a newborn or preterm infant. One group of authors recommends withholding breastfeeding for at 48 hours after a dose and longer in patients with impaired kidney function. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Clarithromycin and breast feeding Because of the low levels of clarithromycin in breastmilk and safe administration directly to infants, it is acceptable in nursing mothers. The small amounts in milk are unlikely to cause adverse effects in the infant. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). Unconfirmed epidemiologic evidence indicates that the risk of infantile hypertrophic pyloric stenosis might be increased by maternal use of macrolide antibiotics during the first two weeks of breastfeeding, but others have questioned this relationship.
  • Clemastine and breast feeding Small occasional doses of clemastine are acceptable during breastfeeding. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
  • Clobazam and breast feeding Limited information indicates that maternal doses of clobazam up to 30 mg daily produce low levels in milk. Short-term use would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. During long-term administration, monitor the infant for possible sedation and poor sucking and weight gain.
  • Clobetasol and breast feeding Clobetasol has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin; clobetasol should be avoided on the nipple. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Clocortolone Pivalate and breast feeding Topical clocortolone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Clofazimine and breast feeding Limited information indicates that clofazimine appears in milk in relatively large amounts. Milk can be colored pink by the drug and breastfed infant's skin can be discolored the typical red color that is common in persons taking the drug. No serious or permanent toxicity has been reported in breastfed infants; however, an alternate drug might be considered.
  • Clomiphene and breast feeding Clomiphene has not been studied during breastfeeding, but several studies found that it suppresses lactation in women who did not want to breastfeed. It appears to act by lowering serum prolactin, especially the post-stimulation surge in serum prolactin. It is likely that clomiphene would interfere with lactation in a nursing mother.
  • Clomipramine and breast feeding Limited evidence indicates that use of clomipramine during breastfeeding is acceptable. For women who were taking clomipramine during pregnancy, the amount of drug in breastmilk may be insufficient to prevent neonatal withdrawal symptoms in breastfed infants. For use as an antidepressant, clomipramine may be less desirable than other antidepressants that have been studied more thoroughly.
  • Clonazepam and breast feeding Maternal clonazepam occasionally causes sedation in their breastfed infants, especially when given with other central nervous system depressants. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant's serum concentration may be indicated if excessive sedation occurs. Because it has a long half-life, a safer, shorter-acting drug should be used as rather than clonazepam. An expert consensus guideline indicates that low-dose clonazepam is an acceptable choice for refractory restless leg syndrome during lactation.
  • Clonidine and breast feeding Because of the high serum levels found in breastfed infants, possible infant side effects, and the possible negative effects on lactation, other antihypertensive agents are preferred, especially while nursing a newborn or preterm infant. Clonidine used as a single postpartum dose as a neuraxial analgesia adjunct probably has not been studied, but it may reduce the need for other medications or their dosages, and appears unlikely to affect breastfeeding.
  • Clopidogrel and breast feeding No published information is available on the use of clopidogrel during breastfeeding. The manufacturer reports that no adverse effects have been observed in breastfed infants with maternal clopidogrel use during lactation in a small number of postmarketing cases. Since no published information is available on the use of clopidogrel during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Clorazepate and breast feeding Clorazepate is excreted into breastmilk and appears to accumulate in the serum of breastfed infants. Because the half-life of clorazepate and its active metabolite are long, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Clotrimazole and breast feeding Because clotrimazole has poor oral bioavailability, it is unlikely to adversely affect the breastfed infant, including topical application to the nipples. It has been used orally in infants with thrush, sometimes successfully after nystatin has failed. Any excess cream or ointment should be removed from the nipples before nursing. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Cloxacillin and breast feeding Limited information indicates that cloxacillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Cloxacillin is acceptable in nursing mothers.
  • Clozapine and breast feeding Because there is little published experience with clozapine during breastfeeding, and sedation and adverse hematologic effects have been reported in breastfed infants, other agents are preferred. If breastfeeding is undertaken by a mother who is taking clozapine, close monitoring of the infant for excessive sedation and periodic monitoring of the infant's white blood cell count is advisable. Several authoritative sources recommend that women taking clozapine not breastfeed.
  • Coagulation Factor IX and breast feeding No information is available on the clinical use of coagulation factor IX during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, coagulation factor IX should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Coagulation Factor X and breast feeding No information is available on the clinical use of coagulation factor X during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, coagulation factor X should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Coal Tar and breast feeding Coal tar applied topically to maternal skin can result in pyrene absorption by the infant, probably by skin-to-skin or skin-to-mouth contact with the mother. Because of the potential toxicity of coal tar to the breastfed infant, alternate drugs are preferred. If a coal tar product is used, it would be prudent to treat the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated.
  • Cobimetinib and breast feeding No information is available on the clinical use of cobimetinib during breastfeeding. Because cobimetinib is 90% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 44 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during cobimetinib therapy and for 2 weeks after the last dose.
  • Codeine and breast feeding Maternal use of codeine during breastfeeding can cause infant drowsiness, central nervous system depression and even death, with pharmacogenetics possibly playing a role. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral codeine to 2-4 days at a low dosage with close infant monitoring, especially in the outpatient setting. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Excessive sedation in the mother often correlates with excess sedation in the breastfed infant. Following these precautions can lower the risk of neonatal sedation. Numerous professional organizations and regulatory agencies recommend that other agents are preferred over codeine or to avoid codeine completely during breastfeeding; however, other opioid alternatives have been studied less and may not be safer.
  • Colchicine and breast feeding Long-term prophylactic maternal doses of colchicine up to 1.5 mg daily produce levels in milk that result in the infant receiving less than 10% of the maternal weight-adjusted dosage. The highest milk levels occur 2 to 4 hours after a dose, so avoiding breastfeeding during this time can minimize the infant dose, although some clinicians simply recommend taking the drug after nursing. No adverse effects in breastfed infants have been reported in case series and a case-control study and some authors consider colchicine safe during breastfeeding in women being treated for familial Mediterranean fever or rheumatic conditions.
  • Colesevelam and breast feeding Colesevelam is a nonabsorbable resin. Because it does not enter the mother's bloodstream, it will not reach the infant via breastmilk. It is acceptable for use during lactation.
  • Colestipol and breast feeding Colestipol is a nonabsorbable resin. Because it does not enter the mother's bloodstream, it will not reach the infant via breastmilk. It is acceptable for use during lactation.
  • Colistimethate and breast feeding Limited data indicate that colistin is minimally excreted into breastmilk following intramuscular administration of colistimethate. Because colistin is poorly absorbed orally, it is unlikely to be absorbed in appreciable amounts by the infant or adversely affect the breastfed infant. However, no studies have evaluated serum levels or adverse effects in breastfed infants whose mothers were receiving colistimethate. Breastfeeding is acceptable with the use of inhaled colistin or colistimethate.
  • Copanlisib and breast feeding No information is available on the clinical use of copanlisib during breastfeeding. Because copanlisib's half-life is about 39 hours, it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during copanlisib therapy and for 1 month after the last dose.
  • Corticotropin and breast feeding No information is available on the clinical use of corticotropin during breastfeeding. It is unlikely to appear in breastmilk and because it is has a molecular weight of 4540 and a half-life of only 10 to 15 minutes. Absorption by the infant is unlikely because it would probably be destroyed in the infant's gastrointestinal tract. Based on animal data, an increase in breastmilk cortisol levels might be expected after administration of corticotropin to a nursing mother.
  • Creatine and breast feeding Creatine is used as a dietary supplement to increase muscle mass and improve exercise performance. Although creatine is a normal component of human milk, milk levels of creatine have not been measured after exogenous administration in humans. Creatine is converted into creatinine in the mother's and infant's bodies. It may increase the infant's serum creatinine, which may alter estimations of the infant's kidney function. Some authors speculate that creatine supplementation of nursing mothers might help avoid creatine deficiency syndromes, but no studies are available that test this hypothesis. Until more data are available, it is probably best to avoid creatine supplementation unless it is prescribed by a healthcare professional.
  • Crizotinib and breast feeding No information is available on the clinical use of crizotinib during breastfeeding. Because crizotinib is 91% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 42 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during crizotinib therapy and for 45 days after the last dose.
  • Cromolyn and breast feeding Although no published data exist on the use of cromolyn during lactation, maternal milk levels are likely to be very low and it is expected to be poorly absorbed from the infant's gastrointestinal tract. An expert panel considers use of cromolyn to be acceptable during breastfeeding.
  • Crotalidae Polyvalent Immune Fab and breast feeding No information is available on the clinical use of crotalidae polyvalent immune fab (ovine) during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Cyclizine and breast feeding Occasional doses of cyclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.
  • Cyclobenzaprine and breast feeding Amounts of cyclobenzaprine in milk appear to be very small and two infants apparently tolerated the drug in milk well. If cyclobenzaprine is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for (drowsiness, adequate weight gain, and developmental milestones), especially in neonates and preterm infants and when using combinations of sedating drugs.
  • Cyclopentolate and breast feeding No information is available on the use of cyclopentolate during breastfeeding. Anticholinergic drugs might interfere with breastfeeding. A single dose of ophthalmic cyclopentolate is not likely to interfere with breastfeeding; however, during long-term use, observe the infant for signs of decreased lactation (e.g., insatiety, poor weight gain). To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Cyclophosphamide and breast feeding Cyclophosphamide appears in milk in potentially toxic amounts; additionally, highly toxic active metabolites could add to the risk to the infant. Neutropenia has been reported in 2 infants whose mothers breastfed them while receiving cyclophosphamide. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant. Most sources consider breastfeeding to be contraindicated during maternal cytotoxic antineoplastic drug therapy, especially alkylating agents such as cyclophosphamide.
  • Cycloserine and breast feeding Limited information from an old study indicates that maternal doses of cycloserine of 1 gram daily produce moderate levels in milk. If cycloserine is required by the mother, it is not a reason to discontinue breastfeeding, especially if the infant is older than 2 months. Exclusively breastfed infants should be monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
  • Cyproheptadine and breast feeding Unless it is intentionally being used to lower maternal serum prolactin levels, cyproheptadine should be avoided during lactation because it may interfere with lactation, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.

Table of contents:

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D

  • Dabigatran and breast feeding Preliminary data from 2 individuals indicate that dabigatran is poorly excreted into breastmilk. However, because it is orally absorbable and no information is available on the effet in breastfed infants, an alternate drug is preferred while nursing a newborn or preterm infant.
  • Dabrafenib and breast feeding No information is available on the clinical use of dabrafenib during breastfeeding. Because dabrafenib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during dabrafenib therapy and for 2 weeks after the last dose.
  • Dacarbazine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as dacarbazine. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, no data are available to determine an appropriate period to withhold breastfeeding. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Daclizumab and breast feeding No information is available on the clinical use of daclizumab during breastfeeding. Because daclizumab is a large protein molecule with a molecular weight of about 144,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, daclizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. Some authors recommend avoiding breastfeeding with daclizumab.
  • Dacomitinib and breast feeding No information is available on the clinical use of dacomitinib during breastfeeding. Because dacomitinib is 98% bound to plasma proteins, the amount in milk is likely to be low. However, because of its potential toxicity in the breastfed infant and its half-life of 70 hours, the manufacturer recommends that breastfeeding be discontinued during dacomitinib therapy and for at least 17 days after the last dose.
  • Dactinomycin and breast feeding No information is available on the use of dactinomycin during breastfeeding. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. The manufacturer recommends that breastfeeding be discontinued during dactinomycin therapy and for 14 days after the last dose.
  • Dalbavancin and breast feeding Because dalbavancin is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal tract, such as diarrhea, vomiting, and candidiasis (e.g., thrush, diaper rash). However, because there is no published experience with dalbavancin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Dalfampridine and breast feeding Because no information is available on the use of dalfampridine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Dalteparin and breast feeding Because of the low levels of dalteparin in breastmilk and its large molecular weight of 2000 to 9000 daltons, amounts ingested by the infant are small and it would not be expected to be absorbed from breastmilk by the infant. No special precautions are required.
  • Dantrolene and breast feeding Because no information is available on the long-term use of dantrolene during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. After short-term use, the drug would be expected to be eliminated from milk in 1 to 2 days.
  • Dapagliflozin and breast feeding No information is available on the clinical use of dapagliflozin during breastfeeding. Dapagliflozin is an uncharged molecule that is 91% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. The manufacturer does not recommend dapagliflozin during breastfeeding because of a theoretical risk to the infant's developing kidney. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Daptomycin and breast feeding Limited and somewhat inconsistent information indicates that daptomycin produces very low levels in milk and it would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Darbepoetin and breast feeding The excretion of darbepoetin alfa in breastmilk or its effects on breastfed infants have not been studied. However, erythropoietin is a normal component of human milk and darbepoetin is immunologically and biologically indistinguishable from native erythropoietin. Intravenous darbepoetin has been given safely to newborn infants in doses much larger than those expected to appear in breastmilk. No special precautions are required during breastfeeding.
  • Darunavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of darunavir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Dasatinib and breast feeding Although one breastfed infants apparently experienced no adverse effects during maternal use of dasatinib, no long-term data are available. Because dasatinib and its metabolite are more than 90% bound to plasma proteins, the amounts in milk are likely to be low. However, there is little published experience with dasatinib during breastfeeding, and an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during dasatinib therapy and for 2 weeks after the last dose.
  • Deep Brain Stimulation and breast feeding Evidence from a few mothers who received deep brain stimulation indicated that no difficulty was encountered with lactation, other than minor discomfort with chest neurostimulators.
  • Deferasirox and breast feeding Deferasirox appears to pass into milk very poorly. Although Australian guidelines recommend against breastfeeding during deferasirox treatment, these were published before a case report of an infant being safely breastfed by a mother with beta-thalassemia receiving deferasirox and finding of no drug in breastmilk. However, since little published information is available on the use of deferasirox during breastfeeding, monitoring of the infant's serum iron is recommended.
  • Deferiprone and breast feeding Because no information is available on the use of deferiprone during breastfeeding and it is orally absorbed, an alternate drug is preferred, especially while nursing a newborn or preterm infant. Australian guidelines recommend against breastfeeding during deferiprone treatment.
  • Deferoxamine and breast feeding Deferoxamine is poorly absorbed orally, so it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Limited information indicates that maternal doses of deferoxamine up to 2 grams daily do not affect iron levels in breastmilk and did not cause any adverse effects in two breastfed infants. Some experts advocate breastfeeding in women receiving deferoxamine for iron overload caused by beta-thalassemia. However, since little published information is available on the use of deferoxamine during breastfeeding, monitoring of the infant's serum iron is recommended.
  • Deflazacort and breast feeding Because no information is available on the use of deflazacort during breastfeeding, an alternate corticosteroid may be preferred, especially while nursing a newborn or preterm infant.
  • Delafloxacin and breast feeding No information is available on the use of delafloxacin during breastfeeding. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of delafloxacin is acceptable in nursing mothers. However, it is preferable to use an alternate drug for which safety information is available.
  • Delavirdine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, exclusive breastfeeding for 6 months is recommended for HIV-infected mothers to reduce the risk of HIV transmission from the mother to the infant compared with mixed feeding. In these settings, abrupt weaning at 4 months does not reduce the risk of HIV transmission or produce an overall health benefit compared to continued breastfeeding, and increases the risk of infant death in HIV-infected infants. Extended antiretroviral prophylaxis in breastfed infants with antiretroviral drugs appears to reduce the rate of HIV transmission during breastfeeding by about half, but the optimal regimen and duration of prophylaxis has not yet been defined. Because there is little published experience with delavirdine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Demeclocycline and breast feeding A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of demeclocycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of demeclocycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Dengue Tetravalent Vaccine, Live and breast feeding Dengue vaccine is a live, attenuated vaccine indicated for children up to 16 years of age. No information is available on the clinical use of dengue vaccine during breastfeeding. However, the viruses were not detected in the milk of rats given the vaccine. If dengue vaccine is required by the mother, it is not a reason to discontinue breastfeeding.
  • Desflurane and breast feeding There is no published experience with desflurane during breastfeeding. Because the serum half-life of desflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. It is possible that requirements for other anesthetic agents would be affected similarly.
  • Desipramine and breast feeding Milk levels of desipramine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Desipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Desirudin and breast feeding Desirudin is no longer marketed in the United States. Because no information is available on the use of desirudin during breastfeeding, an alternate drug is preferred.
  • Desloratadine and breast feeding Because of its expected low milk levels and lack of sedation and anticholinergic effects, maternal use of desloratadine is unlikely to affect a breastfed infant or milk production. Desloratadine might have a negative effect on lactation in combination with a sympathomimetic agent such as pseudoephedrine.
  • Desmopressin and breast feeding Desmopressin from a nasal spray is excreted in negligible amounts into milk and is poorly absorbed orally by the infant, so it appears acceptable to use during breastfeeding. There is no published experience with sublingual desmopressin during breastfeeding. Until more data become available, sublingual desmopressin should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Desogestrel and breast feeding Desogestrel is only available in the United States in combination oral contraceptive products containing 150 mcg of desogestrel and 30 mcg of ethinyl estradiol. Based on the available evidence, expert opinion holds that nonhormonal methods are preferred during breastfeeding and progestin-only contraceptive are preferred over combined oral contraceptives in breastfeeding women, especially during the first 4 weeks postpartum. For further information, consult the record entitled, "Contraceptives, Oral, Combined."
  • Desonide and breast feeding Desonide has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Desonide cream or foam are acceptable to use on the nipple. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Desoximetasone and breast feeding Desoximetasone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Desvenlafaxine and breast feeding Modest doses of desvenlafaxine are excreted into breastmilk, but serum drug levels of breastfed infants are less than 10% of simultaneous maternal levels. Total drug exposure of breastfed infants is about half of that experienced by breastfed infants whose mothers are taking venlafaxine. Breastfed infants, especially newborn or preterm infants, should be monitored for excessive sedation and adequate weight gain if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern. With the related drug venlafaxine, newborn infants of mothers who took the drug during pregnancy sometimes experienced poor neonatal adaptation as seen with other antidepressants such as SSRIs or SNRIs. Similar effects may occur with desvenlafaxine.
  • Dexamethasone and breast feeding Because no information is available on the use of systemic dexamethasone during breastfeeding, an alternate corticosteroid may be preferred, especially while nursing a newborn or preterm infant. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply.
  • Dexbrompheniramine and breast feeding Small, occasional doses of dexbrompheniramine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
  • Dexchlorpheniramine and breast feeding Small, occasional doses of dexchlorpheniramine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use might cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
  • Dexmedetomidine and breast feeding Limited data indicate that very small amounts of dexmedetomidine are excreted into breastmilk for 6 hours after the end of an infusion. Because of the small amounts of colostrum secreted in the first day postpartum, the dose received by a neonate is unlikely to be of any consequence when the drug is used during delivery. The drug is absent from breastmilk by 24 hours after the end of an infusion. Dexmedetomidine would not be expected to cause adverse effects in breastfed infants or neonates.
  • Dexrazoxane and breast feeding No information is available on the use of dexrazoxane during breastfeeding. The manufacturer recommends that women not breastfeed during treatment and for 2 weeks following the final dose of dexrazoxane. However, because dexrazoxane is used with doxorubicin, the abstinence period might be longer, depending on the doxorubicin dose.
  • Dextroamphetamine and breast feeding In dosages prescribed for medical indications, some evidence indicates that dextroamphetamine might not affect nursing infants adversely. The effect of dextroamphetamine in milk on the neurological development of the infant has not been well studied. It is possible that large dosages of dextroamphetamine might interfere with milk production, especially in women whose lactation is not well established. Relevant published information was not found as of the revision date on the safety of breastfeeding during amphetamine abuse. One expert recommends that amphetamines not be used therapeutically in nursing mothers.
  • Dextromethorphan and breast feeding Neither the excretion of dextromethorphan in milk nor its effect on breastfed infants have been studied. It is unlikely that with usual maternal doses amounts in breastmilk would harm the nursing infant, especially in infants over 2 months of age. It is best to avoid the use of products with a high alcohol content while nursing.
  • Dialysis and breast feeding There appear to be no contraindications to breastfeeding by mothers who are on dialysis, although there are few reported cases. Analysis of breastmilk indicates that the predialysis milk concentrations of some solutes are abnormal. Authors who managed one patient suggest that breastfeeding after hemodialysis might be preferable to breastfeeding before hemodialysis and milk pumped just before dialysis should be discarded.
  • Diatrizoate and breast feeding Limited information indicates that maternal doses of diatrizoate up to 38 g (containing 18.5 grams of iodine) produce low levels in milk. In addition, because diatrizoate is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium.
  • Dibucaine and breast feeding Topical dibucaine has not been studied during breastfeeding, but is unlikely to affect her breastfed infant if it is applied away from the breast. However, dibucaine ointment should not be applied to the nipple area. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Dichloralphenazone and breast feeding Short-term or occasional use of dichloralphenazone during breastfeeding is unlikely to adversely affect the breastfed infant, especially if the infant is older than 2 months. Because the active metabolite, trichloroethanol, has a long half-life, long-term use of repeated doses during breastfeeding could result in infant sedation, especially while nursing a neonate or preterm infant. The low doses of dichloralphenazone found in combination migraine products (e.g., Midrin) are less likely to cause drowsiness in the infant unless doses are repeated several times daily. The antipyrine component of dichloralphenazone is considered unlikely to harm the infant. Monitor the infant for excessive drowsiness during use.
  • Dicloxacillin and breast feeding Limited information indicates that dicloxacillin levels in milk are low and are not expected to cause adverse effects in breastfed infants. It is frequently used to treat mastitis in nursing mothers. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Dicloxacillin is acceptable in nursing mothers.
  • Dicyclomine and breast feeding Dicyclomine has not been well studied during breastfeeding. However, one possible case of apnea has been reported in a breastfed infant that is similar to reactions that have occurred in infants given the drug directly. Dicyclomine should not be used during lactation.
  • Didanosine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of didanosine during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Dienogest and breast feeding Dienogest is only available in the United States in a combination oral contraceptive product that also contains estradiol valerate. Based on the available evidence, expert opinion holds that nonhormonal methods are preferred during breastfeeding and progestin-only contraceptives are preferred over combined oral contraceptives in breastfeeding women, especially during the first 4 weeks postpartum. For further information, consult the record entitled, "Contraceptives, Oral, Combined."
  • Diethyltoluamide and breast feeding No information is available on the clinical use of diethyltoluamide (DEET) during breastfeeding. However, the Centers for Disease Control and Prevention and U.S. Environmental Protection Agency consider DEET to be safe and effective during breastfeeding when used as directed. It should be used by breastfeeding women to avoid exposure to mosquito-borne viruses. Avoid application directly to the nipple and other areas where the infant might directly ingest the product.
  • Diflorasone and breast feeding Topical diflorasone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin; diflorasone should be avoided on the nipple. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Diflunisal and breast feeding The small amounts of diflunisal in milk do not appear to pose a serious risk to breastfeeding infants. However, a shorter-acting agents having more published information may be preferred, especially while nursing a newborn or preterm infant.
  • Difluprednate and breast feeding No information is available on the ophthalmic use of difluprednate during breastfeeding. Because absorption from the eye is limited, ophthalmic difluprednate would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Digoxin Immune Fab and breast feeding No information is available on the clinical use of digoxin immune fab (ovine) during breastfeeding. Because it is a large protein molecule with a molecular weight of about 46,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Digoxin and breast feeding Because of the low levels of digoxin in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. If the mother is to receive digoxin intravenously, avoidance of breastfeeding for 2 hours after the dose will lessen the dose the infant receives.
  • Dihydrocodeine and breast feeding Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system (CNS) depression and even death. Like codeine, pharmacogenetics probably plays a role in the extent of CNS depression. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Dihydrocodeine possibly caused severe respiratory depression in one newborn infant whose mother was taking the drug for cough. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Because there is little published experience with dihydrocodine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Diltiazem and breast feeding Based on limited data, amounts of diltiazem ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Dimenhydrinate and breast feeding Small, occasional doses of dimenhydrinate would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug.
  • Dimethyl fumarate and breast feeding There is no published experience with dimethyl fumarate during breastfeeding. Although some authors recommend avoiding breastfeeding during dimethyl fumarate therapy, others and the manufacturer do not. Avoiding breastfeeding for 4 to 5 hours after a dose should minimize infant exposure. The infant should be monitored for adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. Some authors also recommend monitoring for vomiting and diarrhea.
  • Dinutuximab and breast feeding No information is available on the clinical use of dinutuximab during breastfeeding. Because dinutuximab is a large protein molecule with a molecular weight of about 150,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, dinutuximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during dinutuximab therapy.
  • Diphenhydramine and breast feeding Small, occasional doses of diphenhydramine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
  • Diphenoxylate and breast feeding No data exist on the use of diphenoxylate during breastfeeding. One expert panel considers diphenoxylate to be unacceptable during breastfeeding. Based on its chemical and pharmacological similarity to narcotics, occasional small doses of diphenoxylate may be acceptable while breastfeeding an older infant, but alternatives are preferred, especially while nursing a newborn.
  • Dipyridamole and breast feeding No published information is available on the use of dipyridamole during breastfeeding, although labeling states that the drug is excreted into human milk. Until more data become available, dipyridamole should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Dipyrone and breast feeding Dipyrone is not approved for marketing in the United States by the U.S. Food and Drug Administration or in Canada and many European countries because of its adverse reactions, including agranulocytosis. However, it is widely used in other countries during labor and breastfeeding. After ingestion by the mother, dipyrone and its metabolites appear in breastmilk in rather large amounts. It is found in the blood and urine of breastfed infants and can cause pharmacological effects in the breastfed infant. One case of cyanotic episodes in a breastfed infant was attributed to dipyrone in breastmilk. The drug and metabolites are eliminated from the breastmilk by 48 hours after a dose and one manufacturer recommends no breastfeeding for 48 hours after a dose. Safer alternatives are available for analgesia during breastfeeding.
  • Disopyramide and breast feeding Disopyramide is sometimes found in the plasma of nursing infants at levels of 7.5% to 12.5% of the mother's levels. The N-monodesalkyldisopyramide (NMD) metabolite is more anticholinergic than disopyramide itself and appears in breastmilk in levels higher than disopyramide. However, of the cases reported, there are no reports of infant effects. Disopyramide may be used cautiously while breastfeeding when other alternatives are unacceptable. Observe the infant for anticholinergic symptoms. Infant serum concentrations can be monitored if there is any concern about drug-induced adverse effects. Theoretically, disopyramide might decrease the milk supply.
  • Dobutamine and breast feeding No information is available on the use of dobutamine during breastfeeding. Because of its poor oral bioavailability and short half-life, any dobutamine in milk is unlikely to affect the infant.
  • Docetaxel and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. No information is available on the clinical use of docetaxel during breastfeeding. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant. The manufacturer recommends that breastfeeding be discontinued during docetaxel therapy and for 1 week after the last dose.
  • Docusate and breast feeding Docusate is minimally absorbed from the gastrointestinal tract and therefore the drug is unlikely to be found in the maternal serum or breastmilk. Laxatives that are completely unabsorbed may be preferred.
  • Dolutegravir and breast feeding Dolutegravir is detectable in maternal milk and infant plasma during breastfeeding. It appears that elimination by newborn infants is prolonged. In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of dolutegravir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Dopamine and breast feeding No information is available on the use of dopamine during breastfeeding. Because of its poor oral bioavailability and short half-life, any dopamine in milk is unlikely to affect the infant. Intravenous dopamine infusion may decrease milk production. Dopamine is known to reduce serum prolactin in nonnursing women, but no information is available on its effect on milk production in nursing mothers.
  • Doravirine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through 12 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Doripenem and breast feeding No information is available on the clinical use of doripenem during breastfeeding. Its excretion into breastmilk is likely similar to that of imipenem and meropenem, which produce low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush has been reported with beta-lactams, but these effects have not been adequately evaluated. Doripenem is acceptable in nursing mothers.
  • Dornase Alfa and breast feeding No information is available on the clinical use of dornase alpha (hamster) during breastfeeding. Because it is a large protein molecule with a molecular weight of about 37,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Dorzolamide and breast feeding Limited experience with the use of ophthalmic dorzolamide indicate that it is unlikely to adversely affect the breastfed infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Dothiepin and breast feeding Dothiepin is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal doses of up to 225 mg daily produce low levels in milk and breastfed infants' serum, and cause no adverse developmental consequences. Dothiepin would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Doxazosin and breast feeding Limited information indicates that maternal doses of 4 mg daily produce low very levels in milk and would not be expected to cause any adverse effects in breastfed infants.
  • Doxorubicin and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially anthracyclines such as doxorubicin. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, the high levels and persistence of doxorubicinol in milk make defining an appropriate abstinence interval difficult. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Doxycycline and breast feeding A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of doxycycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of doxycycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Doxylamine and breast feeding Small occasional doses of doxylamine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.
  • Dronabinol and breast feeding Dronabinol is the synthetic form of tetrahydrocannabinol, the major active component of cannabis. Tetrahydrocannabinol is found in the breastmilk of mothers who use cannabis products. Because no published information is available with dronabinol use as an antiemetic during breastfeeding, an alternate antiemetic should be used.
  • Droperidol and breast feeding Because little information is available on the long-term use of droperidol during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Single-dose or short-term use during breastfeeding, such as during surgery, is unlikely to adversely affect the breastfed infant, especially if the infant is older than 2 months. When multiple doses are given to the mother, monitor the infant for drowsiness, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.
  • Drospirenone and breast feeding Drospirenone is a progestin that is an analogue of spironolactone. It has antimineralocorticoid and antiandrogenic activities. Amounts in milk are very low and no adverse effects on the breasted infanor mik supply are expected. Based on the available evidence, expert opinion holds that nonhormonal methods are preferred during breastfeeding and progestin-only contraceptives are preferred over combined oral contraceptives in breastfeeding women, especially during the first 4 weeks postpartum. For further information, consult the record entitled, "Contraceptives, Oral, Combined."
  • Dulaglutide and breast feeding No information is available on the clinical use of dulaglutide during breastfeeding. Because dulaglutide is a large protein molecule with a molecular weight of 59,669 daltons, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, dulaglutide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Duloxetine and breast feeding Little published information is available on the use of duloxetine during breastfeeding; however, the dose in milk is low and serum levels were low in two breastfed infants. An alternate drug that has been better studied may be preferred, especially while nursing a newborn or preterm infant. If duloxetine is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Galactorrhea has been reported in women taking duloxetine.
  • Duvelisib and breast feeding No information is available on the clinical use of duvelisib during breastfeeding. Because duvelisib is 98% bound to plasma proteins, the amount in milk is likely to be low. However, because of its potential toxicity in the breastfed infant, the manufacturer recommends that breastfeeding be discontinued during duvelisib therapy and for at least 1 month after the last dose.
  • Dyphylline and breast feeding Because of the relatively high levels in milk and a previous report with theophylline, occasional stimulant effects in infants should be anticipated in breastfed infants. No severe adverse reactions are expected. Amounts in milk can be minimized by avoiding breastfeeding for 3 to 4 hours after a dose.

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.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

E

  • Echothiophate and breast feeding No information is available on the use of echothiophate ophthalmic drops during breastfeeding. Because echothiophate is a quaternary ammonium compound, it is not likely to pass into the breastmilk or reach the bloodstream of the infant.
  • Econazole and breast feeding Topical econazole has not been studied during breastfeeding. Because less than 1% is absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Eculizumab and breast feeding Maternal dosages of eculizumab usually produce undetectable levels in breastmilk. Because eculizumab is a large protein molecule with a molecular weight of about 148,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. No adverse effects attributable to eculizumab have been reported in infants who were breastfed during maternal therapy.
  • Edoxaban and breast feeding Because no information is available on the use of edoxaban during breastfeeding and the drug is orally absorbable, an alternate drug is preferred while nursing a newborn or preterm infant.
  • Edrophonium and breast feeding No information is available on the use of edrophonium during breastfeeding. However, because of its short half-life and quaternary ammonium structure, it is unlikely to be excreted into breastmilk or orally absorbed by the infant. Administering the drug just after breastfeeding and waiting 2 to 3 hours before breastfeeding again should avoid any adverse reactions in the infant.
  • Efavirenz and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with efavirenz during breastfeeding is limited. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine. Treatment of mothers of HIV+ mothers with efavirenz as part of Option B+ therapy does not appear to affect growth of their HIV-negative breastfed infants.
  • Efinaconazole and breast feeding Topical efinaconazole has not been studied during breastfeeding. Because maternal blood levels are very low after topical application to the toenails, it is unlikely that a measurable amount of the drug will enter the breastmilk.
  • Eflornithine and breast feeding Limited information indicates that maternal intravenous eflornithine 400 mg/kg daily for 7 days does not cause any adverse serious effects in breastfed infants. Eflornithine is poorly absorbed after topical application, so it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants.
  • Elagolix and breast feeding No information is available on the use of elagolix during breastfeeding. Elagolix is 80% protein bound, has a half-life of 4 to 6 hours, and it is a peptide that is likely digested in the infant's gastrointestinal tract, so it is unlikely to reach clinically important levels in infant serum. However, because no information is available on the use of elagolix during breastfeeding caution should be used, especially while nursing a newborn or preterm infant.
  • Eletriptan and breast feeding Limited information indicates that a maternal dose of eletriptan up to 80 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Elotuzumab and breast feeding No information is available on the clinical use of elotuzumab during breastfeeding. Because elotuzumab is a large protein molecule with a molecular weight of 148,100, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. However, elotuzumab is administered with dexamethasone and lenalidomide, two drugs which also have no information on use in nursing mothers. The manufacturer recommends that women receiving elotuzumab should not breastfeed.
  • Eluxadoline and breast feeding No information is available on the use of eluxadoline during breastfeeding. Because it has opioid agonist activity, an alternate drug is preferred, especially while nursing a newborn or preterm infant.
  • Elvitegravir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of elvitegravir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Emedastine and breast feeding Because absorption from the eye is limited, emedastine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Emicizumab and breast feeding No information is available on the clinical use of emicizumab during breastfeeding. Because emicizumab is a large protein molecule with a molecular weight of 145,600, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Empagliflozin and breast feeding No information is available on the clinical use of empagliflozin during breastfeeding. Empagliflozin is an uncharged molecule that is 86% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. The manufacturer does not recommend empagliflozin during breastfeeding because of a theoretical risk to the infant's developing kidney. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Emu Oil and breast feeding Emu oil is a mixture of fatty acids derived from the fat of the emu (Dromiceius novahollandiae). It contains linoleic, linolenic myristic, oleic, palmitic, palmitoleic, and stearic acids. It has been used as a moisturizing agent and some animal data indicate that in might promote wound healing and decrease inflammation. An emu oil-based cream (Clemulina Pus cream, Sitar Laboratories, Padua, Italy) applied to the nipples and areolas of breastfeeding mothers after each nursing appeared to improve skin hydration. Whether this led to reduced nipple cracking or any effects on nursing infants was not studied.
  • Enalapril and breast feeding Because of the low levels of enalapril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Enasidenib and breast feeding No information is available on the clinical use of enasidenib during breastfeeding. Because enasidenib is 98.5% bound to plasma proteins and its active metabolite is 96.6% bound to plasma proteins, the amount in milk is likely to be low. However, the half-life of enasidenib is 137 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during enasidenib therapy and for at least 1 month after the end of therapy.
  • Encorafenib and breast feeding No information is available on the clinical use of encorafenib during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during encorafenib therapy and for at least 2 weeks after the final dose.
  • Enflurane and breast feeding There is no published experience with enflurane during breastfeeding. Because the serum half-life of enflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. It is possible that requirements for other anesthetic agents would be affected similarly.
  • Enfuvirtide and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of enfuvirtide during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Enoxacin and breast feeding Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of enoxacin is probably acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available.
  • Enoxaparin and breast feeding Limited information indicates that maternal enoxaparin in doses up to 40 mg daily do not to cause any adverse effects in breastfed infants. Because its large molecular weight of 2000 to 8000 daltons, enoxaparin would not be expected to be excreted into breastmilk or to be absorbed from breastmilk by the infant. No special precautions are required.
  • Entacapone and breast feeding No information is available on the use of entacapone during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Epinastine and breast feeding Because absorption from the eye is limited, epinastine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Epinephrine and breast feeding No information is available on the use of epinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any epinephrine in milk is unlikely to affect the infant. High intravenous doses of epinephrine might reduce milk production or milk letdown. Low-dose intramuscular (such as Epi-Pen), epidural, topical, inhaled or ophthalmic epinephrine are unlikely to interfere with breastfeeding. To substantially diminish the effect of the drug after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Eprosartan and breast feeding Because no information is available on the use of eprosartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Eptifibatide and breast feeding No published information is available on the use of eptifibatide during breastfeeding. Because eptifibatide is a peptide, absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, eptifibatide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Eravacycline and breast feeding Eravacycline is a tetracycline antibiotic. A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of a eravacycline during lactation because the drug is 79 to 90% bound to plasma proteins, so milk levels are likely low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of eravacycline acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Ergonovine and breast feeding Ergonovine given in the immediate postpartum period lowers serum basal prolactin and possibly suckling-induced prolactin increases. It also appears to decrease the rate of breastfeeding. Ergonovine is probably best avoided in mothers who wish to nurse, relying instead on suckling-induced oxytocin release to hasten uterine involution. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
  • Ergotamine and breast feeding Because there is limited published experience with ergotamine during breastfeeding and it might cause adverse effects in the infant, most authorities consider ergotamine to be undesirable to use during nursing.
  • Erlotinib and breast feeding No information is available on the clinical use of erlotinib during breastfeeding. Because erlotinib is 93% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 36 hours and it might accumulate in the infant. It is also given in combination with gemcitabine for pancreatic cancer, which may increase the risk to the infant. The manufacturer recommends that breastfeeding be discontinued during erlotinib therapy and for 2 weeks after the final dose.
  • Ertapenem and breast feeding Limited information indicates that ertapenem produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush has been reported with beta-lactams, but these effects have not been adequately evaluated. Ertapenem is acceptable in nursing mothers.
  • Ertugliflozin and breast feeding No information is available on the clinical use of ertugliflozin during breastfeeding. Ertugliflozin is an uncharged molecule that is 94% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. The manufacturer does not recommend ertugliflozin during breastfeeding because of a theoretical risk to the infant's developing kidney. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Eslicarbazepine and breast feeding No information is available on the use of eslicarbazepine during breastfeeding. However, eslicarbazepine is the active metabolite of oxcarbazepine. Limited information indicates that oxcarbazepine would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants.
  • Esmolol and breast feeding Based on its physicochemical properties and extremely short half-life, esmolol would not be expected to cause any adverse effects in breastfed infants.
  • Estazolam and breast feeding No information is available on the use of estazolam during breastfeeding. Because of the long duration of action of estazolam, an alternate hypnotic is preferred, especially while nursing a newborn or preterm infant.
  • Estradiol Cypionate and breast feeding Estradiol cypionate has not been studied during breastfeeding. However, the similar drug, estradiol valerate, has been used to suppress lactation, usually in combination with testosterone. Generally, estradiol cypionate should be avoided in mothers wishing to breastfeed.
  • Eszopiclone and breast feeding Because no information is available on the use of eszopiclone during breastfeeding, an alternate hypnotic may be preferred, especially while nursing a newborn or preterm infant. Data from the racemate, zopiclone, in larger doses indicate that occasional use while breastfeeding an older infant should pose little risk to the infant, but the infant should be monitored for excessive drowsiness.
  • Etanercept and breast feeding Etanercept is minimally excreted into breastmilk and poorly absorbed by the infant, which would be expected because of its high molecular weight of approximately 150,000. However, long-term follow-up data on infants breastfed during maternal etanercept use are not available. The risk of adverse effects in older infants is not known, but thought to be unlikely. Most experts feel that the drug is a low risk to the nursing infant and can be given during breastfeeding.
  • Ethacrynic Acid and breast feeding Because no information is available on the use of ethacrynic acid during breastfeeding and because intense diuresis might decrease lactation, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ethambutol and breast feeding Limited information indicates that maternal doses of ethambutol up to 15 mg/kg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. The amount of ethambutol in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking ethambutol.
  • Ethionamide and breast feeding Minimal information exists on the use of ethionamide during breastfeeding. Although some developmental problems have been reported in two infants exposed to ethionamide in breastmilk, their mothers were also exposed to several drugs during pregnancy and during breastfeeding, so the problems cannot necessarily be attributed to ethionamide. If ethionamide is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ethosuximide and breast feeding Average ethosuximide dosages of 50 to 60% of the maternal weight-adjusted dosage are excreted in human milk and infant plasma levels of 25 to 30% of maternal levels are common. Although no adverse effects attributable solely to ethosuximide in breastmilk have been reported, monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants. Measurement of an infant serum level might help rule out toxicity if there is a concern.
  • Etidronate and breast feeding Because no information is available on the use of etidronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of etidronate by a breastfed infant is unlikely.
  • Etodolac and breast feeding Because no information is available on the use of etodolac during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Etomidate and breast feeding Amounts of etomidate in milk are very small and decrease rapidly. Existing data indicate that no waiting period is required before resuming breastfeeding after etomidate anesthesia. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Etoposide and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent therapy with etoposide after an appropriate period of breastfeeding abstinence. A period of at least 24 hours is required after a dose of 80 mg/sq m or less. Others have suggested an abstinence period of 72 hours after etoposide use. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Etravirine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine. Etravirine is excreted in breastmilk in concentrations exceeding the maternal plasma HIV inhibitory concentration.
  • Everolimus and breast feeding In one patient, everolimus was not detected in the colostrum of a mother taking everolimus; however, no information is available on the use of everolimus during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Exemestane and breast feeding No information is available on the use of exemestane during breastfeeding. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. The manufacturer recommends that breastfeeding be discontinued during exemestane therapy and for 1 month after the last dose.
  • Exenatide and breast feeding No information is available on the clinical use of exenatide during breastfeeding. Because exenatide is a large peptide molecule with a molecular weight of 4187 daltons, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. It has a short half-life, which might make it a better choice among drugs in this class for nursing mothers. Until more data become available, exenatide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Ezetimibe and breast feeding No relevant published information exists on the use of ezetimibe during breastfeeding. Because of a concern with disruption of infant lipid metabolism, ezetimibe is best avoided during breastfeeding. An alternate drug is preferred, especially while nursing a newborn or preterm infant. Ezetimibe treatment in combination with a statin (e.g., atorvastatin, simvastatin) should be avoided in nursing mothers.
  • Ezogabine and breast feeding Because no information is available on use of ezogabine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If ezogabine is required by the mother, it is not necessarily a reason to discontinue breastfeeding, but monitor the infant for drowsiness, agitation, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of drugs.

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

F

  • Factor Xa (recombinant), Inactivated-zhzo and breast feeding No information is available on the clinical use of coagulation factor Xa during breastfeeding. Because it is a large protein molecule with a molecular weight of about 40,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, coagulation factor X should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Famciclovir and breast feeding Because there is no published experience with famciclovir during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Famotidine and breast feeding Famotidine is used in newborn infants in higher dosages than are transmitted in breastmilk. Famotidine would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Fava Beans and breast feeding Fava beans contain the compounds vicine and convicine. These chemicals are metabolized to divicine and isouramil, which are potent oxidizing agents. In persons with glucose-6-phosphate dehydrogenase (G6PD) deficiency, these compounds cause hemolysis by disrupting the red cell wall. Many cases of hemolysis, and subsequent hyperbilirubinemia have been reported in breastfed infants after maternal fava bean intake. Most of the cases have been reported from around the Mediterranean and Middle East or in infants whose heritage was from this region. The prevalence of G6PD deficiency is relatively high in this geographic area, where perhaps more susceptible variants occur-at least 14 variants of G6PD deficiency are known. Most reports are of male infants, but some female infants have been affected. Favism via breastmilk can be quite severe. One breastfed infant developed renal cortical necrosis following maternal fava bean ingestion. The infant died of renal failure in the hospital 10 days after maternal fava bean ingestion. Mothers nursing a G6PD deficient infant should not consume fava beans.
  • Felbamate and breast feeding Because no information is available on the use of felbamate during breastfeeding, and because it can cause potentially fatal hematologic and hepatic toxicities, authors of authoritative reviews recommend that breastfeeding not be undertaken during maternal felbamate therapy until more safety data are available.
  • Felodipine and breast feeding Because no information is available on the use of felodipine during breastfeeding, an alternate drug may be preferred.
  • Fenofibrate and breast feeding No relevant published information exists on the use of fenofibrate during breastfeeding. Because of a concern with disruption of infant lipid metabolism, fenofibrate is best avoided during breastfeeding. An alternate drug is preferred, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be avoided during fenofibrate therapy and for 5 days after the final dose.
  • Fenoldopam and breast feeding No information is available on the use of fenoldopam during breastfeeding. Because of its poor oral bioavailability and short half-life, any fenoldopam in milk is unlikely to adversely affect the breastfed infant. Also, fenoldopam can be given intravenously to infants. Unlike dopamine, it does not decrease serum prolactin concentrations and might not interfere with nursing.
  • Fenoprofen and breast feeding Some reviewers consider fenoprofen to be acceptable during breastfeeding. Because there is little published experience with fenoprofen during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ferric Carboxymaltose and breast feeding Intravenous iron carboxymaltose increases breastmilk iron in mothers with iron deficiency anemia. Breastfed neonates of these mothers appear to have no serious adverse reactions. Ferric carboxymaltose appears to be acceptable to use in nursing mothers with no special precautions required. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Ferric Citrate and breast feeding Iron is a normal component of human milk. Studies on various forms of iron indicate that breastmilk levels are not increased greatly after exogenous administration. No special precautions are necessary. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Ferric Pyrophosphate Citrate and breast feeding No information is available on the use of ferric pyrophosphate citrate during breastfeeding and the manufacturer recommends that it not be used during breastfeeding. An alternate intravenous drug with more published data available may be preferred. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Ferumoxides and breast feeding Ferumoxides is a complex of iron oxide and dextran, similar to iron dextran. It is not expected to pose a toxic risk to a nursing infant. However, because there is no published experience with ferumoxides during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ferumoxsil and breast feeding Ferumoxsil is not approved for marketing in the United States by the U.S. Food and Drug Administration. No information is available on the clinical use of ferumoxsil during breastfeeding. If ferumoxsil is required by the mother, it is not a reason to discontinue breastfeeding. However, since there is no published experience with ferumoxsil during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ferumoxytol and breast feeding No information is available on the use of ferumoxytol during breastfeeding; however, the drug has been given safely to neonates intravenously. An alternate intravenous iron product with more published data on breastfeeding available may be preferred. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Fesoterodine and breast feeding No information is available on the use of fesoterodine during breastfeeding. Long-term use of fesoterodine might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Fexofenadine and breast feeding Because of its lack of sedation and low milk levels, maternal use of fexofenadine would not be expected to cause any adverse effects in breastfed infants. Fexofenadine might have a negative effect on lactation, especially in combination with a sympathomimetic agent such as pseudoephedrine.
  • Fidaxomicin and breast feeding No information is available on the use of fidxomicin during breastfeeding. Because it is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants.
  • Filgrastim and breast feeding Filgrastim in the pharmaceutical name for granulocyte colony-stimulating factor (G-CSF). Pegfilgrastim is the long-acting form of filgrastim. The excretion of exogenous G-CSF into breastmilk or its effects on breastfed infants have not been well studied. Limited data indicate that filgrastim and a similar G-CSF product, lenograstim, are poorly excreted into breastmilk and are undetectable by 3 days after an injection. Some authors recommend withholding breastfeeding for this period of time. However, filgrastim has been safely given orally to neonates and is not orally absorbed by neonates, so any filgrastim that is excreted into milk is unlikely to adversely affect the breastfed infant.
  • Fingolimod and breast feeding Although fingolimod and its active metabolite are highly bound in maternal plasma and unlikely to reach the breastmilk in large amounts, it is potentially toxic to the breastfed infant. Because there is no published experience with fingolimod during breastfeeding, expert opinion generally recommends that it should be avoided during breastfeeding, especially while nursing a newborn or preterm infant. However, the manufacturer's labeling does not recommend against its use in breastfeeding.
  • Flavoxate and breast feeding No information is available on the use of flavoxate during breastfeeding. Long-term use of trihexyphenidyl might reduce milk production or milk letdown, but a single dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Flecainide and breast feeding Limited information indicates that maternal doses of flecainide up to 200 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Because of the relative lack of data concerning breastfeeding during maternal flecainide therapy, exclusively breastfed infants should be carefully monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
  • Floxacillin and breast feeding Floxacillin (flucloxacillin) is not approved for marketing in the United States by the U.S. Food and Drug Administration. It is acceptable to use during breastfeeding and is frequently used abroad to treat mastitis in nursing mothers. Limited information indicates that floxacillin levels in milk are low and are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Floxacillin is acceptable in nursing mothers.
  • Flunarizine and breast feeding Flunarizine is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. No information is available on the use of flunarizine during breastfeeding. Because of its long half-life of 19 days in children, expert opinion recommends that flunarizine not be used in migraine prophylaxis. An alternate drug is preferred, especially while nursing a newborn or preterm infant.
  • Flunisolide and breast feeding Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled and oral corticosteroids acceptable to use during breastfeeding.
  • Flunitrazepam and breast feeding Flunitrazepam is not approved for marketing in the United States by the U.S. Food and Drug Administration. It is excreted into breastmilk and, because of its long half-life of about 20 hours, it may accumulate in the serum of breastfed infants with repeated doses. Other agents are preferred, especially while nursing a newborn or preterm infant. After a single dose of flunitrazepam, as for sedation before a procedure, there is usually no need to wait to resume breastfeeding, although with a newborn or preterm infant, a cautious approach would be to wait a period of 6 to 8 hours before resuming nursing.
  • Fluocinolide and breast feeding Fluocinolide has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Fluocinonide and breast feeding Fluocinonide has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin; fluocinonide should be avoided on the nipple. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Fluorometholone and breast feeding No information is available on the ophthalmic use of fluorometholone during breastfeeding. Because absorption from the eye is limited, ophthalmic fluorometholone would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Flupenthixol and breast feeding Flupenthixol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal oral doses of up to 4 mg daily or depot injections of 40 mg every 2 weeks produce low levels in milk and breastfed infants' serum, and cause no adverse developmental consequences. Until more data are available, flupenthixol should be used with careful monitoring during breastfeeding.
  • Fluphenazine and breast feeding There is no published experience with fluphenazine during breastfeeding. Very limited long-term follow-up data indicate no adverse developmental effects when other phenothiazines are used alone. Because of the lack of published experience with fluphenazine during breastfeeding, other antipsychotic agents may be preferred, especially wile nursing an newborn or preterm infant. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
  • Flurandrenolide and breast feeding Flurandrenolide has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Flurazepam and breast feeding No information is available on the excretion of flurazepam into breastmilk. One case of infant sedation was reported in a woman taking flurazepam along with other sedating drugs during breastfeeding. Because of the long duration of action of flurazepam, an alternate hypnotic is preferred, especially while nursing a newborn or preterm infant.
  • Flutemetamol F 18 and breast feeding Information in this record refers to the use of flutemetamol F 18 as a diagnostic agent. No information is available on the use of flutemetamol F 18 during breastfeeding. The manufacturer recommends withholding breastfeeding for 24 hours after a diagnostic dose of 185 MBq (5 mCi). This length of time is about 10 half-lives of fluoride F 18 and less than 0.01% of the radioactivity administered will remain in the body. The mother can nurse just before administration of the radiopharmaceutical. If the mother has expressed and saved milk prior to the examination, she can feed it to the infant during the period of nursing interruption.
  • Fluticasone, Inhaled and breast feeding Although not measured, the amounts of inhaled corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled corticosteroids acceptable to use during breastfeeding.
  • Fluticasone, Topical and breast feeding Topical fluticasone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Fluvastatin and breast feeding No relevant published information exists on the use of fluvastatin during breastfeeding. Because of a concern with disruption of infant lipid metabolism, the consensus is that fluvastatin should not be used during breastfeeding. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Fluvoxamine and breast feeding Limited information indicates that maternal fluvoxamine doses of up to 300 mg daily produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. One infant was reported to have an elevated serum level of fluvoxamine, but most who have been tested have undetectable serum levels. Another infant developed diarrhea, vomiting and stimulation after maternal initiation of fluvoxamine. A limited amount of long-term follow-up on growth and development has found no adverse effects in breastfed infants. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state. These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.
  • Formoterol and breast feeding Although no published data exist on the use of formoterol by inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Fosamprenavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of fosamprenavir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Fosfomycin and breast feeding Limited information indicates that fosfomycin produces low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Fosinopril and breast feeding Because no information is available on the use of fosinopril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Fospropofol and breast feeding No information is available on the clinical use of fospropofol during breastfeeding. However, fospropofol is rapidly metabolized to propofol in the body. Amounts of propofol in milk are very small and are not expected to be absorbed by the infant. Although one expert panel recommends withholding nursing for an unspecified time after propofol administration, most recommend that breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse and that discarding milk is unnecessary. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using propofol as a component for induction may delay the onset of lactation.In one study, breastfeeding before general anesthesia induction reduced requirements of propofol and sevoflurane compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. In one case, milk was noted to be green in color 8 hours after a procedure in which propofol was administered; however, several other medications were also used during the procedure.
  • Frovatriptan and breast feeding Because there is no published experience with frovatriptan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Furosemide and breast feeding Because little information is available on the use of furosemide during breastfeeding and because intense diuresis might decrease lactation, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

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  • Gabapentin and breast feeding Limited information indicates that maternal doses of gabapentin up to 2.1 grams daily produce relatively low levels in infant serum. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs. A single oral dose of either 300 mg or 600 mg given to the mother before cesarean section appeared to have no effect on breastfeeding initiation. An expert consensus guideline indicates that gabapentin is an acceptable choice for refractory restless leg syndrome during lactation.
  • Gadobenate and breast feeding There is no published experience with gadobenate during breastfeeding. Gadobenate has been safely used in infants, so it does not appear to pose a substantial risk to a breastfed infant. Guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium.
  • Gadobutrol and breast feeding There is no published experience with gadobutrol during breastfeeding. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. Gadobutrol is one of the most stable gadolinium agents, theoretically making it one of the safer drugs to use during breastfeeding. However, because there is no published experience with gadobutrol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadodiamide and breast feeding Gadodiamide releases more free gadolinium than some other gadolinium-containing contrast agents. However, guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. Other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadofosveset and breast feeding There is no published experience with gadofosveset during breastfeeding. Guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. However, because there is no published experience with gadofosveset during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadopentetate and breast feeding Amounts of gadolinium excreted into breastmilk after maternal gadopentetate are less than 1% of the amount allowed to be given to infants. In addition, because gadopentetate is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Gadopentetate has been associated with some cases of nephrogenic systemic fibrosis in patients with renal impairment. Guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium.
  • Gadoterate and breast feeding There is no published experience with gadoterate during breastfeeding. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. Gadoterate is one of the most stable gadolinium agents, theoretically making it one of the safer drugs to use during breastfeeding. However, because there is no published experience with gadoterate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadoteridol and breast feeding There is no published experience with gadoteridol during breastfeeding. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. Gadoteridol is one of the most stable gadolinium agents, theoretically making it one of the safer drugs to use during breastfeeding. However, because there is no published experience with gadoteridol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadoversetamide and breast feeding There is no published experience with gadoversetamide during breastfeeding. Gadoversetamide releases more free gadolinium than some other gadolinium-containing contrast agents. However, guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. Other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Gadoxetate and breast feeding There is no published experience with gadoxetate during breastfeeding. Guidelines developed by several North American professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a gadolinium-containing contrast medium. However, because there is no published experience with gadoxetate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ganciclovir and breast feeding Several factors might affect the decision to use ganciclovir in a nursing mother. No information is available on the clinical use of ganciclovir during breastfeeding. Cytomegalovirus (CMV) can be transmitted to infants though breastmilk, with preterm and immunocompromised infants at greatest risk. No information is available on any changes in the risk of transmission if the mother is being treated with ganciclovir. Although the manufacturer recommends avoiding breastfeeding during ganciclovir use because of the risk of infant drug toxicity, neonates with CMV infections are often treated directly with ganciclovir. If the mother has a concurrent infection with HIV, breastfeeding is not recommended in the United States and other developed countries.
  • Gefitinib and breast feeding No information is available on the clinical use of gefitinib during breastfeeding. Because gefitinib is 90% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 48 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during gefitinib therapy.
  • Gemcitabine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It might be possible to breastfeed safely during intermittent gemcitabine therapy with an appropriate period of breastfeeding abstinence; the manufacturer recommends an abstinence period of at least 1 week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Gemfibrozil and breast feeding No relevant published information exists on the use of gemfibrozil during breastfeeding. Because of a concern with disruption of infant lipid metabolism, gemfibrozil is best avoided during breastfeeding. An alternate drug is preferred, especially while nursing a newborn or preterm infant.
  • Gemifloxacin and breast feeding No information is available on the clinical use of gemifloxacin during breastfeeding; however, amounts in breastmilk appear to be low. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of gemifloxacin is acceptable in nursing mothers. However, it is preferable to use an alternate drug for which safety information is available.
  • Gentian Violet and breast feeding Gentian violet (crystal violet) was used in the past to treat oral and nipple thrush during breastfeeding. Gentian violet is potentially toxic to the mucous membranes, causing ulceration, and potentially tattooing the skin. It can also interact with DNA, is carcinogenic and mutagenic in rodents, and occasionally causes allergic sensitization, with cross reactions to other triphenylmethane dyes. Its use has been severely curtailed by authorities in England and Australia. It is also very messy, staining skin and clothing. A 2001 survey of the members of the Academy of Breastfeeding Medicine (ABM) found that gentian violet is rarely (1 to 2% of respondents) used by breastfeeding experts for initial treatment of oral thrush and is very infrequently (3 to 4% of respondents) used for recurrent or persistent thrush. ABM guidelines for treating Candida infection of the nipples state that an aqueous solution of gentian violet of less than 0.5% can be used for no more than 7 days on the nipple. However, safer alternatives for treating thrush are available.
  • Gilteritinib and breast feeding No information is available on gilteritinib during breastfeeding. It is 94% bound to plasma proteins, so amounts in milk are likely to be low; however, it has a long half-life of about 113 hours. The manufacturer recommends that breastfeeding be discontinued during gilteritinib therapy and for 2 months after the last dose.
  • Glasdegib and breast feeding No information is available on glasdegib during breastfeeding. It is 91% bound to plasma proteins, so amounts in milk are likely to be low. With a half-life of 17.4 hours, it is likely to be eliminated from milk by 4 to 7 days after the last dose. However, the manufacturer recommends that breastfeeding be discontinued during glasdegib therapy and for at least 30 days after the last dose.
  • Glatiramer and breast feeding Glatiramer is the active portion of the drug, glatiramer acetate. No information is available on the excretion of glatiramer acetate into breastmilk. However, data from the manufacturer indicates that after subcutaneous injection, glatiramer undergoes rapid degradation to amino acids and shorter peptides and that it cannot be detected in the plasma, urine or feces. Furthermore, any glatiramer that did reach the breastmilk would probably be destroyed in the infant's gastrointestinal tract and not absorbed, except perhaps in neonates. Limited information indicates that maternal use of glatiramer acetate does not cause any adverse effects in breastfed infants. Glatiramer acetate is generally considered safe by most experts and appears to be one of the preferred disease-modifying agents for treating multiple sclerosis during breastfeeding.
  • Glimepiride and breast feeding Because no information is available on the use of glimepiride during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with glimepiride.
  • Glipizide and breast feeding Limited data indicate that the levels of glipizide in milk are low. However, an alternate drug for which there is more information may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Glyburide and breast feeding Limited data indicate that the levels of glyburide in milk are negligible. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Glycolic Acid and breast feeding No information is available on the clinical use of glycolic acid (hydroxyacetic acid) on the skin during breastfeeding. Because it is unlikely to be appreciably absorbed or appear in breastmilk, it is considered safe to use during breastfeeding. Avoid application to areas of the body that might come in direct contact with the infant's skin or where the drug might be ingested by the infant via licking.
  • Glycopyrrolate and breast feeding No information is available on the use of glycopyrrolate during breastfeeding. Because glycopyrrolate is a quaternary ammonium compound, it is not likely to be absorbed and reach the bloodstream of the infant, especially when given by inhalation or topically on the skin. Long-term oral use of glycopyrrolate might reduce milk production or milk letdown, but a single dose is unlikely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Gold Sodium Thiomalate and breast feeding Excretion of gold into milk after gold sodium thiomalate has not been rigorously studied. Case reports indicate that gold appears in milk in small quantities and at least a little of it is absorbed because it is detectable in the infant's urine. No convincing cases of toxicity have been reported. Opinions of authors of review articles vary from recommending avoidance to allowing use. Monitoring for possible adverse effects in the breastfed infant would seem prudent.
  • Guaifenesin and breast feeding Neither the excretion of guaifenesin in milk nor its effect on breastfed infants have been studied. It is unlikely that with usual maternal doses amounts in breastmilk would harm the nursing infant, especially in infants over 2 months of age. It is best to avoid the use of products with a high alcohol content while nursing.
  • Guanabenz and breast feeding Because no information is available on the use of guanabenz during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Guanfacine and breast feeding Because no information is available on the use of guanfacine during breastfeeding and its possible negative effects on lactation, other agents may be preferred, especially while nursing a newborn or preterm infant.

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  • Halobetasol and breast feeding Halobetasol has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin; avoid halobetasol on the nipple. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Halofantrine and breast feeding Because no information is available on the use of halofantrine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Haloperidol and breast feeding Limited information indicates that maternal doses of haloperidol up to 10 mg daily produce low levels in milk and usually do not affect the breastfed infant. Very limited long-term follow-up data indicate no adverse developmental effects when haloperidol is used alone. However, use with other antipsychotic drugs occasionally might negatively affect the infant. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
  • Halothane and breast feeding There is no published experience with halothane anesthesia during breastfeeding. Various recommendations have been made regarding breastfeeding after halothane anesthesia, from discarding the first pumping after recovery to discarding breastmilk for 24 to 48 hours after the surgical procedure. Although withholding breastfeeding for 24 h is probably unnecessary, an alternate anesthetic may be preferred, especially while nursing a newborn or preterm infant. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. It is possible that requirements for other anesthetic agents would be affected similarly.
  • Heparin and breast feeding Although heparin itself has not been studied, low molecular weight heparins (e.g., dalteparin, enoxaparin) are not excreted into breastmilk in clinically relevant amounts. Because heparin has an even higher molecular weight of 3000 to 30,000 daltons, it would not be expected to be appreciably excreted into breastmilk or absorbed by the infant. No special precautions are required.
  • Hepatitis A Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to the hepatitis A vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Hepatitis B Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding infants and that breastfeeding is not a contraindication to the hepatitis B vaccine. Hepatitis B vaccine is recommended along with hepatitis B immune globulin to be given by injection to infants of mothers who are positive for hepatitis B surface antigen. No differences exist in infection rates between breast-fed and formula-fed infants born to hepatitis B-infected women, as long as the infant receives these preventative measures at birth. Mothers with hepatitis B are encouraged to breastfeed their infants after their infants receive these preventative measures. Breastfeeding also appears to reduce infant side effects associated with routine childhood immunization. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Hexaminolevulinate and breast feeding No information is available on the clinical use of hexaminolevulinate during breastfeeding. After instillation into the bladder, only about 7% of a dose is absorbed into the maternal bloodstream, so the amount of drug excreted into milk is expected to be minimal. Until more data become available, hexaminolevulinate should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Homatropine Bromide and breast feeding No information is available on the use of homatropine hydrobromide during breastfeeding. Anticholinergic drugs might interfere with breastfeeding. A single dose of ophthalmic homatropine hydrobromide is not likely to interfere with breastfeeding; however, during long-term use, observe the infant for signs of decreased lactation (e.g., insatiety, poor weight gain). To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Human Papillomavirus Vaccines and breast feeding The Centers for Disease Control and Prevention and the several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants. A slightly higher percentage of infants who were breastfed during or after maternal vaccination with the active quadrivalent human papillomavirus vaccine (Gardasil) had pneumonia during the 30 days after maternal vaccination, but these effects were not thought to be vaccine related. No similar data exist for the bivalent vaccine (Cervarix). Maternal vaccination with human papillomavirus vaccine is not a contraindication to breastfeeding.
  • Hydralazine and breast feeding Limited milk level and infant serum level data and a long history of use in postpartum mothers indicate that hydralazine is an acceptable antihypertensive in nursing mothers, even those nursing newborns.
  • Hydrochlorothiazide and breast feeding Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production.
  • Hydrocodone and breast feeding Hydrocodone is a opioid narcotic. Benzhydrocodone is a hydrocodone prodrug that is rapidly converted into hydrocodone in the gastrointestinal tract. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral hydrocodone to a few days at a maximum dosage of 30 mg daily with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
  • Hydrocortisone, Topical and breast feeding Topical hydrocortisone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical hydrocortisone would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area. Maternal use rectally with a cream or by suppository poses very little risk to the breastfed infant.
  • Hydroflumethiazide and breast feeding No information is available on the amount of hydroflumethiazide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over hydroflumethiazide.
  • Hydromorphone and breast feeding Limited data indicate that hydromorphone is excreted into breastmilk in small amounts, but large maternal dosages have caused neonatal central nervous system depression. In general, maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Hydromorphone use should be limited in nursing mothers. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of hydromorphone to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
  • Hydroquinone and breast feeding Topical hydroquinone has not been studied during breastfeeding. Although hydroquinone is not contraindicated during breastfeeding, some experts feel that long-term use of hydroquinone is difficult to justify in a nursing mother. If hydroquinone is used, ensure that the infant's skin does not come into direct contact with the areas of maternal skin that have been treated and the infant does not ingest the product from the mother's skin.
  • Hydroxyurea and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, although the evidence for this recommendation for hydroxyurea is very weak. In doses used for sickle cell disease, hydroxyurea appears to be acceptable to use in nursing mothers. Avoiding breastfeeding for 3 hours after the mother's dose can decrease the infant dose by about half. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.
  • Hydroxyzine and breast feeding Small occasional doses of hydroxyzine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. Other agents are preferred, especially while nursing a newborn or preterm infant.

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  • Ibandronate and breast feeding IBecause no information is available on the use of ibandronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of ibandronate by a breastfed infant is unlikely.
  • Ibrutinib and breast feeding No information is available on the clinical use of ibrutinib during breastfeeding. Because ibrutinib is more than 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during ibrutinib therapy.
  • Ibuprofen and breast feeding Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice as an analgesic or antiinflammatory agent in nursing mothers.
  • Icaridin and breast feeding No information is available on the clinical use of icaridin (picaridin) during breastfeeding. However, the Centers for Disease Control and Prevention and U.S. Environmental Protection Agency consider icaridin to be safe and effective during breastfeeding when used as directed. It should be used by breastfeeding women to avoid exposure to mosquito-borne viruses. Avoid application directly to the nipple and other areas where the infant might directly ingest the product.
  • Idarucizumab and breast feeding No information is available on the clinical use of idarucizumab during breastfeeding. Because it is a large protein molecule with a molecular weight of about 48,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Idelalisib and breast feeding No information is available on the clinical use of idelalisib during breastfeeding. Because idelalisib is more than 84% bound to plasma proteins, the amount in milk is likely to be low. It is sometimes given in combination with rituximab, which may increase the risk to the infant. The manufacturer recommends that breastfeeding be discontinued during idelalisib therapy and for at least 1 month after the last dose.
  • Idursulfase and breast feeding No information is available on the clinical use of idursulfase during breastfeeding. Because it is a large protein molecule with a molecular weight of about 76,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Iloperidone and breast feeding Because no information is available on the use of iloperidone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Imatinib and breast feeding Limited information indicates that maternal doses of imatinib up to 400 mg daily produce low levels of the drug and its active metabolite in milk. Although a few breastfed infants apparently experienced no adverse effects during maternal use of imatinib, no long-term data are available. Until more data are available, imatinib should be used only with careful monitoring during breastfeeding. The manufacturer and some authors recommend that breastfeeding be discontinued during imatinib therapy and for 1 month after therapy.
  • Imiglucerase and breast feeding Imiglucerase is a synthetic form of beta-glucocerebrosidase, which is a normal component of human milk. After therapeutic use of imiglucerase, breastmilk levels are lower than those of normal mothers. Additionally, absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. A limited amount of data support the safety of breastfeeding with imiglucerase. An international panel of clinicians from 9 centers that treat Gaucher's disease reported that, breastfeeding complications were less frequent in mothers who were treated with imiglucerase or alglucerase (the placenta-derived form of the enzyme) postpartum than in untreated mothers with Gaucher's disease. Consider limiting the duration of breastfeeding to about 6 months to avoid excessive bone loss in the nursing mother.
  • Imipenem and Cilastatin and breast feeding Limited information indicates that imipenem produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush has been reported with beta-lactams, but these effects have not been adequately evaluated. Imipenem-cilastatin and imipenem-cilastatin-relebactam are acceptable in nursing mothers.
  • Imipramine and breast feeding Milk levels of imipramine and its metabolite are low and have not been detected in the serum of breastfed infants. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Imipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Some experts consider imipramine one of the antidepressants of choice for nursing mothers. Other agents with may be preferred when large doses are required or while nursing a newborn or preterm infant.
  • IncobotulinumtoxinA and breast feeding No data exist on the medical use of incobotulinumtoxinA during breastfeeding. However, one infant was safely breastfed during maternal botulism and no botulinum toxin was detectable in the mother's milk or infant. Since the doses used medically are far lower than those that cause botulism, amounts ingested by the infant, if any, are expected to be small and not cause any adverse effects in breastfed infants. No special precautions are required.
  • Indacaterol and breast feeding Although no published data exist on the use of indacaterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Indapamide and breast feeding No information is available on the amount of indapamide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over indapamide.
  • Indinavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with indinavir during breastfeeding is limited. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Indium 111 Ibritumomab Tiuxetan and breast feeding Information in this record refers to the use of indium 111 ibritumomab tiuxetan as a diagnostic agent. No information is available on the use of indium 111 ibritumomab tiuxetan during breastfeeding. Because of the long half-life of indium 111 and the potential for serious adverse reactions in nursing infants, the manufacturer recommends not administering the drug in women who wish to continue breastfeeding. If the drug is administered to a nursing mother, breastfeeding should be discontinued. If the drug is given, breastfeeding should be discontinued.
  • Indium In 111 Pentetate and breast feeding Information in this record refers to the use of indium In 111 pentetate as a diagnostic agent. No information is available on the use of indium In 111 pentetate during breastfeeding. Because of the long half-life of indium 111 and the potential for serious adverse reactions in nursing infants, it is best to avoid the drug in women who wish to continue breastfeeding. If the drug is given, breastfeeding should be discontinued.
  • Indomethacin and breast feeding Because of the low levels of indomethcin in breastmilk and therapeutic administration directly to infants, it is acceptable to use in nursing mothers. However, other agents with more published information on use during lactation may be preferable, especially while nursing a newborn or preterm infant.
  • Infliximab and breast feeding Infliximab is usually either not detectable in breastmilk or detectable at very low levels. Absorption of the drug from milk by the infant is minimal. Follow-up of infants exposed in utero and breastfed during maternal infliximab therapy have found no adverse effects and normal development. The measurement of minute concentrations in the milk of some women raises the possibility of local immune suppression in the gastrointestinal tact, but levels were not high enough to be of concern for systemic immunosuppression. Although the manufacturer recommends that breastfeeding be discontinued during infliximab therapy, numerous experts have stated that the drug is a low risk to the nursing infant and breastfeeding can continue during infliximab use.
  • Influenza Vaccines and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to either the live, attenuated (i.e., inhaled) or inactivated (i.e., injected) influenza vaccine, including H1N1 (swine) influenza vaccine. Immunization of the mother during pregnancy increases the amount of influenza antibodies in breastmilk and may offer added protection of their breastfed infants against influenza. Breastmilk antibody responses are higher with the inactivated influenza vaccine than with the live oral vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Inotuzumab Ozogamicin and breast feeding No information is available on the clinical use of inotuzumab oxogamicin during breastfeeding. Because inotuzumab oxogamicin is a large protein molecule with a molecular weight of 168,000 and its active metabolite is 97% plasma protein bound, the amount in milk is likely to be very low. However, the half-life of inotuzumab oxogamicin is about 12.3 days and it might accumulate in the infant. Until more data become available, inotuzumab oxogamicin should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during inotuzumab oxogamicin therapy for at least 2 months after the last dose.
  • Insect Repellent M 3535 and breast feeding No published information is available on the clinical use of insect repellent M 3535 (IR3535) during breastfeeding. However, the Centers for Disease Control and Prevention and U.S. Environmental Protection Agency consider IR3535 to be safe and effective during breastfeeding when used as directed. It should be used by breastfeeding women to avoid exposure to mosquito-borne viruses. Avoid application directly to the nipple and other areas where the infant might directly ingest the product.
  • Interferon Beta and breast feeding The levels of interferon beta-1a in breastmilk are minuscule. In addition, because interferon is poorly absorbed orally, it is not likely to reach the bloodstream of the infant. A small number of nursing mothers receiving interferon beta-1a while partially breastfeeding their infants and one woman exclusively breastfed her infant while taking interferon beta-1b and reported no adverse effects. The Multiple Sclerosis Centre of Excellence on Reproduction and Child Health considers interferon beta to be "moderately safe" to use during breastfeeding, and a French consensus group of neurologists concluded that interferon beta can be used during breastfeeding. No special precautions appear to be required during breastfeeding while using interferon beta. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous interferon-gamma by an average about 10%.
  • Interferon Gamma-1b and breast feeding Interferon gamma is a normal component of human milk. No data are available on the use of exogenous interferon gamma 1b during breastfeeding. However, the amounts of the similar drugs, interferon alfa and interferon beta-1a, excreted into milk are very low. Any interferon in breastmilk is probably destroyed in the infant's gastrointestinal tract and not absorbed, except perhaps in neonates. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous interferon-gamma by an average about 10%.
  • Intrauterine Copper Contraceptive and breast feeding The copper IUD is acceptable to use during breastfeeding as a long-term contraceptive. It has been studied extensively during lactation in comparison with other forms of contraception and does not affect lactation performance or the milk copper concentration. In women who are breastfeeding, insertion of the device should be after 4 weeks postpartum. A meta-analysis found that uterine perforation with IUD insertion was 6 to 10 times more likely in breastfeeding mothers than in non-breastfeeding women, but that the risk of expulsion was no greater in breastfeeding mothers. A more recent prospective study found a slight increase in the risk of expulsion of intrauterine devises with breastfeeding, and the American College of Obstetrics and Gynecology recommends that women be counseled that immediate postpartum insertion may have a higher expulsion rate than later insertion. The copper IUD is considered to be the most effective emergency contraceptive when inserted up to 5 days after unprotected intercourse.
  • Iodipamide and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with iodipamide during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Iodixanol and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. One report of very small amounts of iodine from iodixanol in breastmilk supports this generalization. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium.
  • Iohexol and breast feeding Limited information indicates that maternal doses of iohexol up to 45.3 grams (containing 21 grams of iodine) produce low levels in milk. In addition, because iohexol is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. The manufacturer states that withholding breastfeeding for 10 hours after administration to minimize the exposure of the infant; however, guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium.
  • Iomeprol and breast feeding Iomeprol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Labeling for the drug in the United Kingdom and guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium such as iomeprol.
  • Iopamidol and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with iopamidol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Iopromide and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with iopromide during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Iothalamate and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with iothalamate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ioversol and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with ioversol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ioxaglate and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with ioxaglate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ioxilan and breast feeding Intravenous iodinated contrast media are poorly excreted into breastmilk and poorly absorbed orally so they are not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives a iodine-containing contrast medium. However, because there is no published experience with ioxilan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ipratropium and breast feeding Although no published data exist on the use of ipratropium, its use produces negligible maternal serum levels and any drug in breastmilk would not be absorbed by the infant. The risk to the breastfed infant of maternal ipratropium inhalation is small.
  • Irbesartan and breast feeding Because no information is available on the use of irbesartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Irinotecan and breast feeding Limited data indicate that irinotecan is found in breastmilk for 2 days and its active metabolite is found in breastmilk for up to a week after a dose of 60 mg/square meter, although the highest amounts occur during the first 4 days after a dose. Higher maternal doses have not been studied and the oral absorption and toxicity in breastfed infants are not known. Based on this limited evidence, it appears that breastfeeding should be avoided for at least a week after a dose of irinotecan 60 mg/square meter. Higher dosages probably require a longer abstinence period. Some authors recommend discontinuing breastfeeding during irinotecan therapy. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Iron Dextran and breast feeding Limited data indicate that trace amounts of iron dextran are excreted into breastmilk. No information is available on the clinical use of iron dextran during breastfeeding. However, intravenous iron dextran has been used in preterm infants for anemia of prematurity and would not be expected to cause any adverse effects in breastfed infants. An alternate intravenous drug with more published data available may be preferred. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Iron Isomaltoside 1000 and breast feeding Iron isomaltoside 1000 is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited data indicate that breastmilk iron is increased 3 days after an intravenous infusion of iron isomaltoside, but within the normal range. By 7 days after the dose, breastmilk iron levels were similar to that of mothers taking oral iron. Iron isomaltoside 1000 appears to be acceptable to use in nursing mothers with no special precautions required. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Iron Sucrose and breast feeding Limited data indicate that breastmilk iron is not increased after intravenous infusion of iron sucrose. Amounts of iron ingested by the infant would be normal and are not expected to cause any adverse effects in breastfed infants. The oral form of the drug, called sucroferric oxyhydroxide and used as a phosphate binder, is not orally absorbed it is unlikely to reach the breastmilk or adversely affect the breastfed infant. No special precautions are required. Pasteurization of milk by the Holder method reduces the concentration of iron in milk by about 6.5%.
  • Isoetharine and breast feeding Although no published data exist on the use of isoetharine during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Isoflurane and breast feeding There is no published experience with isoflurane during breastfeeding. Because the serum half-life of isoflurane in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. It is possible that requirements for other anesthetic agents would be affected similarly.
  • Isoniazid and breast feeding The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking isoniazid. Nursing mothers who are taking isoniazid should take 25 mg of oral pyridoxine daily. Because of the low levels of isoniazid in breastmilk and safe administration directly to infants, it is unlikely to cause adverse reactions in infants, but infants should be monitored for rare instances jaundice. Giving the maternal once-daily dose before the infant's longest sleep period will decrease the dose the infant receives. The amount of isoniazid in milk is insufficient to treat tuberculosis in the breastfed infant. If breastfed infants are treated with isoniazid, they should also receive pyridoxine 1 mg/kg daily.
  • Isotretinoin and breast feeding No information is available on the use of isotretinoin during breastfeeding. Various topical agents that are less likely to be absorbed by the mother may be preferred during breastfeeding, especially while nursing a newborn or preterm infant.
  • Isradipine and breast feeding Because no information is available on the use of isradipine during breastfeeding, an alternate drug may be preferred.
  • Itraconazole and breast feeding No information is available on the clinical use of itraconazole during breastfeeding. However, limited data indicate that maternal itraconazole produces levels in milk that are less than the 5 mg/kg daily doses that have been recommended to treat infants. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ivacaftor and breast feeding Information from one maternal-infant pair with ivacaftor and lumacaftor indicates that maternal ivacaftor therapy produce low levels in milk. The breastfed infant had transient elevations in bilirubin and liver enzymes during maternal therapy that could not definitively be attributed to the drugs in breastmilk. Effect of small amounts of ivacaftor in infants and small children is unknown. Until more data are available, monitoring of infant bilirubin and liver enzymes is recommended during breastfeeding with maternal lumacaftor and ivacaftor therapy.
  • Ivermectin and breast feeding Limited data indicate that ivermectin is poorly excreted into breastmilk after oral administration. Amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No data are available on excretion after topical administration, but amounts in breastmilk should be less than after oral administration. Avoid application to the breast area where the infant might directly ingest the drug.
  • Ivosidenib and breast feeding No information is available on the clinical use of ivosidenib during breastfeeding. Because ivosidenib is 92 to 96% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 93 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during erlotinib therapy and for 1 month after the dose.
  • Ixazomib and breast feeding No information is available on the clinical use of ixazomib during breastfeeding. Because its half-life is about 9.5 days, it is likely to accumulate in the infant. It is also given in combination with leflunomide and dexamethasone, which may increase the risk to the infant. The manufacturer recommends that breastfeeding be discontinued during ixazomib therapy and for 90 days after the last dose.
  • Ixekizumab and breast feeding No information is available on the clinical use of ixekizumab during breastfeeding. Because ixekizumab is a large protein molecule with a molecular weight of 146,000, absorption by the infant is unlikely after the first few weeks postpartum, and it will probably be destroyed in the infant's gastrointestinal tract. Until more data become available, ixekizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.

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  • Japanese Encephalitis Vaccine and breast feeding Data concerning the safety of Japanese encephalitis vaccine during breastfeeding are not available. However, the Centers for Disease Control and Prevention and several health professional organizations state that in general vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants. Therefore, breastfeeding is not a contraindication to Japanese encephalitis vaccine in mothers who require it. Breastfed infants should be vaccinated according to the routine recommended schedules.

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  • Kanamycin and breast feeding If kanamycin is required by the mother, it is not a reason to discontinue breastfeeding. Kanamycin is poorly excreted into breastmilk. Newborn infants apparently absorb small amounts of other aminoglycosides, but serum levels with typical three times daily dosages are far below those attained when treating newborn infections and systemic effects of kanamycin are unlikely. Older infants would be expected to absorb even less kanamycin. Because there is little variability in the milk kanamycin levels during multiple daily dose regimens, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure. Data are not available with single daily dose regimens. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
  • Ketamine and breast feeding Breastmilk levels of ketamine have not been measured after administration to humans. Minimal data indicated that ketamine use in nursing mothers may not affect the breastfed infant or lactation. Until more data are available, ketamine should only be used with careful monitoring during breastfeeding. Alternate agents are preferred.
  • Ketoprofen and breast feeding Although ketoprofen has low levels in breastmilk, one center reported that they had received reports of adverse renal and gastrointestinal side effects in breastfed infants whose mothers were taking ketoprofen. Other agents are preferred, especially while nursing a newborn or preterm infant.
  • Ketotifen and breast feeding Because absorption from the eye is limited, ketotifen would not be expected to cause any adverse effects in breastfed infants after maternal use of ketotifen eye drops. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Krypton Kr 81m and breast feeding Information in this record refers to the use of krypton Kr 81m as a diagnostic agent. The International Commission on Radiological Protection and other experts state that breastfeeding need not be interrupted after administration of krypton Kr 81m gas.

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  • Labetalol and breast feeding Because of the low levels of labetalol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in fullterm breastfed infants. No special precautions are required in most infants. However, other agents may be preferred while nursing a preterm infant.
  • Lacosamide and breast feeding Limited information indicates that a maternal dose of 200 mg daily produce low levels in milk. Dosages up to 400 mg daily appeared to not adversely affect development in 3 infants who were breastfed for 7 to 9 months. Until more data are available lacosamide should only be used with careful monitoring during breastfeeding, especially while nursing a newborn or preterm infant.
  • Lanreotide and breast feeding The excretion of lanreotide into breastmilk has not been studied. However, because it has a high molecular weight of 1096 daltons it is likely to be poorly excreted into breastmilk and it is a peptide that is likely digested in the infant's gastrointestinal tract, so it is unlikely to reach the clinically important levels in infant serum. Lanreotide has been given by injection to newborn infants with congenital hyperinsulinemia; reversible mild elevation of liver enzymes occurred in some infants. The manufacturer states that women should not breastfeed during treatment with depot lanreotide and for 6 months following the last dose.
  • Lansoprazole and breast feeding No information is available on the use of lansoprazole during breastfeeding. However, lansoprazole has been used safely in newborn infants, so it is unlikely that the amount in breastmilk would be harmful.
  • Lapatinib and breast feeding No information is available on the clinical use of lapatinib during breastfeeding. Because lapatinib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 24 hours and it might accumulate in the infant. It is also given in combination with capecitabine, which may increase the risk to the infant. The manufacturer recommends that breastfeeding be discontinued during lapatinib therapy and for 1 week after the last dose.
  • Laronidase and breast feeding Limited information from on mother receiving laronidase for mucopolysaccharidosis type I indicates that the drug is not detectable in breastmilk and her breastfed infant suffered no adverse reactions or adverse developmental effects from the drug in milk. If laronidase is required by the mother, it is not a reason to discontinue breastfeeding. Until more data are available, laronidase should be used with careful monitoring during breastfeeding.
  • Latanoprost and breast feeding No information is available on the use of latanoprost during breastfeeding. Because of its short half-life it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Latanoprostene Bunod and breast feeding No information is available on the use of latanoprostene bunod during breastfeeding. Because of the extremely low levels in plasma after application to the eye, it is not likely to reach the breastmilk or bloodstream of the infant or to cause any adverse effects in breastfed infants. To further diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Leflunomide and breast feeding No information is available on the use of leflunomide during breastfeeding, so an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Lenvatinib and breast feeding No information is available on the clinical use of lenvatinib during breastfeeding. Because lenvatinib is more than 98% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 28 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during lenvatinib therapy and for 1 week after the last dose.
  • Lepirudin and breast feeding Lepirudin is no longer marketed in the United States. Limited information indicates that lepirudin in doses up to 100 mg daily produce very low levels in milk. Because of its large molecular weight, it would not be expected to be absorbed from breastmilk by the infant. Lepirudin would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Letermovir and breast feeding No information is available on the use of letermovir during breastfeeding. Because letermovir is 99% bound to plasma proteins, the amount in milk is likely to be very low. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Letrozole and breast feeding No information is available on the use of letrozole during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during letrozole therapy and for 3 weeks after the last dose.
  • Levetiracetam and breast feeding Maternal doses of levetiracetam up to 3500 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. If levetiracetam is required by the mother, it is not a reason to discontinue breastfeeding. However, the infant should be monitored for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants. Maternal serum level monitoring and dosage adjustment is advisable in the early postpartum period if the drug was taken throughout pregnancy and breastfeeding. Some evidence suggests that levetiracetam might reduce the maternal breastmilk supply in some women.
  • Levobunolol and breast feeding Based on its physicochemical properties and its ophthalmic route of administration, levobunolol appears to present a moderately low risk to the breastfed infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Levocabastine and breast feeding Because absorption from the eye is limited, levocabastine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Levodopa and breast feeding Limited data indicate that levodopa is poorly excreted into breastmilk and that the sustained-release product may result in a smaller amount of drug transferred to the breastfed infant than with the immediate-release product. Several studies indicate that levodopa can decrease serum prolactin during lactation. The prolactin level in a mother with established lactation may not affect her ability to breastfeed. The effect of long-term use of levodopa on breastfeeding has not been adequately evaluated, although some mothers were able to successfully breastfeed her infant without apparent harm while using relatively low doses of levodopa and carbidopa for Parkinson's disease.
  • Levomilnacipran and breast feeding Levomilnacipran has not been studied in nursing mothers and the manufacturer recommends that nursing mothers not take levomilnacipran. Because no information is available on the use of levomilnacipran during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Levonorgestrel Implant and breast feeding This record contains information specific to the levonorgestrel implant, which is not available in the United States. Although nonhormonal methods are preferred during breastfeeding, progestin-only contraceptives such as levonorgestrel are considered the hormonal contraceptives of choice during lactation. Fair quality evidence indicates that levonorgestrel does not adversely affect the composition of milk, the growth and development of the infant or the milk supply. Expert opinion holds that the risks of progestin-only contraceptive products usually are acceptable for nursing mothers at any time postpartum. Some evidence indicates that progestin-only contraceptives may offer protection against bone mineral density loss during lactation, or at least do not exacerbate it.
  • Levothyroxine and breast feeding Levothyroxine (T4) is a normal component of human milk. Limited data on exogenous replacement doses of levothyroxine during breastfeeding indicate no adverse effects in infants. The American Thyroid Association recommends that subclinical and overt hypothyroidism should be treated with levothyroxine in lactating women seeking to breastfeed. Levothyroxine dosage requirement may be increased in the postpartum period compared to prepregnancy requirements patients with Hashimoto's thyroiditis.
  • Lifitegrast and breast feeding Breastmilk levels of lifitegrast have not been measured in humans. Because absorption from the eye is limited, ophthalmic lifitegrast would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Linaclotide and breast feeding No information is available on the use of linaclotide during breastfeeding. Linaclotide is minimally absorbed from the gastrointestinal tract and the drug and its active metabolite is not measurable in plasma following administration of recommended doses. Linaclotide would not be expected to enter the breastmilk and cause any adverse effects in breastfed infants
  • Linagliptin and breast feeding No information is available on the clinical use of linagliptin during breastfeeding. Linagliptin's plasma protein binding ranges from 80% to over 99%, so it is unlikely to pass into breastmilk in clinically important amounts and might be a better choice among drugs in this class for nursing mothers. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with linagliptin.
  • Lindane and breast feeding Topical application of lindane can increase lindane milk levels for at least several days. Because it is potentially toxic in infants, is a persistent environmental contaminant, and possibly has estrogenic effects that could decrease lactation as well as affect the nursing infant, another agent is preferred.
  • Liothyronine and breast feeding Liothyronine (T3) is a normal component of human milk. If replacement doses of liothyronine are required by the mother, it is not necessarily a reason to discontinue breastfeeding. However, because no information is available on the use of exogenous liothyronine during breastfeeding, an alternate drug may be preferred. The American Thyroid Association recommends that subclinical and overt hypothyroidism should be treated with levothyroxine in lactating women seeking to breastfeed. Liothyronine dosage requirement may be increased in the postpartum period compared to prepregnancy requirements patients with Hashimoto's thyroiditis.
  • Liotrix and breast feeding Liotrix is a mixture of levothyroxine (T4) and liothyronine (T3), which are normal components of human milk. Limited data on exogenous replacement doses of levothyroxine during breastfeeding indicate no adverse effects in infants. No information is available on the use of exogenous liothyronine during breastfeeding. The American Thyroid Association recommends that subclinical and overt hypothyroidism should be treated with levothyroxine in lactating women seeking to breastfeed. Thyroid dosage requirement may be increased in the postpartum period compared to prepregnancy requirements patients with Hashimoto's thyroiditis.
  • Liraglutide and breast feeding No information is available on the clinical use of liraglutide during breastfeeding. Because liraglutide is a large peptide molecule with a molecular weight of 3751 daltons, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, liraglutide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Lisdexamfetamine and breast feeding Lisdexamfetamine is a prodrug of dextroamphetamine. In dosages prescribed for medical indications, some evidence indicates that dextroamphetamine might not affect nursing infants adversely. The effect of dextroamphetamine in milk on the neurological development of the infant has not been well studied. It is possible that large dosages of dexroamphetamine might interfere with milk production, especially in women whose lactation is not well established. Relevant published information was not found as of the revision date on the safety of breastfeeding during amphetamine abuse. One expert recommends that amphetamines not be used therapeutically in nursing mothers.
  • Lisinopril and breast feeding Because no information is available on the use of lisinopril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Lisuride and breast feeding Lisuride is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. It lowers serum prolactin and is approved in some countries for lactation suppression. Some experts recommend lisuride as a safer alternative to bromocriptine for lactation suppression, but others recommend avoiding all lactation suppressants. Data are insufficient recommend one treatment for lactation suppression over another.
  • Lixisenatide and breast feeding No information is available on the clinical use of lixisenatide during breastfeeding. Because lixisenatide is a large peptide molecule with a molecular weight of 4858 daltons, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, lixisenatide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Lodoxamide and breast feeding Although no published data exist on the use of lodoxamide during lactation, maternal milk levels are likely to be very low after the use eye drops. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Lofexidine and breast feeding No information is available on the use of lofexidine during breastfeeding. Lofexidine is chemically and pharmacologically related to clonidine, which reaches high levels in milk and in the breastfed infant. Although it is not contraindicated during breastfeeding, lofexidine should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Lomefloxacin and breast feeding No information is available on the use of lomefloxacin during breastfeeding. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of lomefloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available.
  • Lomitapide and breast feeding No relevant published information exists with the use of lomitapide during breastfeeding. Because of a concern with disruption of infant lipid metabolism and possible tumorigenicity, lomitapide should not be used during breastfeeding.
  • Lopinavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Lopinavir has been well studied during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Loracarbef and breast feeding Although no information is available on the use of loracarbef during breastfeeding, beta-lactam antibiotics are generally not be expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with beta-lactams, but these effects have not been adequately evaluated. Loracarbef is acceptable in nursing mothers.
  • Loratadine and breast feeding Because of its lack of sedation and low milk levels, maternal use of loratadine would not be expected to cause any adverse effects in breastfed infants. Loratadine might have a negative effect on lactation, especially in combination with a sympathomimetic agent such as pseudoephedrine. The British Society for Allergy and Clinical Immunology recommends loratadine at its lowest dose as a preferred choice if an antihistamine is required during breastfeeding.
  • Lorazepam and breast feeding Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is safely administered directly to infants. Evidence from nursing mothers indicates that lorazepam does not cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.
  • Lorlatinib and breast feeding No information is available on the clinical use of lorlatinib during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during lorlatinib therapy and for 7 days after the last dose.
  • Lormetazepam and breast feeding Lormetazepam is not approved for marketing in the United States by the U.S. Food and Drug Administration. Lormetazepam has low levels in breastmilk and a short half-life relative to many other benzodiazepines. Limited evidence from nursing mothers indicates that lorazepam does not cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.
  • Losartan and breast feeding Because no information is available on the use of losartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Loteprednol and breast feeding No information is available on the ophthalmic use of loteprednol during breastfeeding. Because absorption from the eye is limited, ophthalmic loteprednol would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Lovastatin and breast feeding No relevant published information exists on the use of lovastatin during breastfeeding. Because of a concern with disruption of infant lipid metabolism, the consensus is that lovastatin should not be used during breastfeeding. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Loxapine and breast feeding Because no information is available on the use of loxapine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Lubiprostone and breast feeding No information is available on the use of lubiprostone during breastfeeding. The manufacturer reports that the drug and its metabolite are undetectable in rat milk and would not be expected to cause any adverse effects in a breastfed infant. Monitor the breastfed infant for diarrhea.
  • Luliconazole and breast feeding Topical luliconazole has not been studied during breastfeeding. Because it is poorly absorbed after topical use and is highly plasma protein bound, it is a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Lumacaftor and Ivacaftor and breast feeding Information from one maternal-infant pair indicates that maternal lumacaftor and ivacaftor therapy produce low levels in milk. The breastfed infant had transient elevations in bilirubin and liver enzymes during maternal therapy that could not definitively be attributed to the drugs in breastmilk. Effect of small amounts of these compounds in infants and small children is unknown. Until more data are available, monitoring of infant bilirubin and liver enzymes is recommended during breastfeeding with maternal lumacaftor and ivacaftor therapy.
  • Lurasidone and breast feeding Lurasidone is more than 99% bound to plasma proteins. so it is unlikely that the drug would be excreted into milk in sufficient amounts to affect a breastfed infant. But since there is no published experience with lurasidone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Table of contents:

.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

.N | .O | .P | .Q | .R | .S | .T | .U | .V | .W | .X | .Y | .Z

M

  • Magnesium Aspartate and breast feeding No information is available on the excretion of magnesium following magnesium aspartate during breastfeeding. However, other magnesium salts have been studied. Intravenous magnesium sulfate increases milk magnesium concentrations only slightly. Oral absorption of magnesium by the infant is poor, so maternal magnesium aspartate is not expected to affect the breastfed infant's serum magnesium. Magnesium aspartate supplementation during pregnancy might delay the onset of lactation, but it can be taken during breastfeeding and no special precautions are required.
  • Magnesium Citrate and breast feeding No information is available on the clinical use of magnesium citrate during breastfeeding. However, other magnesium salts have been studied. Intravenous magnesium sulfate increases milk magnesium concentrations only slightly. Oral absorption of magnesium by the infant is poor, so maternal magnesium citrate is not expected to affect the breastfed infant's serum magnesium. Magnesium citrate supplementation during pregnancy might delay the onset of lactation, but it can be taken during breastfeeding and no special precautions are required.
  • Magnesium Hydroxide and breast feeding A study on the use of magnesium hydroxide during breastfeeding found no adverse reactions in breastfed infants. Intravenous magnesium increases milk magnesium concentrations only slightly. Oral absorption of magnesium by the infant is poor, so maternal magnesium hydroxide is not expected to affect the breastfed infant's serum magnesium. Magnesium hydroxide supplementation during pregnancy might delay the onset of lactation, but it can be taken during breastfeeding and no special precautions are required.
  • Magnesium Oxide and breast feeding No information is available on the clinical use of magnesium oxide during breastfeeding. However, other magnesium salts have been studied. A study on the use of magnesium hydroxide during breastfeeding found no adverse reactions in breastfed infants. Intravenous magnesium increases milk magnesium concentrations only slightly. Oral absorption of magnesium by the infant is poor, so maternal magnesium hydroxide is not expected to affect the breastfed infant's serum magnesium. Magnesium oxide supplementation during pregnancy might delay the onset of lactation, but it can be taken during breastfeeding and no special precautions are required.
  • Magnesium Sulfate and breast feeding Intravenous magnesium increases milk magnesium concentrations only slightly and oral absorption of magnesium by the infant is poor, so maternal magnesium therapy is not expected to affect the breastfed infant's serum magnesium. Although intravenous magnesium sulfate given prior to delivery might affect the infant's ability to breastfeed, intention to breastfeed may be a more important determinant of breastfeeding initiation. Postpartum use of intravenous magnesium sulfate for longer than 6 hours appears to delay the onset of lactation.
  • Malathion and breast feeding Malathion appears to be poorly absorbed after topical application, so it is not likely to reach the breastmilk in large amounts. However, breastmilk excretion of malathion has not been studied after application of the 0.5% lotion. Until more data become available, an alternate agent is preferred.
  • Mangafodipir and breast feeding Mangafodipir is a chelate of manganese that releases free manganese ions into the bloodstream after it is metabolized. Because there is no published experience with mangafodipir during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Maprotiline and breast feeding Because there is little published experience with maprotiline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Maraviroc and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of maraviroc during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission.Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Measles-Mumps-Rubella Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to MMR vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Although rubella vaccine virus might be excreted into milk, the virus usually does not infect the infant. If an infection does occur, it is well tolerated because the viruses are attenuated. No clear evidence exists of live attenuated measles or mumps vaccine virus excretion into breastmilk.
  • Measles-Mumps-Rubella-Varicella Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to measles, mumps, rubella and varicella virus vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Although rubella vaccine virus might be excreted into milk, the virus usually does not infect the infant. If an infection does occur, it is well tolerated because the viruses are attenuated. No clear evidence exists of live attenuated measles or mumps vaccine virus excretion into breastmilk.
  • Mebendazole and breast feeding Limited data indicate that mebendazole is poorly excreted into breastmilk and poorly absorbed orally. Reports on the use of mebendazole during breastfeeding have found no adverse reactions in breastfed infants. There are rare case reports of a decrease in milk supply following use of mebendazole, but no convincing evidence that these were caused by the drug. No special precautions are required.
  • Meclizine and breast feeding Occasional doses of meclizine are probably acceptable during breastfeeding. Large doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established.
  • Meclofenamate and breast feeding Because no information is available on the use of meclofenamate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Mefenamic Acid and breast feeding Because there is little published experience with mefenamic acid during breastfeeding and it is potentially toxic, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Mefloquine and breast feeding Very small amounts of mefloquine are excreted in breastmilk; the amount of drug is not sufficient to harm the infant nor is the quantity sufficient to protect the child from malaria. Breastfeeding infants should receive the recommended dosages of mefloquine.
  • Meloxicam and breast feeding Because no information is available on the use of meloxicam during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Meningococcal Vaccines and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to meningococcal vaccine. Immunization of the mother during the third trimester of pregnancy markedly increases the amount of meningococcal antibodies in breastmilk. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Mepenzolate and breast feeding No information is available on the use of mepenzolate during breastfeeding. Because mepenzolate is a quaternary ammonium compound, it is not likely to be absorbed and reach the bloodstream of the infant. Long-term use of mepenzolate might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Mepolizumab and breast feeding No information is available on the clinical use of mepolizumab during breastfeeding. Because mepolizumab is a large protein molecule with a molecular weight of 149,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, mepolizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Meprobamate and breast feeding If meprobamate is required by the mother, it is not necessarily a reason to discontinue breastfeeding. However, because there is little published experience with meprobamate during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant, or when other drugs that can cause sedation are used simultaneously.
  • Meropenem and breast feeding Although no information is available on the use of meropenem during breastfeeding, milk levels appear to be low and beta-lactams are generally not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with beta-lactams, but these effects have not been adequately evaluated. Vaborbactam, which is available in the combination product Vabomere, has not been studied in nursing mothers, but the combination is expected to have similar concerns as with meropenem alone.
  • Mesalamine and breast feeding Mesalamine is poorly excreted into breastmilk. However, rather high levels of the mesalamine metabolite N-acetyl-5-ASA appear in breastmilk and its effects on breastfed infants are unknown. A few cases of diarrhea have been reported in infants exposed to mesalamine, although the rate is not high. Most experts consider mesalamine derivatives to be safe during breastfeeding. If mesalamine is required by the mother, it is not a reason to discontinue breastfeeding, but carefully observe breastfed infants for diarrhea during maternal use of mesalamine.
  • Metaproterenol and breast feeding Although no published data exist on the use of metaproterenol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Metformin and breast feeding Data from well-conducted studies indicate that metformin levels in milk are low and infants would receive less than 0.5% of their mother's weight-adjusted dosage. Milk metformin levels are relatively constant during maternal metformin use, so timing of breastfeeding with respect to the administration times is of little benefit. Although the dose in milk is low, metformin is sometimes detectable in low levels in the serum of breastfed infants. One sizeable prospective study found no adverse effects in breastfed infants. Metformin should be used with caution while nursing newborn and premature infants and those with renal impairment.
  • Methazolamide and breast feeding Because no information is available on the use of methazolamide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Methenamine and breast feeding Both the hippurate and mandelate salts of methenamine pass into milk in small quantities and appear acceptable to use, even while nursing a newborn.
  • Methicillin and breast feeding Amounts of methicillin ingested by the infant in breastmilk are small and would not be expected to cause any adverse effects. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Methicillin is acceptable in nursing mothers.
  • Methohexital and breast feeding Amounts of methohexital in milk are very small. Existing data indicate that no waiting period is required before resuming breastfeeding after a single dose of methohexital. Breastfeeding can be resumed as soon as the mother has recovered sufficiently to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Methoxsalen and breast feeding No information is available on the use of methoxsalen during breastfeeding. Expert opinion indicates that due to the photosensitizing effects of methoxsalen, breastfeeding should be withheld for 24 hours after an oral dose to allow for 95% of the drug to be eliminated in the mother's urine. The same precaution probably applies to patients receiving methoxsalen as a part of therapy for cutaneous T-cell lymphoma. Use of topical methoxsalen is not contraindicated during breastfeeding, but avoid direct contact of the treated skin with the skin of the infant.
  • Methyclothiazide and breast feeding No information is available on the amount of methyclothiazide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over methyclothiazide.
  • Methyldopa and breast feeding Because of the low levels of methyldopa in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Methylphenidate and breast feeding In dosages prescribed for medical indications, limited evidence indicates that methylphenidate levels in milk are very low and not detectable in infant serum. The effects of methylphenidate in milk on the neurological development of the infant have not been well studied. If methylphenidate is required by the mother, it is not a reason to discontinue breastfeeding. It is possible that large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established.
  • Methylprednisolone and breast feeding Amounts of methylprednisolone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With maternal intravenous doses of methylprednisolone 1 gram, fully breastfed infants would receive doses less than their daily cortisol output, and much less than a therapeutic dose on the day of infusion; accumulation of the drug does not occur in breastmilk with 3 consecutive daily doses. Avoiding breastfeeding during the infusion for as little as 2 hours after a 1 gram intravenous dose would markedly reduce infant exposure. Breastfeeding abstinence for 2 to 4 hours would further reduce the infant dose. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply.
  • Metipranolol and breast feeding Based on its physicochemical properties and its ophthalmic route of administration, metipranolol eye drops would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Metolazone and breast feeding No information is available on the amount of metolazone in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over metolazone.
  • Metoprolol and breast feeding Because of the low levels of metoprolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies on the use of metoprolol during breastfeeding have found no adverse reactions in breastfed infants. No special precautions are required.
  • Metyrapone and breast feeding Evidence from two patients indicate that amounts of metyrapone and its active metabolite in breastmilk are very small and unlikely to adversely affect a breastfed infant. Exposure of the infant can be markedly decreased by avoiding nursing for 2 to 2.5 hours after each dose.
  • Mexiletine and breast feeding Limited information indicates that maternal doses of mexiletine up to 600 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Because of the relative lack of data concerning breastfeeding during maternal mexiletine therapy, exclusively breastfed infants should be carefully monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
  • Mianserin and breast feeding Mianserin is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal doses up to 60 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Until more data are available, mianserin should be used with careful monitoring during breastfeeding.
  • Miconazole and breast feeding Because miconazole has poor oral bioavailability, it is unlikely to adversely affect the breastfed infant, including topical application to the nipples. However, miconazole ointment appears to have no advantage over lanolin for treating sore nipples during breastfeeding and a survey of members of the Academy of Breastfeeding Medicine found topical miconazole is rarely prescribed to nursing mothers to treat thrush. Any excess cream or ointment should be removed from the nipples before nursing. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Midazolam and breast feeding The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing. However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age. After general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. With prolonged use (days) of intravenous therapy, an active metabolite can accumulate in the mother and might affect the infant, but data in breastfeeding are lacking.
  • Midostaurin and breast feeding No information is available on the clinical use of midostaurin during breastfeeding. Because midostaurin and its active metabolites are 99.8% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during midostaurin therapy and for at least 4 months after the last dose. Avoiding breastfeeding is particularly important when midostaurin is given with other cancer chemotherapy agents.
  • Mifepristone and breast feeding Limited information indicates that breastfeeding need not be interrupted after a single dose of mifepristone. A dose of 200 mg might be preferable to a 600 mg dose in nursing mothers
  • Migalastat and breast feeding No information is available on the use of migalastat during breastfeeding. Because no information is available on the use of migalastat during breastfeeding caution should be used, especially while nursing a newborn or preterm infant.
  • Miglitol and breast feeding Limited data indicate that miglitol is poorly excreted into breastmilk. Because miglitol is also poorly absorbed orally, it is unlikely to adversely affect the breastfed infant.
  • Milnacipran and breast feeding Milnacipran has not been studied in nursing mothers and the manufacturer recommends that nursing mothers not take milnacipran. Because no information is available on the use of milnacipran during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Mineral Oil and breast feeding Small amounts of mineral oil can be found in breastmilk, apparently from absorption of hydrocarbons from cosmetics over long periods of time. Because mineral oil is poorly absorbed orally, little or none will not reach the bloodstream of the infant or cause any adverse effects in breastfed infants. One small study supports the lack of effect of maternal mineral oil on the bowels of their breastfed infants. Oral use of mineral oil by the nursing mother is acceptable, although repeated use should be avoided because it may cause a deficiency of fat-soluble vitamins. The use of mineral oil or ointments containing mineral oil on or near the breast may expose the infant to high levels of mineral paraffins via licking. Only water-miscible cream products should be applied to the breast.
  • Minocycline and breast feeding Many reviews state that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of minocycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of minocycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). Black discoloration of breastmilk has been reported with minocycline.
  • Minoxidil and breast feeding Because of the minimal amount of information on this potent agent, use minoxidil with caution, particularly when therapy involves a large maternal dosage or breastfeeding a newborn. Topical minoxidil should pose low risk to the breastfed infant.
  • Mipomersen and breast feeding No relevant published information exists with the use of mipomersen during breastfeeding. Because of a concern with disruption of infant lipid metabolism, mipomersen should not be used during breastfeeding.
  • Mirtazapine and breast feeding Limited information indicates that maternal doses of up to 120 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. If mirtazapine is required by the mother, it is not a reason to discontinue breastfeeding. Exclusively breastfed infants should be monitored for behavioral side effects and adequate growth if this drug is used during lactation.
  • Misoprostol and breast feeding Mispoprostol is a prostaglandin E1 analogue. Prostaglandin E1 and other prostaglandins appear normally in colostrum and milk. Because of the extremely low levels of misoprostol in breastmilk, amounts ingested by the infant are trivial and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Mitoxantrone and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, such as mitoxantrone. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence, but the duration of abstinence is not clear. In one patient, mitoxantrone was still detectable in milk 28 days after a dose of 6 mg per square meter. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Moclobemide and breast feeding Moclobemide is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal doses of moclobemide up to 900 mg daily produce low levels in milk. Although several breastfed infants apparently experienced no adverse effects during maternal use of moclobemide, no rigorous, long-term data are available. Until more data are available, moclobemide should only be used with careful monitoring during breastfeeding, especially while nursing a newborn or preterm infant.
  • Modafinil and breast feeding No information is available on the excretion of modafinil into breastmilk. The amount of the R-enantiomer of modafinil, armodafinil, in one nursing mother was very low. Minimal information from women who breastfed their infant's while using modafinil found no adverse effects in the infants. Until more safety data are available, modafinil should be used with careful infant monitoring during breastfeeding, or an alternate drug may be preferred.
  • Moexipril and breast feeding Because no information is available on the use of moexipril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Molindone and breast feeding Because there is no published experience with molindone during breastfeeding, other antipsychotic agents are preferred.
  • Mometasone, Nasal and breast feeding Neither inhaled mometasone nor mometasone nasal implants have been studied during breastfeeding. Although not measured, the amounts of nasal corticosteroids absorbed into the maternal bloodstream and excreted into breastmilk are probably too small to affect a breastfed infant. Reviewers and an expert panel consider inhaled corticosteroids acceptable to use during breastfeeding.
  • Mometasone, Topical and breast feeding Neither topical mometasone nor the mometasone nasal implant have been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids or the slow-release implant would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Montelukast and breast feeding Very low levels of montelukast appear in breastmilk. Montelukast is approved for use in children as young as 6 months of age and has been used in neonates in dosages far greater than the amounts in breastmilk. Amounts ingested by the infant would not be expected to cause any adverse effects in breastfed infants No special precautions are required.
  • Morphine and breast feeding Epidural morphine given to mothers for postcesarean section analgesia results in trivial amounts of morphine in their colostrum and milk. Intravenous or oral doses of maternal morphine in the immediate postpartum period result in higher milk levels than with epidural morphine. Labor pain medication may delay the onset of lactation. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death, although low-dose morphine might be preferred over other opiates. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of morphine to a 2 to 3 days at a low dosage with close infant monitoring, especially in the outpatient setting. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
  • Moxetumomab Pasudotox and breast feeding No information is available on the clinical use of moxetumomab pasudotox during breastfeeding. Moxetumomab pasudotox is a recombinant immunotoxin consisting of the Fv portion of the anti-CD22 antibody covalently fused to a 38 KDa fragment of Pseudomonas exotoxin-A (PE38) with potential anti-cancer activity. Because moxetumomab is a large protein molecule with a molecular weight of about 63,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, moxetumomab pasudotox should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Moxidectin and breast feeding No information is available on the clinical use of moxidectin during breastfeeding. However, amounts in breastmilk appear to be low and would not be expected to cause any adverse effects in breastfed infants. Until more data become available, moxidectin should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Mupirocin and breast feeding Because less than 1% is absorbed after topical application, mupirocin is considered a low risk to the nursing infant. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Mupirocin applied topically to the nipples appears to be relatively ineffective as a treatment for sore, cracked nipples.
  • Mycophenolate and breast feeding Because no information is available on the use of mycophenolate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

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  • Nabumetone and breast feeding Because no information is available on the use of nabumetone during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Nadolol and breast feeding Because of its relatively extensive excretion into breastmilk and its renal excretion, other beta-adrenergic blocking drugs are preferred to nadolol, especially while nursing a newborn or preterm infant.
  • Nafcillin and breast feeding Although no information is available on the use of nafcillin during breastfeeding, penicillins are generally not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Nafcillin is acceptable in nursing mothers.
  • Naftifine and breast feeding Topical naftifine has not been studied during breastfeeding. Because only 4 to 6% is absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream, gel or liquid products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Nalbuphine and breast feeding Nalbuphine is excreted into breastmilk in amounts much smaller than the dose given to infants for analgesia. Because nalbuphine has poor oral absorption, it is unlikely to adversely affect the breastfed infant. No special precautions are required. Labor pain medication may delay the onset of lactation.
  • Nalidixic Acid and breast feeding Limited information indicates that maternal doses of nalidixic acid up to 2 grams daily produce low levels in milk and would usually not be expected to cause any adverse effects in breastfed infants with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). Nalidixic acid should be avoided while breastfeeding a glucose-6-phosphate dehydrogenase (G6PD) deficient infant. Other agents are preferred, especially while nursing a newborn or preterm infant.
  • Naloxegol and breast feeding No information is available on the excretion of naloxegol into breastmilk. Because of the possibility of inducing opioid withdrawal in the breastfed infant, the manufacturer recommends that breastfeeding is not recommended during treatment with naloxegol.
  • Naloxone and breast feeding No information is available on the excretion of naloxone into breastmilk. Because it is not orally bioavailable, it is unlikely to affect the breastfed infant. However, if naloxone is required by the mother for an opiate overdose, she should withhold nursing until the opiate is out of her system.
  • Naltrexone and breast feeding Limited data indicate that naltrexone is minimally excreted into breastmilk. If naltrexone is required by the mother, it is not a reason to discontinue breastfeeding.
  • Naproxen and breast feeding Limited information indicates that levels of naproxen in breastmilk are low and adverse effects in breastfed infants are apparently uncommon. However, because of naproxen's long half-life and reported serious adverse reaction in a breastfed neonate, other agents may be preferred while nursing a newborn or preterm infant.
  • Naratriptan and breast feeding Because there is no published experience with naratriptan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Natalizumab and breast feeding Natalizumab is excreted into breastmilk in some, but not all, women. The time of the peak level in breastmilk is variable, but might be as long as 6 months. Because natalizumab is a large protein molecule with a molecular weight of about 149,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Some experts recommend avoiding breastfeeding with natalizumab, while others do not. Until more data become available, natalizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Nateglinide and breast feeding No information is available on the use of nateglinide during breastfeeding. Nateglinide is a weak acid that is over 98% protein bound, so it is unlikely to pass into breastmilk in clinically important amounts. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with nateglinide. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Nebivolol and breast feeding Because no information is available on the use of nebivolol during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Nedocromil and breast feeding Because there is no published experience with protriptyline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Nefazodone and breast feeding Limited information indicates that usual doses of nefazodone produce low but variable levels in milk that would not be expected to cause adverse effects in a breastfed infant, especially if the infant is older than 2 months. However, adverse effects in a breastfed preterm infant have been reported. If nefazodone is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, other drugs may be preferred, especially while nursing a newborn or preterm infant.
  • Nefopam and breast feeding The amount of nefopam in breastmilk with usual maternal dosages is small. Nefopam does not appear to adversely affect the milk supply or the neurobehavioral scores of breastfed neonates. Breastfeeding is acceptable during maternal use of nefopam.
  • Nelfinavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with nelfinavir during breastfeeding is limited. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Neostigmine and breast feeding Limited data indicate that use of neostigmine to treat myasthenia gravis may be acceptable during breastfeeding, although pyridostigmine may be preferred. Monitor newborns because abdominal cramps after each breastfeeding has been reported. Because of its short half-life, single doses of neostigmine to reverse neuromuscular blockade following surgery are unlikely to adversely affect the breastfed infant more than transiently.
  • Nepafenac and breast feeding No information is available on the clinical use of nepafenac during breastfeeding. Maternal use of nepafenac eye drops would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Neratanib and breast feeding No information is available on the clinical use of neratanib during breastfeeding. Because neratanib and its metabolite are over 99% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during neratanib therapy.
  • Netarsudil and breast feeding No information is available on the use of netarsudil during breastfeeding. Because netarsudil poorly absorbed by the mother after administration to the eye, it is unlikely to adversely affect the breastfed infant. Until more data become available, netarsudil should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Nevirapine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Nevirapine has been well studied in nursing mothers. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through 12 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine. Because of the long half-life of nevirapine, subtherapeutic nevirapine concentrations can persist in breastmilk and infant serum for relatively long periods, potentially increasing the risk of development of nevirapine-resistant HIV infections when it is used alone for prophylaxis in the mother.
  • Nicardipine and breast feeding Because of the low levels of nicardipine in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Nifedipine and breast feeding Because of the low levels of nifedipine in breastmilk, amounts ingested by the infant are small, even in women with a genetic variant of breast cancer resistance protein that increases the amount of drug transferred to milk. No adverse effects have been reported among infants exposed to nifedipine in breastmilk. Nifedipine is used to treat painful nipple vasospasm (e.g., Raynaud phenomenon) in nursing mothers.
  • Nifurtimox and breast feeding Limited information indicates that maternal doses of nifurtimox up to 15 mg/kg daily produce do not cause any adverse serious effects in breastfed infants. Breastmilk levels and a computer simulation found that the dose that an exclusively breastfed infant would receive through breastmilk would be much less than the dose given to treat Chagas disease in newborn infants. Other authors consider that breastfeeding is not contraindicated during the use of nifurtimox.
  • Nilotinib and breast feeding Although the amount of nilotinib in milk appears to be small and one breastfed infants apparently experienced no adverse effects during maternal use of nilotinib, no long-term data are available. Because nilotinib is 98% bound to plasma proteins, the amounts in milk are likely to be low. However, there is little published experience with nilotinib during breastfeeding, and an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during nilotinib therapy and for 14 days after the last dose.
  • Nimodipine and breast feeding Based on limited data, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Nintedanib and breast feeding No information is available on the clinical use of nintedanib during breastfeeding. Because nintedanib is more than 97% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 9.7 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during nintedanib therapy.
  • Nipple Piercing and breast feeding Although controlled studies have not been performed, piercing of the nipples seems to not interfere with lactation in most cases, although poor latching, and milk leakage from the infant's mouth have been reported. Some breast jewelry may pierce the areola as well as the nipple. Reversible hyperprolactinemia and galactorrhea occurred in two individuals who developed infections of the nipple and mastitis. Infections are estimated to occur after 10% to 20% of nipple piercings. Healing time after nipple piercing is 6 to 12 months, and up to a year longer if infection or trauma occur. Occasionally, mastitis occurs after piercing. A theoretical concern is aspiration of the nipple jewelry by the nursing infant and injury of the infant's mouth and gums. Although these complications apparently have not been reported, nipple jewelry should be removed before nursing, and preferably during the entire duration of breastfeeding.
  • Niraparib and breast feeding No information is available on the clinical use of niraparib during breastfeeding. Because niraparib is 83% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during niraparib therapy and for 1 month following therapy.
  • Nisoldipine and breast feeding Because no information is available on the use of nisoldipine during breastfeeding, an alternate drug may be preferred.
  • Nitazoxanide and breast feeding Limited information indicates that a maternal dose of 500 mg of nitazoxanide produces low levels of an active metabolite, tizoxanide, in breastmilk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. But until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Nitrazepam and breast feeding Nitrazepam is not approved for marketing in the United States by the U.S. Food and Drug Administration. It is excreted into breastmilk in small amounts. Because of its long half-life of about 30 hours, it may accumulate in the serum of breastfed infants with repeated doses. Other agents are preferred, especially while nursing a newborn or preterm infant.
  • Nitrendipine and breast feeding Based on limited data, it is unlikely that nitrendipine will reach the infant in clinically important amounts. However, it may be preferable to use another agent drug for which more safety information is available.
  • Nitrofurantoin and breast feeding Administration of nitrofurantoin directly to infants under 1 month of age and in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency is contraindicated because of potential hemolysis in these infants. However, the time of greatest risk for hemolysis in fullterm newborns without G6PD deficiency might be as short as 8 days after birth. Nitrofurantoin doses in milk are low and it can be used while breastfeeding older infants, but alternate drugs are preferred in mothers of infants under 8 days of age, or infants with G6PD deficiency of any age. Observe infants for possible diarrhea.
  • Nitrogen, Liquid and breast feeding No information is available on the clinical use of liquid nitrogen on the skin during breastfeeding. Because it is a nontoxic gas that is unlikely to appear in breastmilk or be absorbed by the infant, it is considered safe to use during breastfeeding. No special precautions are required.
  • Nitrogen-13 and breast feeding Information in this record refers to the use of nitrogen-13 radiopharmaceuticals as diagnostic agents. The International Commission on Radiological Protection also recommends that breastfeeding need not be interrupted after administration of radiopharmaceuticals containing nitrogen-13.
  • Nitroglycerin and breast feeding Topical use of nitroglycerin for anal fissures by nursing mothers appears to have no adverse effects on their breastfed infants. Topical use on the nipples has been used for alleviation of Raynaud phenomenon of the nipples, but only after cessation of breastfeeding. Nitroglycerin should not be used topically on the nipples during breastfeeding. Sublingual and intravenous nitroglycerin have not been studied during breastfeeding. Observe infants for flushing and discomfort after breastfeeding.
  • Nitroprusside and breast feeding Breastmilk levels of nitroprusside sodium have not been measured after exogenous administration. Because of its short half-life of 2 minutes, it is unlikely to appear in breastmilk. However, its toxic metabolite, thiocyanate, is excreted into milk and can be directly toxic to the infant as well as inhibiting iodide transport into breastmilk. Cyanide is another toxic metabolite of nitroprusside that may enter breastmilk. An alternate drug is therefore preferred, during breastfeeding. If use of nitroprusside sodium is unavoidable, the mother should refrain from breastfeeding.
  • Nitrous Oxide and breast feeding Because the serum half-life of nitrous oxide in the mother is short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Some evidence indicates that primiparous mothers who use inhaled nitrous oxide during labor for analgesia have better breastfeeding success than mothers who do not. If used as part of general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Nivolumab and breast feeding No information is available on the clinical use of nivolumab during breastfeeding. Because nivolumab is a large protein molecule with a molecular weight of 146,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, nivolumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during nivolumab therapy and for 5 months after the last dose of the drug.
  • Nizatidine and breast feeding Because of the low levels of nizatidine in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required. Histamine H2-antagonists with more extensive use might be preferred in newborns.
  • Nonoxynol-9 and breast feeding Nonoxynol-9 is a relatively nontoxic nonionic surfactant and only trivial amounts of the drug have been found in the milk of animals after vaginal administration. Limited information indicates that breastfed infants of mothers using vaginal nonoxynol-9 experienced no adverse effects. Vaginal use of nonoxynol-9 is acceptable in nursing mothers.
  • Norepinephrine and breast feeding No information is available on the use of norepinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any norepinephrine in milk is unlikely to affect the infant. High intravenous doses of norepinephrine might reduce milk production or milk letdown.
  • Norethynodrel and breast feeding Norethynodrel is only available in the United States in combination oral contraceptive products. Based on the available evidence, expert opinion holds that nonhormonal methods are preferred during breastfeeding and progestin-only contraceptive are preferred over combined oral contraceptives in breastfeeding women, especially during the first 4 weeks postpartum. For further information, consult the record entitled, "Contraceptives, Oral, Combined."
  • Norfloxacin and breast feeding No information is available on the clinical use of norfloxacin during breastfeeding; however, amounts in breastmilk appear to be low. Fluoroquinolones such as norfloxacin have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. In addition, the calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. The serum and milk levels and oral bioavailability of norfloxacin are the lowest of any of the fluoroquniolones, so the risk to the infant should be minimal. Use of norfloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Nortriptyline and breast feeding Because of the low levels of nortriptyline in breastmilk, amounts ingested by the infant are small and usually not been detected in the serum of the infant, although the less active metabolites are often detectable in low levels in infant serum. Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Most authoritative reviewers consider nortriptyline one of the preferred antidepressants during breastfeeding.
  • Nystatin and breast feeding Although no information exists on the milk excretion of nystatin, it is virtually unabsorbed orally, therefore most reviewers and clinicians consider it acceptable for use in nursing mothers, including topical application to the nipples. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any excess cream should be removed from the nipples before nursing. Nystatin is less effective than other topical agents for the treatment of thrush.

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  • Obiltoxaximab and breast feeding No information is available on the clinical use of obiltoxaximab during breastfeeding. Because obiltoxaximab is a large protein molecule with a molecular weight of 148,000, absorption by the infant is unlikely after the first few weeks postpartum, and it will probably be destroyed in the infant's gastrointestinal tract. Until more data become available, obiltoxaximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Obinutuzumab and breast feeding No information is available on the clinical use of obinutuzumab during breastfeeding. Because obinutuzumab is a large protein molecule with a molecular weight of about 150,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, obinutuzumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during obinutuzumab therapy.
  • Ocrelizumab and breast feeding No information is available on the clinical use of ocrelizumab during breastfeeding. Because ocrelizumab is a large protein molecule with a molecular weight of about 148,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, ocrelizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Octreotide and breast feeding The excretion of octreotide into breastmilk has not been studied. However, because it has a high molecular weight of 1019 daltons it is likely to be poorly excreted into breastmilk. It is poorly absorbed orally and has been safely administered directly to infants by injection, so it is unlikely to adversely affect the breastfed infant. One breastfed infant experienced no adverse effects during maternal use of octreotide. Until more data are available, octreotide should be used in nursing mothers with careful infant monitoring, especially if the infant is under 2 months of age.
  • Olanzapine and breast feeding Maternal doses of olanzapine up to 20 mg daily produce low levels in milk and undetectable levels in the serum of breastfed infants. In most cases, short-term side effects have not been reported, but sedation has occurred. Limited long-term follow-up of infants exposed to olanzapine indicates that infants generally developed normally. Systematic reviews of second-generation antipsychotics concluded that olanzapine seemed to be a first-line agent during breastfeeding. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
  • Olaparib and breast feeding No information is available on the clinical use of olaparib during breastfeeding. Because olaparib is 82% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during olaparib therapy and for one month after the last dose.
  • Olmesartan and breast feeding Because no information is available on the use of olmesartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Olodaterol and breast feeding Although no published data exist on the use of olodaterol during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Olopatadine and breast feeding Because absorption from the eye is limited, olopatadine would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Olsalazine and breast feeding Limited data indicate that olsalazine is poorly excreted into breastmilk. However, olsalazine is a mesalamine prodrug. Rather high levels of the mesalamine metabolite N-acetyl-5-ASA appear in breastmilk and its effects on breastfed infants are unknown. A few cases of diarrhea have been reported in infants exposed to mesalamine, although the rate is not high. Most experts consider mesalamine derivatives to be safe during breastfeeding. If olsalazine is required by the mother, it is not a reason to discontinue breastfeeding, but carefully observe breastfed infants for diarrhea during maternal use of olsalazine.
  • Omadacycline and breast feeding No information is available on the use of omadacycline during breastfeeding. The manufacturer states that breastfeeding is not recommended during treatment and for 4 days after the last dose. However, based on the excretion of other tetracycline antibiotics omadacycline, amounts in milk are expected to be low and probably poorly absorbed orally by the breastfed infant. If an infant is breastfed, monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis. As a theoretical precaution, avoid prolonged or repeat courses during nursing.
  • Omalizumab and breast feeding Because omalizumab is a large protein molecule with a molecular weight of 145,058, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. The manufacturer reports that 186 infants have been breastfed during maternal omalizumab therapy, with no increase in infectious complications.
  • Omeprazole and breast feeding Limited information indicates that maternal omeprazole doses of 20 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.
  • Ondansetron and breast feeding Little published information is available on the clinical use of ondansetron during breastfeeding, although it is apparently frequently used for nausea after cesarean section, usually in doses of 4 to 8 mg intravenously. Use after cesarean section appears to not affect the onset of breastfeeding. No adverse infant effects have been reported and the drug has been used in infants. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Oritavancin and breast feeding Because oritavancin is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal tract, such as diarrhea, vomiting, and candidiasis (e.g., thrush, diaper rash). However, because there is no published experience with oritavancin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Orlistat and breast feeding Because orlistat is poorly absorbed orally, it is unlikely that any orlistat is excreted into milk or absorbed by the infant. Therefore, it is unlikely to adversely affect the breastfed infant.
  • Oseltamivir and breast feeding Limited data indicate that oseltamivir and its active metabolite are poorly excreted into breastmilk. Maternal dosages of 150 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Infants over 1 year of age can receive oseltamivir directly in doses much larger than those in breastmilk.
  • Osimertinib and breast feeding No information is available on the clinical use of osimertinib during breastfeeding. Because osimertinib is 95% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 48 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during osimertinib therapy and for 2 weeks after the final dose.
  • Oxacillin and breast feeding Limited information indicates that oxacillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Oxacillin is acceptable in nursing mothers.
  • Oxaprozin and breast feeding Because there is no published experience with oxaprozin during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Oxazepam and breast feeding Oxazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is administration directly to infants. Oxazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.
  • Oxcarbazepine and breast feeding Limited information indicates that oxcarbazepine would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants.
  • Oxiconazole and breast feeding Topical oxiconazole has not been studied during breastfeeding. Because less than 1% is absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Oxybutinyn and breast feeding No information is available on the use of oxybutynin during breastfeeding. Long-term use of oxybutynin might reduce milk production or milk letdown, but a single dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Oxycodone and breast feeding Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Infant sedation is common and well documented with maternal use of oxycodone. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral oxycodone (and combinations) to a 2 to 3 days, especially in the outpatient setting. A maximum oxycodone dosage of 30 mg daily is suggested, although some sources recommend avoiding oxycodone during breastfeeding. Oxycodone elimination is decreased in young infants with much inter-individual variability. Monitor the infant closely for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Other agents are preferred over oxycodone during breastfeeding.
  • Oxygen-15 and breast feeding Information in this record refers to the use of oxygen-15 radiopharmaceuticals as diagnostic agents. The International Commission on Radiological Protection also recommends that breastfeeding need not be interrupted after administration of radiopharmaceuticals containing oxygen-15.
  • Oxymetazoline and breast feeding Although no information exists on the use of oxymetazoline specifically during breastfeeding, very little should reach the infant through breastmilk because of the local administration and limited absorption into the maternal bloodstream. It is recommended over oral systemic decongestants such as pseudoephedrine during breastfeeding. Topical use on the face is unlikely to present a risk to the nursing infant.
  • Oxymorphone and breast feeding No data are available on the use of oxymorphone during breastfeeding. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of oral oxymorphone to a few days at low dosages, with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Other agents are preferred over oxymorphone during breastfeeding.
  • Oxytetracycline and breast feeding A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of oxytetracycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of oxytetracycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Oxytocin and breast feeding Oxytocin is an essential lactation hormone released during breastfeeding that appears to have calming effect on the mother. Administration of exogenous oxytocin to mothers having difficulty in breastfeeding has not been clearly shown to have a beneficial effect on lactation success or in the treatment of breast engorgement. It might be of benefit in women who have lost the neuronal connection between the breast and hypothalamus. Effects on the infant are unlikely when given during breastfeeding. Numerous studies suggest that oxytocin given during labor can negatively affect breastfeeding, possibly by reducing sucking behavior in the newborn in a dose-dependent manner, although study methodology and consistency has varied considerably. One study found that all rhythmic reflexes, the antigravity reflex, and total primitive neonatal reflexes were inhibited by intrapartum oxytocin administration, unrelated to dose, which could adversely affect breastfeeding.
  • Ozenoxacin and breast feeding No information is available on ozenoxacin cream during breastfeeding. Because ozenoxacin is poorly absorbed after topical application, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants after maternal application away from the breast. Although quinolones are generally acceptable for systemic use, ozenoxacin should be avoided on the nipple because the infant could ingest the drug via licking.

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  • Palbociclib and breast feeding No information is available on the clinical use of palbociclib during breastfeeding. Because palbociclib is 85% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 29 hours and it might accumulate in the infant. It is also given in combination with letrozole or fulvestrant, which may increase the risk to the infant. The manufacturer recommends that breastfeeding be discontinued during palbociclib therapy and for 3 weeks after the last dose.
  • Paliperidone and breast feeding Although no data are available for the use of paliperidone during breastfeeding, it is the active metabolite of risperidone. Risperidone data indicate that the concentrations of paliperidone (9-hydroxyrisperidone) in breastmilk are low, and amounts ingested by the infant are small. Because there is no published experience with paliperidone during breastfeeding and little long-term follow-up data, other agents may be preferred, especially while nursing a newborn or preterm infant. Because paliperidone is available only as a sustained-release product, timing of nursing with respect to doses would not be useful.
  • Palivizumab and breast feeding No information is available on the clinical use of palivizumab during breastfeeding. Because palivizumab is a large protein molecule with a molecular weight of about 148,000, the amount in milk is likely to be very low and absorption is unlikely because it will probably be destroyed in the infant's gastrointestinal tract.
  • Pamidronate and breast feeding Limited information indicates that maternal doses of pamidronate of 30 mg intravenously produce very low levels in milk. Because pamidronate has a serum half-life of about 3 hours, is highly bound to calcium and is poorly absorbed orally (0.3 to 3% in adults), absorption of pamidronate by a breastfed infant is unlikely. Until more data become available, withholding nursing for 12 to 24 hours after a dose should ensure that the breastfed infant is exposed to little or no pamidronate. Other evidence indicates that breastfeeding after cessation of long-term pamidronate treatment appears to have no adverse effects on the infant. Some experts recommend monitoring the infant's serum calcium during the first 2 months postpartum if the mother received pamidronate during pregnancy or nursing.
  • Pancuronium and breast feeding No information is available on the use of pancuronium during breastfeeding. Because it is highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Pantoprazole and breast feeding Maternal pantoprazole doses of 40 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.
  • Papaya and breast feeding Papaya (Carica papaya) fruit contains the proteolytic enzymes papain and chymopapain before ripening, but they are not present in the ripe fruit. Cooked, unripe papaya fruit has been used orally as a galactogogue in India and Melanesia; however, no scientifically valid clinical trials support this use. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production. Papaya leaves, which contain papain and other enzymes, are also used in some products, but have no known lactation-related uses. No data exist on the excretion of any components of papaya into breastmilk or on the safety and efficacy of papaya in nursing mothers or infants. Papaya fruit is "generally recognized as safe" (GRAS) as a food by the U.S. Food and Drug Administration. Papaya also contains carotenoids and can improve beta-carotene and vitamin A status in nursing mothers. Allergic reactions to papaya, such as asthma and skin rashes are not uncommon and cross reaction with other substances such as latex and kiwi have occurred. Those with allergies to papaya or cross reacting substances should avoid papaya.
  • Parenteral Nutrition and breast feeding Several women receiving either partial or total parenteral nutrition have reportedly breastfed their infants successfully. One prominent group encourages lactation among their patients receiving parenteral nutrition if the mother wishes, with the understanding that formula supplementation may be necessary depending on the adequacy of her milk supply. Infants' growth should be monitored closely as a means of determining adequate nutrition.
  • Paromomycin and breast feeding No information is available on the clinical use of paromomycin during breastfeeding. Because paromomycin is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants.
  • Paroxetine and breast feeding Because of the low levels of paroxetine in breastmilk, amounts ingested by the infant are small and paroxetine has not been detected in the serum of most infants tested. Occasional mild side effects have been reported, especially in the infants of mothers who took paroxetine during the third trimester of pregnancy, but the contribution of the drug in breastmilk is not clear. Most authoritative reviewers consider paroxetine one of the preferred antidepressants during breastfeeding. Occasional mild side effects such as insomnia, restlessness and increased crying have ben reported in breastfed infants. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state. These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.
  • Pasireotide and breast feeding The excretion of pasireotide into breastmilk has not been studied. However, because it has a high molecular weight of 1047 daltons it is likely to be poorly excreted into breastmilk and it is a peptide that is likely digested in the infant's gastrointestinal tract. It is unlikely to reach the clinically important levels in infant serum. However, the manufacturer states that nursing mothers should not use pasireotide.
  • Patiromer and breast feeding Because patiromer is not orally absorbed it is unlikely to reach the breastmilk or adversely affect the breastfed infant. No special precautions are required.
  • Pazopanib and breast feeding No information is available on the clinical use of pazopanib during breastfeeding. Because pazopanib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 31 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during pazopanib therapy and for 2 weeks after the final dose.
  • Pegademase Bovine and breast feeding No information is available on the clinical use of pegademase bovine during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Peginesatide and breast feeding No information is available on the clinical use of peginesatide during breastfeeding. Because of its large molecular weight of 4900 daltons, excretion into breastmilk should be minimal and it would not be expected to be absorbed from breastmilk by the infant. However, until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Peginterferon Beta and breast feeding Although no information is available on peginterferon beta-1a in breastmilk, the levels of conventional interferon beta-1a in breastmilk are minuscule. In addition, because interferon is poorly absorbed orally, it is not likely to reach the bloodstream of the infant. A small number of nursing mothers receiving interferon beta-1a while partially breastfeeding their infants and one woman exclusively breastfed her infant while taking interferon beta-1b and reported no adverse effects. The Multiple Sclerosis Centre of Excellence on Reproduction and Child Health considers interferon beta to be "moderately safe" to use during breastfeeding, and a French consensus group of neurologists concluded that interferon beta can be used during breastfeeding. No special precautions appear to be required during breastfeeding while using interferon beta. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous interferon-gamma by an average about 10%.
  • Pegvaliase and breast feeding No information is available on the use of pegvaliase-pqpz during breastfeeding. Absorption of the drug by the infant from breastmilk is unlikely because it is a polypeptide that is probably destroyed in the infant's gastrointestinal tract. Pegvaliase-pqpz may decrease the phenylalanine content of breastmilk. The manufacturer recommends monitoring blood phenylalanine concentrations in breastfeeding women treated with pegvaliase-pqpz.
  • Pegvisomant and breast feeding Limited data indicate that pegvisomant is poorly excreted into breastmilk. Because pegvisomant is not orally absorbed, it is unlikely to adversely affect the breastfed infant.
  • Pembrolizumab and breast feeding No information is available on the clinical use of pembrolizumab during breastfeeding. Because pembrolizumab is a large protein molecule with a molecular weight of about 149,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, pembrolizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during pembrolizumab therapy and for 4 months after the last dose.
  • Pemetrexed and breast feeding Most sources consider breastfeeding to be contraindicated during maternal high-dose antineoplastic drug therapy. The manufacturer recommends that mothers should not to breastfeed during treatment with pemetrexed and for one week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Pemirolast and breast feeding Although no published data exist on the use of pemirolast during lactation, maternal milk levels are likely to be very low after the use eye drops.
  • Penbutolol and breast feeding Based on its physicochemical properties, penbutolol appears to present a low-risk to the breastfed infant. Because there is no published experience with penbutolol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Penciclovir and breast feeding Although there is no published experience with penciclovir during breastfeeding, infant side effects are unlikely with maternal topical application to small areas of the mother's body away from the breast. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Penicillamine and breast feeding Limited information indicates that penicillamine is not detectable in breastmilk and no adverse effects have been reported among breastfed infants whose mothers were taking the drug. Copper and zinc levels in breastmilk are reduced in mothers receiving penicillamine. Penicillamine has been used with apparent safety during nursing of 3 infants. In infants who breastfeed infrequently, taking the drug right after nursing and waiting 4 to 6 hours before nursing again should minimize the amount of penicillamine in breastmilk. Copper and zinc levels in breastmilk are reduced in patients taking penicillamine. The implications for infants of this effect are not known.
  • Penicillin G and breast feeding Limited information indicates that penicillin G produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Penicillin G is acceptable in nursing mothers.
  • Penicillin V and breast feeding Limited information indicates that penicillin V produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Penicillin V is acceptable in nursing mothers.
  • Pentazocine and breast feeding No information is available on the use of pentazocine during breastfeeding. Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of pentazocine to a few days at a low dosage with close infant monitoring. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Other agents are preferred over pentazocine during breastfeeding.
  • Pentobarbital and breast feeding Because there is little published experience with pentobarbital during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Pentoxifylline and breast feeding Limited data indicate that pentoxifylline is poorly excreted into breastmilk. It would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Peramivir and breast feeding Because peramivir is poorly absorbed orally, it is not likely to reach the bloodstream of the infant in clinically important amounts. However, because no information is available on the use of peramivir breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Perampanel and breast feeding No information is available on use of perampanel during breastfeeding. If perampanel is required by the mother, it is not necessarily a reason to discontinue breastfeeding, but monitor the infant for drowsiness, agitation, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of drugs.
  • Perflutren and breast feeding No information is available on the clinical use of perflutren during breastfeeding. Because of the extremely short elimination half-life of perflutren (<2 minutes) from the body, use of perflutren either as albumin microspheres or lipid microspheres is acceptable in nursing mothers. Because of the lack of information, the American College of Radiology states that temporary (~24 hours) pumping and discarding of milk may be considered. However, this recommendation appears to be excessively cautious.
  • Perindopril and breast feeding Limited information indicates that only low levels of perindopril and its active metabolite are found in breastmilk, which is consistent with other drugs in this class. Amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Permethrin and breast feeding Because less than 2% is absorbed after topical application, rapid metabolism to inactive metabolites and safe application directly on infants' skin, topical permethrin products are acceptable in nursing mothers. Extensive exposure, such as from agricultural use or malaria control might have long-term health concerns because residues can be found in breastmilk. Only water-miscible cream, gel or liquid products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Perphenazine and breast feeding Limited information indicates that maternal doses of perphenazine up to 24 mg daily produce low levels in milk. Very limited long-term follow-up data indicate no adverse developmental effects when other phenothiazines are used alone. Monitor the infant for excessive drowsiness during breastfeeding and for developmental milestones, especially if other antipsychotics are used concurrently.
  • Pertuzumab and breast feeding No information is available on the clinical use of pertuzumab during breastfeeding. Because pertuzumab is a large protein molecule with a molecular weight of about 148,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, pertuzumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during pertuzumab therapy and for 7 months after the last dose.
  • Phenazopyridine and breast feeding The safety of phenazopyridine is not established in infants or during breastfeeding. Because it can cause methemoglobinemia, sulfhemoglobinemia, and hemolytic anemia, it should be avoided while breastfeeding, especially with an infant under 1 month of age or with glucose-6-phosphate dehydrogenase (G6PD) deficiency.
  • Phenindamine and breast feeding Small occasional doses of phenindamine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Phenobarbital and breast feeding Inter- and intrapatient variability in excretion of phenobarbital into breastmilk is extensive. Phenobarbital in breastmilk apparently can decrease withdrawal symptoms in infants who were exposed in utero, but it can also cause drowsiness in some infants, especially when used with other sedating drugs. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Sometimes breastfeeding might have to be limited or discontinued because of excessive drowsiness and poor weight gain. If there is concern, measurement of the infant's serum phenobarbital concentration might help rule out toxicity.
  • Phenprocoumon and breast feeding Phenprocoumon is not approved for sale by the U.S. Food and Drug Administration (FDA). Limited information indicates that anticoagulant maternal doses of phenprocoumon produce low levels in milk. Until more data are available, shorter-acting anticoagulants are preferred, especially if the infant is younger than 2 months.
  • Phosphorus P 32 and breast feeding Information in this record refers to the use of phosphorus P 32 as a therapeutic agent. No information is available on the use of phosphorus P 32 during breastfeeding. Use of phosphate P 32 as a skin patch to treat skin cancers poses no risk to breastfed infants after removal of the patch from the mother's skin
  • Phototherapy and breast feeding Phototherapy for psoriasis is generally acceptable; however, nursing should be withheld for 24 hours after ingestion of an oral psoralen, such as methoxsalen. Laser therapy was used in some Russian and Austrian studies to prevent and treat lactation mastitis and nipple fissures. A study from Bulgaria compared laser therapy to metoclopramide to increase serum prolactin and milk supply. However, these studies are rather old and not well controlled. More recent studies found that laser application to cesarean section wounds did not adversely affect serum prolactin and LED light applied to the nipple improved the pain from nipple lesions one day sooner than sham therapy. Case reports have also been published from Australia indicating low-level laser therapy assists in healing nipple trauma and bleeding. A study from China indicated that high-intensity red light (630 nM) plus antibiotics were more effective than antibiotics alone in healing mastitis and preventing recurrence. One small study found that low-level laser therapy of the breasts resulted in increases in serum prolactin, and breastmilk lactose, protein. In general, laser therapy and phototherapy are considered acceptable during breastfeeding.
  • Pimecrolimus and breast feeding Topical pimecrolimus has not been studied during breastfeeding; however, it is used topically in children as young as 3 months of age. Because it is poorly absorbed after topical application and plasma concentrations after topical use in adults are less than 2 mcg/L, it is a low risk to the nursing infant. Do not apply to the nipple area and avoid direct contact of the infant with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Pindolol and breast feeding Recommendation for Use During Lactation: Limited information indicates that maternal pindolol produces low levels in milk. It also has a short half-life and only moderate renal excretion, so it would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Pioglitazone and breast feeding No information is available on the clinical use of pioglitazone during breastfeeding. Pioglitazone is over 99% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Piperacillin and Tazobactam and breast feeding Limited information indicates that piperacillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Tazobactam has not been studied in nursing mothers. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated.
  • Piperacillin and breast feeding Limited information indicates that piperacillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Piperacillin is acceptable in nursing mothers.
  • Pirbuterol and breast feeding Although no published data exist on the use of pirbuterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Piroxicam and breast feeding Low amounts of piroxicam in milk and failure to detect piroxicam or its metabolites in the urine of 2 older infants indicates that it would not be expected to cause adverse effects in older breastfed infants. Because there is no published experience with piroxicam during breastfeeding in the newborn period, shorter-acting agents may be preferred while nursing a newborn or preterm infant.
  • Pitavastatin and breast feeding No relevant published information exists on the use of pitavastatin during breastfeeding. Because of a concern with disruption of infant lipid metabolism, the consensus is that pitavastatin should not be used during breastfeeding. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Plazomicin and breast feeding Plazomycin is an aminoglycoside antibiotic similar to gentamicin and amikacin. No information is available on the use of plazomycin during breastfeeding. However, based on the excretion of other aminoglycoside antibiotics, amounts in milk are expected to be low. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
  • Plecanatide and breast feeding No information is available on the use of plecanatide during breastfeeding. Plecanatide is minimally absorbed from the gastrointestinal tract and the drug and its active metabolite is not measurable in plasma following administration of recommended doses. Plecanatide would not be expected to enter the breastmilk and cause any adverse effects in breastfed infants.
  • Pneumococcal Vaccines and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to pneumococcal vaccine. Immunization of the mother during the third trimester of pregnancy markedly increases the amount of pneumococcal antibodies in breastmilk. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Poliovirus Vaccines and breast feeding The Centers for Disease Control and Prevention and American Academy of Pediatrics state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to poliovirus vaccine. The injectable polio vaccine now recommended in the United States is inactivated and poses no risk when given to mothers who are breastfeeding. Breastfeeding also appears to reduce infant side effects associated with routine childhood immunization and can reduce the efficacy of oral polio vaccines. However, some studies indicate that breastfeeding might improve infant response to oral polio vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Exclusive breastfeeding improves the response to oral polio vaccine in countries with poor infant nutrition and high rates of infant diarrhea.
  • Polycarbophil and breast feeding No published experience exists with polycarbophil calcium during breastfeeding. However, the drug is not absorbed from the gastrointestinal tract, so it cannot enter the breastmilk. No special precautions are required.
  • Polyethylene Glycol and breast feeding No published experience exists with polyethylene glycol during breastfeeding. However, the drug is very poorly absorbed from the gastrointestinal tract, so it cannot enter the breastmilk in important amounts. No special precautions are required.
  • Polymyxin B and breast feeding Because it is poorly absorbed after topical application, polymyxin B is considered a low risk to the nursing infant. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Polythiazide and breast feeding No information is available on the amount of polythiazide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over polythiazide.
  • Ponatinib and breast feeding No information is available on the clinical use of ponatinib during breastfeeding. Because ponatinib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 24 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during ponatinib therapy and for 6 days following the last dose.
  • Povidone-Iodine and breast feeding The use of povidone-iodine in the mother near term and during breastfeeding increases breastmilk iodine levels and can cause transient hypothyroidism in breastfed infants, especially in geographic areas that are iodine deficient. Maternal exposure to povidone-iodine near term can sometimes interfere with thyroid studies done as a part of newborn screening tests. Although iodine from povidone-iodine is minimally absorbed through intact adult skin, exposure of mothers who are or will be breastfeeding to povidone-iodine should be minimized by using lower concentrations of povidone-iodine, applying it to the smallest possible surface areas of the body, shortening contact time, and avoiding repeated applications. Iodine absorption can be extensive with vaginal use; avoid douching with povidone iodine or use of iodine-containing tampons during breastfeeding.
  • Pramipexole and breast feeding No information is available on the use of pramipexole during breastfeeding, but it suppresses serum prolactin and may interfere with breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Pramlintide and breast feeding Pramlintide has a high molecular weight, so it is unlikely to pass into breastmilk in clinically important amounts. It also has a short half-life and it is a peptide that is likely digested in the infant's gastrointestinal tract, so it is unlikely to reach the clinically important levels in infant serum. However, because no information is available on the use of pramlintide during breastfeeding an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with pramlintide.
  • Prasugrel and breast feeding No published information is available on the use of prasugrel during breastfeeding. Until more data become available, prasugrel should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Pravastatin and breast feeding Levels of pravastatin in milk are low, but no relevant published information exists with its use during breastfeeding. The consensus opinion is that women taking a statin should not breastfeed because of a concern with disruption of infant lipid metabolism. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Praziquantel and breast feeding Because of the minute levels of praziquantel in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Expert opinion holds that lactation should not be a contraindication to maternal treatment with praziquantel. To minimize infant exposure, a single dose can be taken just before the infant's longest sleep period or an alternate method of feeding (e.g., stored milk) can be used for 24 to 36 hours after a single dose or the last of a series of doses.
  • Prazosin and breast feeding Because little is available on the use of prazosin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Prednicarbate and breast feeding Topical prednicarbate has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Prednisone and breast feeding Amounts of prednisone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With high maternal doses, the use of prednisolone instead of prednisone and avoiding breastfeeding for 4 hours after a dose theoretically should decrease the dose received by the infant. However, these maneuvers are not necessary with short-term use. High doses might occasionally cause temporary loss of milk supply.
  • Pregabalin and breast feeding Llimited data indicate that amounts of pregabalin in breastmilk are low. If pregabalin is required by the mother of an older infant, it is not a reason to discontinue breastfeeding, but until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Prilocaine and breast feeding No information is available on the use of prilocaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk, a single dose of prilocaine injected during breastfeeding, such as for a dental procedure, is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Topical application of prilocaine to the mother is unlikely to affect her breastfed infant if it is applied away from the breast. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Primidone and breast feeding Ample evidence exists that primidone taken during nursing can affect the breastfed infant. Infant serum levels of primidone and its metabolites are often near or in the therapeutic range and symptoms of sedation and poor nursing have been reported. On the other hand, infants exposed in utero sometimes have withdrawal symptoms that are either alleviated by breastfeeding or worsened when breastfeeding is abruptly stopped. If primidone is required by the mother, it is not a reason to discontinue breastfeeding. However the infant must be monitored for drowsiness, adequate nursing and weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant drugs. Measurement of an infant serum level might help rule out toxicity if there is a concern.
  • Probenecid and breast feeding Limited information indicates that maternal doses of probenecid up to 2 grams daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. In animal studies, probenecid increased the breastmilk excretion of cimetidine, possible via an interaction with an active transport mechanism in the breast. The implications of enhanced excretion of drugs given with probenecid for nursing mothers and their infants has not been studied; however, only a few drugs are known to undergo active transport into breastmilk.
  • Procainamide and breast feeding Maternal doses of procainamide 2 grams daily produced low levels of the drug and its active metabolite in the milk of one mother. Although it would not be expected to cause adverse effects in older breastfed infants, the relative lack of data concerning breastfeeding during maternal procainamide therapy would argue for careful monitoring if this drug is used while breastfeeding a neonate possibly Measurement of infant serum levels could help to rule out toxicity if there is a concern.
  • Procaine Penicillin G and breast feeding Limited information indicates penicillin G produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Procaine penicillin G is acceptable in nursing mothers.
  • Prochlorperazine and breast feeding Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of prochlorperazine for the treatment of nausea and vomiting poses little risk to the breastfed infant.
  • Promethazine and breast feeding Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of promethazine for the treatment of nausea and vomiting poses little risk to the breastfed infant. With repeated doses, observe infants for excess sedation. Because promethazine can lower basal prolactin secretion, promethazine might interfere with the establishment of lactation if given during labor, before lactation is well established or with a sympathomimetic such as pseudoephedrine. An antiemetic without potent histamine blocking action is preferred in nursing mothers.
  • Propafenone and breast feeding Limited information indicates that maternal doses of propafenone up to 900 mg daily produce low levels in milk. If propafenone is required by the mother it is not a reason to discontinue breastfeeding. Until more data become available, propafenone should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Propantheline and breast feeding No information is available on the use of propantheline during breastfeeding. Because propantheline is a quaternary ammonium compound, it is not likely to be absorbed and reach the bloodstream of the infant. Long-term use of propantheline might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Propofol and breast feeding Amounts of propofol in milk are very small and are not expected to be absorbed by the infant. Although one expert panel recommends withholding nursing for an unspecified time after propofol administration, most recommend that breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse and that discarding milk is unnecessary. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using propofol as a component for induction may delay the onset of lactation. In one study, breastfeeding before general anesthesia induction reduced requirements of propofol and sevoflurane compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women. Two case reports noted green discoloration of breastmilk after nursing mothers received propofol.
  • Propoxyphene and breast feeding Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death. Newborn infants seem to be particularly sensitive to the effects of even small dosages of propoxyphene may be particularly prone to causing these effects. Propoxyphene should be avoided during breastfeeding.
  • Propranolol and breast feeding Because of the low levels of propranolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies during breastfeeding have found no adverse reactions in breastfed infants clearly attributable to propranolol. No special precautions are required. Propranolol has been used successfully in cases of persistent pain of the breast during breastfeeding.
  • Protriptyline and breast feeding Because there is no published experience with protriptyline during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Prucalopride and breast feeding No published experience exists with prucalopride during breastfeeding. However, the manufacturer reports an unpublished study that indicates a relatively low amount of drug in breastmilk. Until more data become available, monitor the breastfed infant for diarrhea.
  • Pseudoephedrine and breast feeding Although the small amounts of pseudoephedrine in breastmilk are unlikely to harm the nursing infant, it may cause irritability occasionally. A single dose of pseudoephedrine decreases milk production acutely and repeated use seems to interfere with lactation. Mothers with newborns whose lactation is not yet well established or in mothers who are having difficulties producing sufficient milk should not receive pseudoephedrine. A treatment scheme has been reported for mothers with hypergalactia that uses pseudoephedrine to decrease milk supply.
  • Psyllium and breast feeding Few data are available on psyllium use during breastfeeding. However, the drug is not absorbed from the gastrointestinal tract, so it cannot enter the breastmilk. Psyllium is acceptable to use during breastfeeding.
  • Pyrantel and breast feeding No information is available on the use of pyrantel pamoate during breastfeeding. It is poorly absorbed orally, so excretion into breastmilk and absorption by the breastfed infant is unlikely.
  • Pyrazinamide and breast feeding Limited information indicates that maternal pyrazinamide therapy produces low levels in milk and would not usually be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Exclusively breastfed infants should be monitored for rare cases of jaundice, hepatitis and arthralgia if this drug is used during lactation. The amount of pyrazinamide in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking pyrazinamide.
  • Pyrethrins and breast feeding Because absorption after topical application is very limited, occasional pyrethrins and piperonyl butoxide use is acceptable in nursing mothers. Extensive exposure, such as from agricultural use or malaria control might have long-term health concerns because residues can be found in breastmilk. Only water-miscible cream, gel or liquid products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Pyridostigmine and breast feeding Because of the low levels of pyridostigmine in breastmilk, amounts ingested by the infant are small and infant serum levels are very low. Pyridostigmine is not be expected to cause any adverse effects in breastfed infants. Most mothers with myasthenia gravis are able to nurse successfully with pyridostigmine treatment, but occasionally breastfeeding must be discontinued to avoid excessive fatigue in the mother.
  • Pyrilamine and breast feeding Small, occasional doses of pyrilamine are probably acceptable during breast feeding. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly, in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Pyrimethamine and breast feeding No adverse reactions in breastfed infants have been reported and it is acceptable in nursing mothers. In HIV-infected women, elevated viral HIV loads in milk were decreased after treatment with chloroquine to a greater extent than other women who were treated with the combination of sulfadoxine and pyrimethamine. It has been suggested that maternal pyrimethamine clearance might be increased during lactation, but data are insufficient to make a definitive conclusion.

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  • Quazepam and breast feeding No information is available on the long-term use of quazepam during breastfeeding. Because the drug and metabolites could accumulate in the breastfed infant, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Quetiapine and breast feeding Maternal quetiapine doses of up to 400 mg daily produce low levels in milk. Limited long-term follow-up of infants exposed to quetiapine indicates that infants generally developed normally. Systematic reviews of second-generation antipsychotics concluded that quetiapine seemed to be the first- or second-choice agent during breastfeeding. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
  • Quinapril and breast feeding Because of the low levels of quinapril in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Quinidine and breast feeding Limited information indicates that maternal doses of quinidine up to 1.8 grams daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Exclusively breastfed infants should be carefully monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
  • Quinine and breast feeding Because of the low levels of quinine in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. The dosage in milk is far below those required to treat an infant for malaria. However, quinine should not be used in mothers with an infant who is glucose-6-phosphate dehydrogenase (G6PD) deficient. Even the relatively small amounts of quinine in tonic water ingested by the mother have caused hemolysis in G6PD-deficient infants.
  • Quniupristin-Dalfopristin and breast feeding Quinupristin and dalfopristin are relatively large molecules that are unlikely to be excreted into breastmilk in large amounts or to be absorbed orally by the breastfeeding infant. However, since no information is available on the use of quinupristin and dalfopristin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

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  • Rabeprazole and breast feeding Because no information is available on the use of rabeprazole during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rabies Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to rabies vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Radiotherapy and breast feeding Some expert opinion recommends not breastfeeding during radiotherapy treatment of breast cancer because the suckling effect from the infant might augment skin toxicity from radiotherapy in the treated breast(s). High-dose breast radiation for the therapy of breast cancer can decrease or eliminate subsequent milk production in the treated breast, but not the untreated breast. Medical professionals sometimes advise mothers who have received breast cancer surgery and radiation not to breastfeed; however, it appears that these concerns are unfounded. Lower radiation doses to the breast in the treatment of Hodgkin lymphoma appear to have only a minor effect on subsequent lactation success, but cranial irradiation for Hodgkin's lymphoma can reduce subsequent breastmilk production. Women who were treated as children for leukemia with cranial radiation often have difficulty in nursing their infants. For information on diagnostic X-rays, see the LactMed entry for X-rays.
  • Raltegravir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of raltegravir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through 12 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Ramelteon and breast feeding No information is available on the use of ramelteon during breastfeeding. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ramipril and breast feeding Because no information is available on the use of ramipril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ranitidine and breast feeding Although interpatient variability exists, the dose of ranitidine in breastmilk is less than the dose used in newborn infants. Maternal ranitidine would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Rasagiline and breast feeding No clinical use of rasagiline during breastfeeding has been reported. Rasagiline might reduce serum prolactin and interfere with milk production. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rasburicase and breast feeding No information is available on the clinical use of rasbicurase during breastfeeding. Because it is a large protein molecule with a molecular weight of about 34,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Ravulizumab and breast feeding No information is available on the use of ravulizumab during breastfeeding. Because ravulizumab is a large protein molecule with a molecular weight of about 148,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. The manufacturer recommends that breastfeeding be discontinued during ravulizumab therapy and for 8 months after the final dose.
  • Reboxetine and breast feeding Reboxetine is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal doses of up to 10 mg daily produce low levels in milk and appear to not result in any adverse effects in breastfed infants. Until more data are available, reboxetine should be used with careful monitoring during breastfeeding.
  • Regadenoson and breast feeding No information is available on the use of regadenoson during breastfeeding. To avoid exposure of the infant to regadenoson, nursing mothers should avoid breastfeeding for 10 hours after drug administration.
  • Regorafenib and breast feeding No information is available on the clinical use of regorafenib during breastfeeding. Because regorafenib is 99.5% bound to plasma proteins, the amount in milk is likely to be low. However, one of its metabolites has a half-life of up to 70 hours, and might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during regorafenib therapy and for 2 weeks after the final dose.
  • Remifentanil and breast feeding Because the half-life of remifentanil is extremely short, it is unlikely to cause any adverse effects in the breastfed newborn if it is given to the mother for labor analgesia or a surgical procedure. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of remifentanil to a few days. However, because no information is available on the use of remifentanil during breastfeeding, an alternate drug may be preferred if the mother requires prolonged administration of remifentanil during the early postpartum period. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.
  • Repaglinide and breast feeding No information is available on the use of repaglinide during breastfeeding. Repaglinide is a weak acid that is over 98% protein bound, so it is unlikely to pass into breastmilk in clinically important amounts. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with repaglinide. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Reserpine and breast feeding Because no information is available on the use of reserpine during breastfeeding and it might adversely affect the breastfed infant, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Reslizumab and breast feeding No information is available on the clinical use of reslizumab during breastfeeding. Because reslizumab is a large protein molecule with a molecular weight of 147,000, absorption by the infant is unlikely after the first few weeks postpartum, and it will probably be destroyed in the infant's gastrointestinal tract. Until more data become available, reslizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Retapamulin and breast feeding No information is available on the use of retapamulin during breastfeeding. Because retapamulin is poorly absorbed after topical application, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants after maternal application away from the breast. Only water-miscible cream or gel products should be applied to the breast, because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Revefenacin and breast feeding No information is available on the use of revefenacin during breastfeeding. Because the drug is only 3% absorbed orally, it is unlikely to affect the breastfed infant. Long-term use of revefenacin might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Rhenium-186 HEDP and breast feeding Information in this record refers to the use of rhenium-186 HEDP (rhenium-186 etidronate) as a therapeutic agent. No information is available on the therapeutic use of rhenium HEDP during breastfeeding. Because strontium can substitute for calcium in infant bones, the manufacturer and expert opinion recommend discontinuing breastfeeding before a nursing mother receives rhenium HEDP.
  • Ribociclib and breast feeding No information is available on the clinical use of ribociclib during breastfeeding. Because protein binding of ribociclib is 70%, clinically important amounts of the drug might pass into breastmilk. The manufacturer recommends that breastfeeding be discontinued during ribociclib therapy and for at least 3 weeks after the final dose.
  • Rifabutin and breast feeding The amount of rifabutin in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking rifabutin.
  • Rifampin and breast feeding Limited information indicates that there are low levels of rifampin in breastmilk that would not be expected to cause any adverse effects in breastfed infants. The amount of rifampin in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking rifampin.
  • Rifamycin and breast feeding Rifamycin is negligibly absorbed orally and used only for gastrointestinal infections. It is not likely to reach the breastmilk or bloodstream of the infant or cause any adverse effects in breastfed infants after maternal use.
  • Rifapentine and breast feeding The amount of rifapentine in milk is insufficient to treat tuberculosis in the breastfed infant. The Centers for Disease Control and Prevention and other professional organizations state that breastfeeding should not be discouraged in women taking rifapentine.
  • Rifaximin and breast feeding Rifaximin is poorly absorbed orally and used only for gastrointestinal infections. It is not likely to reach the breastmilk or bloodstream of the infant or cause any adverse effects in breastfed infants after maternal use. However, no published experience exists with rifaximin during breastfeeding; therefore, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rilpivirine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of rilpivirine during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Riluzole and breast feeding Limited information indicates that maternal doses of riluzole up to 100 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Until more data are available, use riluzole with caution, particularly when breastfeeding a newborn.
  • Rimexolone and breast feeding No information is available on the ophthalmic use of rimexolone during breastfeeding. Because absorption from the eye is limited, ophthalmic rimexolone would not be expected to cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Risankizumab and breast feeding No information is available on the clinical use of risankizumab during breastfeeding. Because risankizumab is a large protein molecule with a molecular weight of about 146,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, risankizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. Risankizumab is a human immunoglobulin G1 (IgG1) antibody. Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G in mature milk by 60 to 79%. A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Specific IgG subclasses decreased by different amounts, with IgG1 activity decreasing by about 37%. None of the studies measured IgG activity.
  • Risedronate and breast feeding Because no information is available on the use of risedronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of risedronate by a breastfed infant is unlikely.
  • Risperidone and breast feeding Limited information indicates that maternal risperidone doses of up to 6 mg daily produce low levels in milk. However, use with other antipsychotic drugs occasionally might negatively affect the infant. Because there is little published experience with risperidone during breastfeeding and little long-term follow-up data, other agents may be preferred, especially while nursing a newborn or preterm infant. Systematic reviews of second-generation antipsychotics concluded that risperidone seemed to be a second-line agent during breastfeeding because of the limited data available and higher excretion into milk relative to other agents. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
  • Rituximab and breast feeding Rituximab is a genetically engineered chimeric murine/human monoclonal antibody that targets CD20, a B-cell-specific surface antigen. Limited data indicate that the amount in milk is very low and absorption is unlikely because it is a protein with a molecular weight of 143,860, it is probably destroyed in the infant's gastrointestinal tract. Although 2 breastfed infants apparently experienced no adverse effects during maternal use of rituximab, no long-term data are available. If rituximab is required by the mother, it is not a reason to discontinue breastfeeding. Until more data become available, rituximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during rituximab therapy and for 6 months after the last dose.
  • Rivaroxaban and breast feeding Limited information indicates that a maternal dose of rivaroxaban of 30 mg daily produces low levels in milk. If rivaroxaban is required by the mother, it is not a reason to discontinue breastfeeding. However, until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rizatriptan and breast feeding Because there is no published experience with rizatriptan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Rocuronium and breast feeding Limited information on the use of rocuronium during breastfeeding indicates that no adverse infant effects occur. Because it is short acting, highly polar and poorly absorbed orally, it is not likely to reach the breastmilk in high concentration or to reach the bloodstream of the infant. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using rocuronium as a component may delay the onset of lactation.
  • Ropinirole and breast feeding No information is available on the use of ropinirole during breastfeeding, but it suppresses serum prolactin and may interfere with breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rosiglitazone and breast feeding No information is available on the clinical use of rosiglitazone during breastfeeding. Rosiglitazone is over 99% protein bound in plasma, so it is unlikely to pass into breastmilk in clinically important amounts. The manufacturer recommends avoiding breastfeeding during rosiglitazone use, so pioglitazone might be a better choice of the drugs in this class for nursing mothers.
  • Rosuvastatin and breast feeding Levels of rosuvastatin in milk are low, but no relevant published information exists with its use during breastfeeding. The consensus opinion is that women taking a statin should not breastfeed because of a concern with disruption of infant lipid metabolism. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Rotigotine and breast feeding No information is available on the use of rotigotine during breastfeeding, but it suppresses serum prolactin and may interfere with breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Roxithromycin and breast feeding Roxithromycin is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Because of the low levels of roxithromycin in breastmilk, it would not be expected to cause adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). Unconfirmed epidemiologic evidence indicates that the risk of infantile hypertrophic pyloric stenosis might be increased by maternal use of macrolide antibiotics during the first two weeks of breastfeeding, but others have questioned this relationship.
  • Rubella Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to rubella vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules. Although rubella vaccine virus might be excreted into milk, the virus usually does not infect the infant. If an infection does occur, it is well tolerated because the viruses are attenuated.
  • Rubidium Chloride Rb 82 and breast feeding Information in this record refers to the use of rubidium chloride Rb 82 as a diagnostic agent. No information is available on the use of rubidium chloride Rb 82 during breastfeeding. The manufacturer recommends withholding breastfeeding for 1 hour after a diagnostic dose of rubidium chloride Rb 82.This length of time is greater than 10 half-lives of the radioisotope, so the nursing infant should not be exposed to radiation if this guideline is followed. The mother can nurse just before administration of the radiopharmaceutical. If the mother has expressed and saved milk prior to the examination, she can feed it to the infant during the period of nursing interruption.
  • Rucaparib and breast feeding No information is available on the clinical use of rucaparib during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during rucaparib therapy and for 2 weeks following therapy.
  • Rufinamide and breast feeding Because no information is available on the use of rufinamide during breastfeeding and because it is potentially toxic to the breastfed infant, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ruxolitinib and breast feeding No information is available on the clinical use of ruxolitinib during breastfeeding. Because ruxolitinib is 97% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during ruxolitinib therapy and for 2 weeks after the last dose.

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  • Saccharin and breast feeding Because of the low levels of saccharin in breastmilk, amounts ingested by the infant after typical maternal intake are small and would not be expected to cause any adverse effects in breastfed infants. However, some authors suggest that women may wish to limit the consumption of nonnutritive sweeteners while breastfeeding because their effect on the nursing infants are unknown.
  • Sacubitril and breast feeding Sacubitril is available in the United States only in combination with valsartan. Because no information is available on the use of sacubitril or valsartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Safinamide and breast feeding No information is available on the use of safinamide during breastfeeding. Because of liver toxicity in nursing rat pups, the manufacturer recommends that the drug not be used in nursing mothers. Alternate agents are preferred.
  • Salicylic Acid and breast feeding No information is available on the clinical use of salicylic acid on the skin during breastfeeding. Because it is unlikely to be appreciably absorbed or appear in breastmilk, it is considered safe to use during breastfeeding. Avoid application to areas of the body that might come in direct contact with the infant's skin or where the drug might be ingested by the infant via licking.
  • Salmeterol and breast feeding Although no published data exist on the use of salmeterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. The authors of several reviews agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
  • Salsalate and breast feeding Salsalate has not been studied during breastfeeding, but salsalate results in salicylic acid in the blood. Salicylic acid and aspirin have been studied during breastfeeding. The excretion of salicylate into breastmilk increases disproportionately as the maternal dosage increases. Long-term, high-dose maternal aspirin ingestion probably caused metabolic acidosis in one breastfed infant. Reye's syndrome is associated with aspirin administration to infants with viral infections, but the risk of Reye's syndrome from salicylate in breastmilk is unknown. An alternate drug is preferred over salsalate.
  • Saquinavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of saquinavir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Sarecycline and breast feeding No information is available on the use of sarecycline during breastfeeding. The manufacturer states that breastfeeding is not recommended during treatment. However, based on the excretion of other tetracycline antibiotics, amounts in milk are expected to be low and probably poorly absorbed orally by the breastfed infant. If an infant is breastfed, monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis. As a theoretical precaution, avoid prolonged or repeat courses during nursing.
  • Saxagliptin and breast feeding No information is available on the clinical use of saxagliptin during breastfeeding. Saxagliptin has a shorter half-life than the other dipeptidyl-peptidase IV inhibitors, so it might be a better choice among drugs in this class for nursing mothers. Monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with saxagliptin. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Scopolamine and breast feeding No information is available on the use of scopolamine during breastfeeding. Use during labor appears to have a detrimental effect on newborn infants' nursing behavior. Long-term use of scopolamine might reduce milk production or milk letdown, but a single systemic or ophthalmic dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain). To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Secobarbital and breast feeding Because there is little published experience with secobarbital during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Secukinumab and breast feeding No information is available on the clinical use of secukinumab during breastfeeding. Because secukinumab is a large protein molecule with a molecular weight of 151,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, secukinumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Selegiline and breast feeding A minimal amount of clinical use of selegiline during breastfeeding has been reported. Although no adverse reactions have been reported in the breastfed infants, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer of the selegiline transdermal patch recommends that breastfeeding is not recommended during treatment and for 5 days after the final dose.
  • Selinexor and breast feeding No information is available on the use of selinexor during breastfeeding. Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. The manufacturer recommends that mothers should not to breastfeed during treatment with selinexor and for one week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Semaglutide and breast feeding No information is available on the clinical use of semaglutide during breastfeeding. Because semaglutide is a peptide molecule with a molecular weight of 4113 daltons and is over 99% protein bound, the amount in milk is likely to be very low. Absorption by the infant is unlikely because the drug is probably destroyed in the infant's gastrointestinal tract. Until more data become available, semaglutide should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Senna and breast feeding Although an early uncontrolled report using an old senna product found increased frequency of diarrhea in breastfed infants, several controlled studies using modern senna products found no effect on the infant. Usual doses of senna are acceptable to use during breastfeeding.
  • Sertraline and breast feeding Because of the low levels of sertraline in breastmilk, amounts ingested by the infant are small and is usually not detected in the serum of the infant, although the weakly active metabolite norsertraline (desmethylsertraline) is often detectable in low levels in infant serum. Rarely, preterm infants with impaired metabolic activity might accumulate the drug and demonstrate symptoms similar to neonatal abstinence. Most authoritative reviewers consider sertraline a preferred antidepressants during breastfeeding. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding, although this might be a reflection of their disease state. These mothers may need additional breastfeeding support. Breastfed infants exposed to an SSRI during the third trimester of pregnancy have a lower risk of poor neonatal adaptation than formula-fed infants.
  • Sevelamer and breast feeding Because sevelamer is not orally absorbed, sevelamer does not reach the breastmilk or adversely affect the breastfed infant after maternal administration. A suspension of sevelamer has been added directly to breastmilk to lower the phosphorus concentration of milk. This could be a useful maneuver for breastmilk use in infants with renal impairment; however, clinical use has not been reported. In addition to lowering average phosphorus content by 65% to over 80%, the calcium content of breastmilk was reduced by almost as much and the casein content also decreased somewhat. With sevelamer hydrochloride, the chloride content increased by 60% and the pH changed from 6.8 to 7.8, although pH appears to rebound over time. Addition of large amounts of sevelamer to artificial formula also lowers the copper, magnesium, manganese, potassium, sulfur and zinc concentrations by about 20%. Similar reductions might occur with breastmilk.
  • Sevoflurane and breast feeding There is little published experience with sevoflurane during breastfeeding. Because the serum half-life of sevoflurane in the mother short and the drug is not expected to be absorbed by the infant, no waiting period or discarding of milk is required. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. General anesthesia for cesarean section using sevoflurane as a component may delay the onset of lactation. In one study, breastfeeding before general anesthesia induction reduced requirements of sevoflurane and propofol compared to those of nursing mothers whose breastfeeding was withheld or nonnursing women.
  • Sibutramine and breast feeding Because there is no published experience with sibutramine during breastfeeding, an alternate therapy may be preferred, especially while nursing a newborn or preterm infant. Information on the effect of sibutramine on serum prolactin is somewhat conflicting.
  • Sildenafil and breast feeding Limited data indicate that sildenafil and its active metabolite in breastmilk are poorly excreted into breastmilk. Amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Siltuximab and breast feeding No information is available on the clinical use of siltuximab during breastfeeding. Because siltuximab is a large protein molecule with a molecular weight of about 145,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, siltuximab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during siltuximab therapy.
  • Simethicone and breast feeding Although no data are available on the use of simethicone during breastfeeding, it is known that simethicone is not absorbed orally. Therefore, it cannot be transferred to breastmilk. It is also used safely in breastfed infants. No special precautions are required.
  • Simvastatin and breast feeding No relevant published information exists on the use of simvastatin during breastfeeding. Because of a concern with disruption of infant lipid metabolism, the consensus is that simvastatin should not be used during breastfeeding. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Sincalide and breast feeding Sincalide is a synthetic octapeptide analogue of cholecystokinin. Because sincalide has a molecular weight of 1143, the amount in milk is likely to be very low and oral absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. The serum half-life of sincalide is less than 2 minutes, indicating that withholding breastfeeding for 10 minutes after a dose should ensure that the infant is not exposed to the drug.
  • Siponimod and breast feeding Although siponimod is highly bound in maternal plasma and unlikely to reach the breastmilk in large amounts, it is potentially toxic to the breastfed infant. Because there is no published experience with siponimod during breastfeeding, expert opinion generally recommends that the closely related drug fingolimod should be avoided during breastfeeding, especially while nursing a newborn or preterm infant. However, the manufacturer's labeling does not recommend against the use of siponimod in breastfeeding.
  • Sirolimus and breast feeding Because almost no information is available on the use of sirolimus during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Sitagliptin and breast feeding No information is available on the clinical use of sitagliptin during breastfeeding. Sitagliptin has a shorter half-life than most other dipeptidyl-peptidase IV inhibitors, so it might be a better choice among drugs in this class for nursing mothers. Monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with saxagliptin. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Sodium Chromate Cr 51 and breast feeding Information in this record refers to the use of sodium chromate Cr 51 as a diagnostic agent. No information is available on the use of sodium chromate Cr 51 during breastfeeding. The manufacturer recommends withholding breastfeeding after a diagnostic dose of sodium chromate Cr 51, but does not provide a specific duration. The long biological and physical half-lives of chromium may preclude resumption of breastfeeding of the infant. Mothers concerned about the level of radioactivity in their milk could ask to have it tested at a nuclear medicine facility at their hospital and when the radioactivity is at background levels they may safely resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published.
  • Sodium Ferric Gluconate Complex and breast feeding No information is available on the use of sodium ferric gluconate complex during breastfeeding. Ferrlecit contains 9 mg/mL of benzyl alcohol, which may enter breastmilk and be absorbed by the infant. An alternate intravenous drug with more published data available may be preferred.
  • Sodium Iodide I 123 and breast feeding Information in this record refers to the use of sodium iodide I 123 as a diagnostic agent. Considerable controversy exists in the literature concerning the breastfeeding interruption time after the diagnostic use of sodium iodide I 123, partly depending on assumptions used for the levels of impurities, especially I 125, in commercial products. Some international agencies state that breastfeeding should be interrupted for more than 3 weeks following diagnostic use of sodium iodide I 123. This usually will result in permanent discontinuation of breastfeeding for this infant. However, other experts recommend much shorter times. Recent information indicates that I 125 contamination is currently much less than earlier estimates. The American Thyroid Association recommends discontinuation of breastfeeding for only 3 to 4 days after a diagnostic scan and UK authorities recommend a cessation of 42 hours after a 20 MBq dose. The safest course of action may be to have breastmilk tested at a nuclear medicine facility at a hospital. When the radioactivity is at a safe level the mother may resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published. Mothers who receive a dose less than 400 MBq for a thyroid scan need not refrain from close contact with their infants.
  • Sodium Oxybate and breast feeding Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB). GHB is an endogenous substance and low amounts are normally found in breastmilk. Large doses of GHB have been used as a substance of abuse. Infants have been successfully breastfed by mothers taking sodium oxybate therapeutically for narcolepsy. With the typical 2 doses per night treatment regimen, nursing should usually be withheld from the time of the first dose to 4 to 6 hours after the second dose and breastfeeding can be continued during the day. No information is available on the use or safety of GHB as a drug of abuse during breastfeeding.
  • Sodium Phosphate P 32 and breast feeding Information in this record refers to the use of sodium phosphate P 32 as a therapeutic agent. No information is available on the use of sodium phosphate P 32 during breastfeeding. The European Association of Nuclear Medicine recommends using other modalities to treat polycythemia vera and essential thrombocytopenia in patients under 60 to 65 years of age and states that the drug is contraindicated in nursing mothers. If a nursing mother is given sodium phosphate P 32 systemically, breastfeeding should be discontinued permanently for this child.
  • Sodium Phosphate and breast feeding Phosphate is a normal constituent of breastmilk. Phosphate concentrations have not been measured in breastmilk after large maternal doses of sodium phosphate, such a 30 gram oral dose for pre-procedural bowel evacuation. However, the added phosphate in breastmilk is likely to be only about 130 mg over 24 hours in this situation. The increase from a typical dose of a rectal enema would be considerably less than this amount. Breastmilk sodium concentration is tightly regulated, and will not be affected. It is probably not necessary to suspend breastfeeding after the use of oral sodium phosphate solutions given once or twice for bowel evacuation before a procedure, but if there is concern, suspension of nursing for 24 hours after a dose should result in negligible increase in phosphate ingestion by the infant. Use of a phosphate rectal enema by a nursing mother would require no special precautions.
  • Sodium Picosulfate and breast feeding Sodium picosulfate is not absorbed from the gastrointestinal tract, and its active metabolite, which is absorbed, is not detectable in breastmilk. Sodium picosulfate can be taken during breastfeeding and no special precautions are required.
  • Sodium Stibogluconate and breast feeding Limited information indicates that maternal doses of sodium stibogluconate up to 1.4 grams daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. However, if withholding nursing during therapy is elected, breastfeeding can be reinstituted 24 to 48 hours after the last dose.
  • Solifenacin and breast feeding Because there is no published experience with solifenacin during breastfeeding and it has a long half-life averaging 55 hours, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Long-term use of solifenacin might reduce milk production or milk letdown. During long-term use, observe the infant for signs of decreased milk production (e.g., insatiety, poor weight gain) and for anticholinergic symptoms (e.g., constipation, urinary retention, UTI, dry mouth).
  • Solriamfetol and breast feeding No information is available on the use of solriamfetol during breastfeeding. If solriamfetol is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the breastfed infant for adverse reactions, such as agitation, insomnia, poor feeding, and reduced weight gain.
  • Somatrem and breast feeding Because somatrem is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. However, there is no published experience with somatrem during breastfeeding, so an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Sonidegib and breast feeding No information is available on the clinical use of sonidegib during breastfeeding. Because sonidegib is 97% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is about 28 days and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during sonidegib therapy.
  • Sorafenib and breast feeding No information is available on the clinical use of sorafenib during breastfeeding. Because sorafenib is 99.5% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is 25 to 48 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during sorafenib therapy and for 2 weeks after the last dose.
  • Sotalol and breast feeding Because of its extensive excretion into breastmilk, its renal excretion and minimal safety data in breastfed infants, other beta-adrenergic blocking drugs are preferred to sotalol, especially while nursing a newborn or preterm infant. Some authors recommend using sotalol during breastfeeding only while monitoring the infant closely for signs of beta-blockade. Infants over 2 months of age have more mature kidney function and are less likely to be affected by sotalol in milk.
  • Sparfloxacin and breast feeding No information is available on the use of sparfloxacin during breastfeeding. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of sparfloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available.
  • Spinosad and breast feeding No information is available on the clinical use of spinosad during breastfeeding. Because it is not systemically absorbed after topical application, it should not be present in breastmilk. However, the topical suspension contains benzyl alcohol, which may be systemically absorbed through the skin. High doses of benzyl alcohol are potentially toxic to neonates, but it is unlikely that doses this high reach breastmilk. The manufacturer states that mothers concerned about benzyl alcohol could pump and discard breastmilk for 8 hours, but this is probably unnecessary. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Stavudine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Published experience with stavudine during breastfeeding is limited. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine. Stavudine should not be used in first-line regimens because of its metabolic toxicities.
  • Stiripentol and breast feeding Because no information is available on the use of stiripentol during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Streptomycin and breast feeding Similar to other aminoglycoside antibiotics, streptomycin is poorly excreted into breastmilk. Newborn infants apparently absorb small amounts of aminoglycosides, but serum levels are far below those attained when treating newborn infections and systemic effects of streptomycin are unlikely. Older infants would be expected to absorb even less streptomycin Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (e.g., thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.
  • Strontium Chloride Sr 89 and breast feeding IInformation in this record refers to the use of strontium 89 as a therapeutic agent. No information is available on the therapeutic use of strontium 89 during breastfeeding. It has been estimated that about 9% of the strontium in the maternal bloodstream reaches breastmilk for another strontium isotope, strontium 90. Because strontium can substitute for calcium in infant bones, the manufacturer and expert opinion recommend discontinuing breastfeeding before a nursing mother receives strontium 89 chloride.
  • Succcinylcholine and breast feeding No information is available on the use of succinylcholine during breastfeeding. Because it is rapidly eliminated and poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. A general anesthetic regimen that included succinylcholine for cesarean section caused a delay in the time to the first breastfeeding, but the part that succinylcholine played in this difference in outcome in unknown.
  • Sucralfate and breast feeding No data are available on sucralfate use during breastfeeding; however, it is virtually unabsorbed orally. Most authorities consider sucralfate acceptable to use during breastfeeding. No special precautions are required.
  • Sucralose and breast feeding Sucralose has been found in the breastmilk of some nursing mothers who report consuming artificially sweetened beverages and sweetener packets in the past 24 hours and in all women given a sucralose-sweetened soda. Because sucralose is poorly absorbed after oral ingestion, it is not likely to reach the bloodstream of the infant or cause immediate adverse effects in breastfed infants. Some authors note that the levels of sucralose in milk can exceed the sweetness threshold in milk and affect intestinal enzymes and the microbiome. They suggest that women may wish to limit the consumption of nonnutritive sweeteners while breastfeeding because their effect on the nursing infants are unknown.
  • Sugammadex and breast feeding No information is available on the clinical use of sugammadex during breastfeeding. Because sugammadex is a large, highly polar molecule with a molecular weight of 2002, the amount in milk is likely to be very low and oral absorption by the infant is unlikely. Sugammadex is acceptable to use during breastfeeding.
  • Sulconazole and breast feeding Topical sulconazole has not been studied during breastfeeding. About 11% of a dose is absorbed after topical application. It is considered a low risk to the nursing infant; however, other antifungal agents with less absorption may be preferred, especially while nursing a newborn or preterm infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Sulfamethoxazole and breast feeding With healthy, fullterm infants it appears acceptable to use sulfamethoxazole during breastfeeding after the newborn period. The time of greatest risk for hemolysis in fullterm newborns without glucose-6-phosphate dehydrogenase (G6PD) deficiency might be as short as 8 days after birth. Until further data are accumulated, alternate agents should probably be used in jaundiced, ill, stressed or premature infants, because of the risk of bilirubin displacement and kernicterus. Sulfamethoxazole should be avoided while breastfeeding a G6PD deficient infant.
  • Sulfasalazine and breast feeding Sulfasalazine and its active metabolite mesalamine are poorly excreted into breastmilk. However, rather high levels of the mesalamine metabolite N-acetyl-5-ASA appear in breastmilk and its effects on breastfed infants are unknown. Another sulfasalazine metabolite, sulfapyridine, also appears in milk and infant serum and might cause hemolysis, especially in newborn infants and in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The time of greatest risk for hemolysis in fullterm newborns without G6PD deficiency might be as short as 8 days after birth. Bloody diarrhea has occurred in an infant whose mother was taking sulfasalazine and a few cases of diarrhea have been reported in infants exposed to mesalamine in breastmilk, although the rate is not high. Most experts consider mesalamine derivatives to be safe during breastfeeding. If sulfasalazine is required by the mother, it is not a reason to discontinue breastfeeding, but carefully observe breastfed infants for diarrhea. Other mesalamine derivatives that do not contain a sulfonamide are preferred.
  • Sulfisoxazole and breast feeding With healthy, fullterm infants it appears acceptable to use sulfisoxazole during breastfeeding after the newborn period. Until further data are accumulated, alternate agents should probably be used in jaundiced, ill, stressed or premature infants, because of the risk of bilirubin displacement and kernicterus. Sulfisoxazole should be avoided while breastfeeding a glucose-6-phosphate dehydrogenase (G6PD) deficient infant.
  • Sulfur Hexafluoride and breast feeding No published experience exists with sulfur hexafluoride during breastfeeding. Because the half-life of the agent is about 10 minutes and absorption of the drug by the infant is unlikely. If sulfur hexafluoride is required by the mother, it is not a reason to discontinue breastfeeding. Because of the lack of information, the American College of Radiology states that temporary (~24 hours) pumping and discarding of milk may be considered.
  • Sulfur and breast feeding Sulfur 5% to 10% in a petrolatum base is safe for topical use in children, including infants under 2 months of age. This makes it a useful alternative to organic insecticides for treating scabies in nursing mothers; however, the petrolatum base makes undesirable for use on the breast.
  • Sulindac and breast feeding Because no information is available on the use of sulindac during breastfeeding, its relatively long half-life and glucuronide metabolite, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Sumatriptan and breast feeding BBecause of the low levels of sumatriptan in breastmilk, amounts ingested by the infant are small. It also has poor oral bioavailability, further decreasing infant exposure to the drug. Some authors have suggested that withholding breastfeeding for 8 hours after a single subcutaneous injection would virtually eliminate infant exposure to the drug. The manufacturer recommends withholding breastfeeding for 12 hours after a dose. Withholding breastfeeding might be helpful in extreme cases, such as in the mother of a preterm infant, but sumatriptan would not be expected to cause any adverse effects in most breastfed infants. One anecdotal report of lactation ceasing after a single injection of sumatriptan has not been verified.
  • Sunitinib and breast feeding No information is available on the clinical use of sunitinib during breastfeeding. Because sunitinib and its metabolite are over 90% bound to plasma proteins, the amount in milk is likely to be low. However, one of its metabolites has a half-life of up to 110 hours, and might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during sunitinib therapy and for at least 4 weeks after the last dose.

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  • Tafenoquine and breast feeding No information is available on the use of tafenoquine during breastfeeding. Tafenoquine can cause hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. If tafenoquine is needed by the mother, testing the mother and infant for G6PD deficiency is required before the drug is given. Because the half-life of tafenoquine averages 15 days, the manufacturer recommends that breastfeeding should not breastfeed for 3 months after the dose if the infant is G6PD deficient.
  • Tafluprost and breast feeding No information is available on the use of tafluprost during breastfeeding. Because of the extremely low levels in plasma after application to the eye, it is not likely to reach the breastmilk or bloodstream of the infant or to cause any adverse effects in breastfed infants. To further diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Tagraxofusp and breast feeding No information is available on the use of tagraxofusp during breastfeeding. The manufacturer recommends that breastfeeding be discontinued during tagraxofusp therapy and for 1 week after the final dose.
  • Talazoparib and breast feeding No information is available on the clinical use of talazoparib during breastfeeding. Because talazoparib is 74% bound to plasma proteins, the amount in milk is likely to be low. The manufacturer recommends that breastfeeding be discontinued during talazoparib therapy and for one month after the last dose.
  • Taliglucerase alfa and breast feeding No information is available on the clinical use of taliglucerase alfa during breastfeeding. Taliglucerase alfa is a biosynthetic synthetic enzyme closely related to beta-glucocerebrosidase, which is a normal component of human milk. Because it is a large protein molecule with a molecular weight of about 61,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. A limited amount of data support the safety of breastfeeding with alglucerase (the placenta-derived form of the enzyme) and imiglucerase (another biosynthetic form of the enzyme). An international panel of clinicians from 9 centers that treat Gaucher's disease reported that, breastfeeding complications were less frequent in mothers who were treated with alglucerase or imiglucerase postpartum than in untreated mothers with Gaucher's disease. Consider limiting the duration of breastfeeding to about 6 months to avoid excessive bone loss in the nursing mother.
  • Tamoxifen and breast feeding Since tamoxifen can suppress postpartum lactation and its excretion into breastmilk is not known, it should be avoided in nursing mothers.
  • Tapentadol and breast feeding Little information is available on the use of tapentadol during breastfeeding. Because it has opioid agonist activity, an alternate drug is preferred, especially while nursing a newborn or preterm infant. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics. Monitor infants for excess sedation and respiratory depression. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately. Withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breastfeeding is stopped.
  • Tattooing and breast feeding No data are available on the safety of tattooing during breastfeeding. Theoretical concerns relate to transmission of pigments or infections to the infant during breastfeeding and in the United States, blood donation is not permitted for 12 months after a tattoo as a precaution. Opinion appears to favor not obtaining a new tattoo during breastfeeding. Tattooing of the nipple-areola area is sometimes used as part of nipple reconstruction in plastic surgery.
  • Tavaborole and breast feeding Topical tavaborole has not been studied during breastfeeding. Because blood levels are very low after topical application to the toenails, it is unlikely that a measurable amount of the drug will enter the breastmilk.
  • Tazarotene and breast feeding Topical tazarotene has not been studied during breastfeeding. Some experts feel it should not be used on greater than 20% of the body surface area while nursing because of possible absorption. If tazarotene is used, ensure that the infant's skin does not come into direct contact with the areas of maternal skin that have been treated and the infant does not ingest the product from the mother's skin.
  • Tedizolid and breast feeding Because there is no published experience with tedizolid during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Teicoplanin and breast feeding Teicoplanin is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited data indicate that teicoplanin is poorly excreted into breastmilk. Because teicoplanin is not orally absorbed it is unlikely to adversely affect the breastfed infant. One infant was safely breastfed during maternal therapy with teicoplanin and ceftriaxone. Until more information becomes available, monitor the breastfed infant for gastrointestinal disturbances such as diarrhea, particularly in newborn and preterm infants.
  • Telaprevir and breast feeding Telaprevir is not marketed in the United States and has not been studied in nursing mothers. Because it must be used with ribavirin and peginterferon alfa, it is not considered a good choice during breastfeeding. When it was marketed, the manufacturer recommended that mothers taking telaprevir not breastfeed their infants.
  • Telavancin and breast feeding Because telavancin is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal tract, such as diarrhea, vomiting, and candidiasis (e.g., thrush, diaper rash). However, because there is no published experience with telavancin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Telithromycin and breast feeding Because there is no published experience with telithromycin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Telmisartan and breast feeding Because no information is available on the use of telmisartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Temazepam and breast feeding Because of the low levels of temazepam in breastmilk and its relatively short half-life, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Taking the bedtime dose after the infant's last feeding of the day may minimize the dose received by an older infant who is sleeping through the night.
  • Temozolamide and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, especially alkylating agents such as temozolamide. It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence; however, no data are available to determine an appropriate period to withhold breastfeeding. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.
  • Temsirolimus and breast feeding Temsirolimus is a prodrug of sirolimus. Because no information is available on the use of temsirolimus or sirolimus during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer recommends that breastfeeding be discontinued during bevacizumab therapy and for 3 weeks following the last dose.
  • Terazosin and breast feeding Because no information is available on the use of terazosin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Terbutaline and breast feeding Maternal use of oral or inhaled terbutaline is unlikely to affect a breastfed infant. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use. Terbutaline use as a tocolytic agent might decrease the duration of breastfeeding.
  • Terconazole and breast feeding Vaginal terconazole has not been studied during breastfeeding. Other antifungal agents may be preferred, especially while nursing a newborn or preterm infant
  • Teriflunomide and breast feeding Because there is no published experience with teriflunomide during breastfeeding, it should be avoided during breastfeeding, especially while nursing a newborn or preterm infant.
  • Testosterone and breast feeding Limited data indicate that a low-dose (100 mg) subcutaneous testosterone pellet given to a nursing mother appears not to increase milk testosterone levels markedly. Testosterone has low oral bioavailability because of extensive first-pass metabolism, so it is unlikely to affect the breastfed infant. One breastfed infant seemed not to be adversely affected by low-dose maternal testosterone therapy.
  • Tetracaine and breast feeding No information is available on the use of tetracaine during breastfeeding. Based on the low excretion of other local anesthetics into breastmilk, a single dose of injected tetracaine during breastfeeding, such as for a dental procedure, is unlikely to adversely affect the breastfed infant. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Topical application of tetracaine to the mother is unlikely to affect her breastfed infant if it is applied away from the breast. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Tetracycline and breast feeding A number of reviews have stated that tetracycline is contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines. However, a close examination of available literature indicates that there is not likely to be harm in short-term use of tetracycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of tetracycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Tezacaftor and Ivacaftor and breast feeding Information from one maternal-infant pair with ivacaftor and lumacaftor indicates that maternal ivacaftor therapy produce low levels in milk; tezacaftor has not been studied in breastfeeding. The breastfed infant had transient elevations in bilirubin and liver enzymes during maternal therapy that could not definitively be attributed to the drugs in breastmilk. Effect of small amounts of ivacaftor in infants and small children is unknown. Until more data are available, monitoring of infant bilirubin and liver enzymes is recommended during breastfeeding with maternal lumacaftor and ivacaftor therapy.
  • Theophylline and breast feeding An expert panel considers use of theophylline to be acceptable during breastfeeding. Maternal theophylline use may occasionally cause stimulation and irritability and fretful sleep in infants. Newborn and especially preterm infants are most likely to be affected because of their slow elimination and low serum protein binding of theophylline. There is no need to avoid theophylline products; however, keep maternal serum concentrations in the lower part of the therapeutic range and monitor the infant for signs of theophylline side effects. Infant serum theophylline concentrations can help to determine if signs of agitation are due to theophylline. Avoiding breastfeeding for an 2 hours after intravenous or 4 hours after an immediate-release oral theophylline product can decrease the dose received by the breastfed infant. When theophylline is given as an oral sustained-release product, timing of nursing with respect to the dose is of little or no benefit.
  • Thiethylperazine and breast feeding Based on minimal excretion of other phenothiazine derivatives, it appears that occasional short-term use of thiethylperazine for the treatment of nausea and vomiting poses little risk to the breastfed infant.
  • Thioguanine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, although antimetabolites such as thioguanine appear to pose the least risk to breastfed infants. Thioguanine levels in milk are reportedly low. Thioguanine nucleosides are active intracellular metabolites of azathioprine and have been measured in breastmilk and in infant serum following maternal use of azathioprine as an immunosuppressant. Although amounts in milk were low in breastmilk and mostly undetectable in infant serum, relatively low dosages of azathioprine were used. After high-dose chemotherapy, it might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence. Although no data are available to determine an appropriate period to withhold breastfeeding, the drug's terminal half-life suggests that withholding breastfeeding for 4 days may be sufficient. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.
  • Thiopental and breast feeding Amounts of thiopental in milk are very small. Existing data indicate that no waiting period is required before resuming breastfeeding after thiopental anesthesia. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.
  • Thioridazine and breast feeding Because there is no published experience with thioridazine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Thiothixene and breast feeding Because there is no published experience with thiothixene during breastfeeding, other antipsychotic agents are preferred.
  • Thyroid and breast feeding Thyroid is an animal-derived mixture of levothyroxine (T4) and liothyronine (T3), which are normal components of human milk. Limited data on exogenous replacement doses of levothyroxine during breastfeeding indicate no adverse effects in infants. If thyroid is required by the mother, it is not a reason to discontinue breastfeeding. The American Thyroid Association recommends that subclinical and overt hypothyroidism should be treated with levothyroxine in lactating women seeking to breastfeed. Thyroid dosage requirement may be increased in the postpartum period compared to prepregnancy requirements patients with Hashimoto's thyroiditis.
  • Tiagabine and breast feeding Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs. Because there is very limited published experience with tiagabine during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Ticagrelor and breast feeding No published information is available on the use of ticagrelor during breastfeeding. Because ticagrelor and its active metabolite are more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. If it is used by a nursing mother, monitor the infant for bruising and bleeding.
  • Ticarcillin and Clavulanic Acid and breast feeding Limited information indicates that ticarcillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Clavulanic acid has not been studied in nursing mothers. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Ticarcillin and clavulanic acid is acceptable is acceptable in nursing mothers.
  • Ticarcillin and breast feeding Limited information indicates that ticarcillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush have been reported with penicillins, but these effects have not been adequately evaluated. Ticarcillin is acceptable in nursing mothers.
  • Tigecycline and breast feeding Tigecycline is a tetracycline antibiotic. A number of reviews have stated that tetracyclines are contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines.However, a close examination of available literature indicates that there is not likely to be harm in short-term use of a tigecycline during lactation because the drug is 71 to 89% bound to plasma proteins, so milk levels are likely low and absorption by the infant is inhibited by the calcium in breastmilk. Short-term use of tigecycline is acceptable in nursing mothers. As a theoretical precaution, avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash).
  • Tiludronate and breast feeding Because no information is available on the use of tiludronate during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of tiludronate by a breastfed infant is unlikely.
  • Tinzaparin and breast feeding Although tinzaparin has not been studied, other low molecular weight heparins (e.g., dalteparin, enoxaparin) are not excreted into breastmilk in clinically relevant amounts. Because there is no published experience with tinzaparin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Tioconazole and breast feeding Vaginal tioconazole has not been studied during breastfeeding. Other antifungal agents may be preferred, especially while nursing a newborn or preterm infant.
  • Tiotropium and breast feeding Although no published data exist on the use of tiotropium, its use produces negligible maternal serum levels and any drug in breastmilk would not be absorbed by the infant. The risk to the breastfed infant of maternal tiotropium inhalation is small.
  • Tipranavir and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. No published information is available on the use of tipranavir during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine.
  • Tocainide and breast feeding Tocainide was removed from the market in the United States in 2003 because it can cause serious and potentially fatal hematological adverse effects. Limited data indicate that rather large amounts of tocainide are excreted into breastmilk. Because of the relative lack of data concerning breastfeeding during maternal tocainide therapy and is potential toxicity, tocainide should be avoided during breastfeeding.
  • Tofacitinib and breast feeding No information is available on the clinical use of tofacitinib during breastfeeding. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. The manufacturer and an expert panel recommend that breastfeeding be discontinued during tofacitinib therapy and for 18 hours after the last dose of Xeljanz or 36 hours after the last dose of Xeljanz XR.
  • Tolazamide and breast feeding Because no information is available on the use of tolazamide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Tolbutamide and breast feeding Tolbutamide is excreted into breastmilk in small amounts that should cause no harm to the breastfed infant. Monitor breastfed infants for signs of hypoglycemia such as jitteriness, excessive sleepiness, poor feeding, seizures cyanosis, apnea, or hypothermia. If there is concern, monitoring of the breastfed infant's blood glucose is advisable during maternal therapy with hypoglycemic agents.
  • Tolcapone and breast feeding No information is available on the use of tolcapone during breastfeeding. An alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Tolmetin and breast feeding Because of the low levels of tolmetin in breastmilk and its short half-life, it is unlikely to adversely affect the breastfed infant. However, because there is no published experience with breastfeeding during tolmetin use, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Tolnaftate and breast feeding Topical tolnaftate has not been studied during breastfeeding and no data are available on the extent of its absorption after topical application. Because it is probably poorly absorbed after topical application, it is considered a low risk to the nursing infant. Avoid application to the nipple area and ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream, gel or liquid products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Tolterodine and breast feeding No information is available on the use of tolterodine during breastfeeding. Long-term use of tolterodine might reduce milk production or milk letdown. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Topiramate and breast feeding Limited information indicates that maternal doses of topiramate up to 200 mg daily produce relatively low levels in infant serum. Monitor the infant for diarrhea, drowsiness, irritability, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.
  • Topotecan and breast feeding Most sources consider breastfeeding to be contraindicated during maternal high-dose antineoplastic drug therapy. The manufacturer recommends that women not breastfeed during treatment with topotecan and for 1 week after the last dose. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Torsemide and breast feeding Because no information is available on the use of torsemide during breastfeeding and because intense diuresis might decrease lactation, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Tramadol and breast feeding The excretion of tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyltramadol, are excreted. With usual maternal dosage, the amount excreted into breastmilk is much less than the dose that has been given to newborn infants for analgesia. A study of breastfeeding in breastfed newborn infants found no adverse effects attributable to tramadol. Although tramadol is unlikely to adversely affect nursing infant, the U.S. Food and Drug Administration and the manufacturer recommend against the use of tramadol during breastfeeding. If tramadol is used, monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties or limpness, and contact a physician immediately if any of these occur.
  • Trametinib and breast feeding No information is available on the clinical use of trametinib during breastfeeding. Because trametinib is 97% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is 3.9 to 4.8 days and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during trametinib therapy and for 4 months after the last dose.
  • Trandolapril and breast feeding Because no information is available on the use of trandolapril during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Tranexamic Acid and breast feeding Amounts of tranexamic acid in breastmilk appear to be low. Although an international consensus panel recommended against using tranexamic acid during breastfeeding, a subsequent controlled study found no adverse outcomes among breastfed infants whose mothers took tranexamic acid in dosages up to 4 grams daily during breastfeeding. One center in Canada reports routine use of tranexamic acid 3 grams daily in nursing mothers with bleeding disorders until bleeding stops. If tranexamic acid is required by a mother, it is not a reason to discontinue breastfeeding; however, until more data become available, medical supervision and follow-up of the breastfed infant is recommended.
  • Transcutaneous Electric Nerve Stimulation and breast feeding Transcutaneous electric nerve stimulation (TENS) is a method of using electrical stimulation of nerves using electrodes affixed to the skin. It is most often used to treat pain. Two small, low-quality studies found it useful for alleviating uterine pain caused by breastfeeding in the early postpartum period in hospitalized women. There are also anecdotal reports of TENS being used for nipple stimulation to induce lactation in adoptive mothers. However, no scientific evaluation of the safety or efficacy of this use could be located.
  • Tranylcypromine and breast feeding Because little information is available on the use of tranylcypromine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Travoprost and breast feeding No information is available on the use of travoprost during breastfeeding. Because of its short half-life it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Trazodone and breast feeding Limited information indicates that trazodone levels in milk are low and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months or when doses of 100 mg or less are used at bedtime for sleep.
  • Treprostinil and breast feeding One patient taking treprostinil breastfed her infant for one year without any complications. However, until more data are available, treprostinil should only be used with careful monitoring during breastfeeding.
  • Tretinoin and breast feeding Tretinoin has not been studied during breastfeeding. Breastfeeding should probably be avoided after oral use. Because it is poorly absorbed after topical application, it is considered a low risk to the nursing infant. Ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.
  • Triamcinolone and breast feeding Because no information is available on the use of oral or injectable triamcinolone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, use of triamcinolone as a nasal spray or local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants. Reviewers and an expert panel consider inhaled and oral corticosteroids acceptable to use during breastfeeding. Local injections, such as for tendinitis, would not be expected to cause any adverse effects in breastfed infants, but might occasionally cause temporary loss of milk supply. See also Triamcinolone, Topical.
  • Triamcinolone, Topical and breast feeding Topical triamcinolone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking. Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.
  • Triamterene and breast feeding Because there is no published experience with triamterene during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Triazolam and breast feeding Because little information is available on the use of triazolam during breastfeeding, an alternate hypnotic may be preferred, especially while nursing a newborn or preterm infant. Triazolam has a relatively short half-life, so occasional use while breastfeeding an older infant should pose little risk to the infant, but monitor the infant for excessive drowsiness.
  • Trichlormethiazide and breast feeding No information is available on the amount of trichlormethiazide in breastmilk. Intense diuresis with large doses may decrease breastmilk production. Other diuretics in low doses are preferred over trichlormethiazide.
  • Trichloroacetic Acid and breast feeding No information is available on the clinical use of trichloroacetic acid on the skin during breastfeeding. Because it is unlikely to be appreciably absorbed or appear in breastmilk, it is considered safe to use during breastfeeding. Avoid application to areas of the body that might come in direct contact with the infant's skin or where the drug might be ingested by the infant via licking.
  • Triclabendazole and breast feeding No information is available on the use of triclabendazole during breastfeeding. Because of protein binding of 96% to 99% for the drug and metabolites, exposure of the breastfed infant is likely to be low.
  • Trientine and breast feeding Limited information indicates that trientine is not detectable in breastmilk, and no adverse effects have been reported among breastfed infants whose mothers were taking the drug. The effect of trientine on breastmilk copper and zinc concentrations in milk is conflicting, but breastfed infants appear to have normal serum copper and zinc plasma levels. Based on available data, it appears that trientine is acceptable to use during breastfeeding.
  • Trifluoperazine and breast feeding Limited information indicates that maternal doses of trifluoperazine up to 10 mg daily do not affect the breastfed infant. Very limited long-term follow-up data indicate no adverse developmental effects when other phenothiazines are used alone. Because there is little published experience with trifluoperazine during breastfeeding, other antipsychotic agents may be preferred, especially wile nursing an newborn or preterm infant.
  • Trihexyphenidyl and breast feeding Limited information indicates that maternal doses of trihexyphenidyl up to 4 mg daily together with haloperidol did not produce any adverse effects in breastfed infants. Long-term use of trihexyphenidyl might reduce milk production or milk letdown, but a single dose is not likely to interfere with breastfeeding. During long-term use, observe for signs of decreased lactation (e.g., insatiety, poor weight gain).
  • Trimethobenzamide and breast feeding Because no information is available on the continuous use of trimethobenzamide during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Occasional, short-term use of trimethobenzamide for the treatment of nausea and vomiting appears to be acceptable.
  • Trimethoprim and breast feeding Because of the low levels of trimethoprim in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
  • Trimethoprim-Sulfamethoxazole and breast feeding With healthy, fullterm infants it appears acceptable to use sulfamethoxazole and trimethoprim during breastfeeding after the newborn period. The time of greatest risk for hemolysis in fullterm newborns without glucose-6-phosphate dehydrogenase (G6PD) deficiency might be as short as 8 days after birth. Until further data are accumulated, alternate agents should probably be used in jaundiced, ill, stressed or premature infants, because of the risk of bilirubin displacement and kernicterus. Sulfamethoxazole and trimethoprim should be avoided while breastfeeding a G6PD-deficient infant.
  • Trimipramine and breast feeding Because there is no published experience with trimipramine during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Tripelennamine and breast feeding Small occasional doses of tripelennamine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Triprolidine and breast feeding Small, occasional doses of triprolidine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic such as pseudoephedrine or before lactation is well established. The nonsedating antihistamines are preferred alternatives.
  • Tropicamide and breast feeding No information is available on the use of tropicamide during breastfeeding. Anticholinergic drugs might interfere with breastfeeding. A single dose of ophthalmic tropicamide is not likely to interfere with breastfeeding; however, during long-term use, observe the infant for signs of decreased lactation (e.g., insatiety, poor weight gain). To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Trovafloxacin and breast feeding No information is available on the clinical use of trovafloxacin during breastfeeding; however, amounts in breastmilk appear to be low. Fluoroquinolones have traditionally not been used in infants because of concern about adverse effects on the infants' developing joints. However, recent studies indicate little risk. The calcium in milk might prevent absorption of the small amounts of fluoroquinolones in milk, but insufficient data exist to prove or disprove this assertion. Use of trovafloxacin is acceptable in nursing mothers with monitoring of the infant for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). However, it is preferable to use an alternate drug for which safety information is available.
  • Tuberculin and breast feeding There is no reason to withhold breastfeeding after tuberculosis skin testing or to avoid skin testing in nursing mothers.
  • Typhoid Vaccine and breast feeding The Centers for Disease Control and Prevention and several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to typhoid vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.

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  • Ulipristal and breast feeding Ulipristal is a selective progesterone receptor modulator used in a single dose as an emergency postcoital contraceptive. No information is available on the clinical use of ulipristal during breastfeeding. The manufacturer recommends avoiding use of ulipristal acetate during breastfeeding; others recommend withholding breastfeeding for 24 hours after use, based on the low levels in breastmilk.
  • Umeclidinium and breast feeding Although no published data exist on the use of umeclidinium during breastfeeding, it produces low systemic maternal serum levels and any drug in breastmilk are not likely to be absorbed by the infant. The risk to the breastfed infant of maternal umeclidinium inhalation is small. Combination products such as Anoro Ellipta are likely to be acceptable for similar reasons.
  • Unoprostone and breast feeding No information is available on the use of unoprostone during breastfeeding. Because of its short half-life it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
  • Urea C 13 and breast feeding Information in this record refers to the use of urea C13 as a diagnostic agent. Because carbon 13 is not radioactive, no special precautions are required for nursing mothers.
  • Urea C 14 and breast feeding Information in this record refers to the use of urea C14 as a diagnostic agent. No information is available on the use of urea C14 during breastfeeding. However, administration of urea C14 directly to pediatric patients is considered to be safe. The International Commission on Radiological Protection recommends that breastfeeding need not be interrupted after administration of urea C14.
  • Ursodiol and breast feeding Because of the low levels of ursodiol (ursodeoxycholic acid) in breastmilk, amounts ingested by the infant are small and are not expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Uva Ursi and breast feeding Uva ursi (Arctostaphylos uva-ursi) leaves contain arbutin, which is hydrolyzed to hydroquinone. Uva ursi has no specific lactation-related uses, but is most often used as a urinary antiseptic. No data exist on the excretion of any components of uva ursi into breastmilk or on the safety and efficacy of uva ursi in nursing mothers or infants. Uva ursi is generally considered to be contraindicated during breastfeeding because of a lack of data and its potential toxicity.

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  • Valacyclovir and breast feeding The dosage of acyclovir in milk after valacyclovir is less than 1% of a typical infant dosage and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required when using valacyclovir during breastfeeding. In one study, administration of valacyclovir to mothers with concurrent herpes simplex type 2 and HIV infections reduced breastmilk shedding of the HIV virus in breastmilk at 6 and 14 weeks postpartum, but not later. In another study in HIV-positive mothers, valacyclovir did not reduced breastmilk shedding of cytomegalovirus (CMV) or infant CMV acquisition.
  • Valdecoxib and breast feeding Valdecoxib was removed from sale in the United States by the U.S. Food and Drug Administration because of long-term cardiovascular toxicity. Limited information indicates that levels of valdecoxib in breastmilk are low. Because there is little published experience with valdecoxib safety during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Valganciclovir and breast feeding Valganciclovir is rapidly converted to ganciclovir. Several factors might affect the decision to use valganciclovir in a nursing mother. No information is available on the clinical use of ganciclovir or valganciclovir during breastfeeding. Cytomegalovirus (CMV) can be transmitted to infants though breastmilk, with preterm and immunocompromised infants at greatest risk. No information is available on any changes in the risk of transmission if the mother is being treated with ganciclovir or valganciclovir. Although the manufacturer recommends avoiding breastfeeding during valganciclovir use because of the risk of infant drug toxicity, neonates with CMV infections are often treated directly with ganciclovir or valganciclovir. If the mother has a concurrent infection with HIV, breastfeeding is not recommended in the United States and other developed countries.
  • Valsartan and breast feeding Because no information is available on the use of valsartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Vancomycin and breast feeding Limited information indicates that vancomycin produces low levels in milk and because vancomycin is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. No special precautions are required.
  • Vandetanib and breast feeding No information is available on the clinical use of vandetanib during breastfeeding. Because vandetanib is 90% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is 19 days and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during vandetanib therapy and for 4 months after the last dose.
  • Varenicline and breast feeding Varenicline is a partial nicotine agonist used to assist smoking cessation. One researcher points out that based on animal data on nicotine, varenicline might interfere with normal infant lung development and recommends against its use in nursing mothers. Because no information is available on the use of varenicline during breastfeeding, an alternate drug is preferred, especially while nursing a newborn or preterm infant. If a mother chooses to breastfeed while taking varenicline, she should monitor her infant for seizures and excessive vomiting.
  • Varicella Vaccine and breast feeding The Centers for Disease Control and Prevention and the several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to varicella vaccine. Breastfed infants should be vaccinated according to the routine recommended schedules.
  • Vasopressin and breast feeding No information is available on the clinical use of vasopressin (arginine vasopressin) during breastfeeding. However, a vasopressin derivative, desmopressin results in only small increases in milk arginine vasopressin levels. Because vasopressin is not orally absorbed it is unlikely to adversely affect the breastfed infant.
  • Vedolizumab and breast feeding Some information indicates that maternal vedolizumab injections appear to produce low levels in breastmilk and to not adversely affect the nursing infant. Because vedolizumab is a large protein molecule with a molecular weight of about 147,000, absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Most experts feel that the drug is probably safe during nursing. Until more data become available, vedolizumab should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Velaglucerase alfa and breast feeding No information is available on the clinical use of velaglucerase during breastfeeding. Velalglucerase is a synthetic form of beta-glucocerebrosidase, which is a normal component of human milk. Studies with other forms of the enzyme have found very low levels of the enzyme in breastmilk. Absorption by the infant is unlikely because it is probably destroyed in the infant's gastrointestinal tract. A limited amount of data support the safety of breastfeeding with alglucerase (the placenta-derived form of the enzyme) and imiglucerase (another biosynthetic form of the enzyme). An international panel of clinicians from 9 centers that treat Gaucher's disease reported that, breastfeeding complications were less frequent in mothers who were treated with alglucerase or imiglucerase postpartum than in untreated mothers with Gaucher's disease. Consider limiting the duration of breastfeeding to about 6 months to avoid excessive bone loss in the nursing mother.
  • Vemurafenib and breast feeding No information is available on the clinical use of vemurafenib during breastfeeding. Because vemurafenib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is 57 hours and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during vemurafenib therapy and for 2 weeks after the final dose.
  • Venlafaxine and breast feeding Infants receive venlafaxine and its active metabolite in breastmilk, and the metabolite of the drug can be found in the plasma of most breastfed infants; however, concurrent side effects have rarely been reported. Breastfed infants, especially newborn or preterm infants, should be monitored for excessive sedation and adequate weight gain if this drug is used during lactation, possibly including measurement of serum levels of desvenlafaxine (O-desmethylvenlafaxine), to rule out toxicity if there is a concern. However, newborn infants of mothers who took the drug during pregnancy may experience poor neonatal adaptation syndrome as seen with other antidepressants such as SSRIs or SNRIs. Use of venlafaxine during breastfeeding has been proposed as a method of mitigating infant venlafaxine withdrawal symptoms, but this has not been rigorously demonstrated.
  • Verapamil and breast feeding Limited information indicates that maternal doses of verapamil up to 360 mg daily produce low levels in milk. Newborns may have detectable verapamil serum levels, but levels are low. Verapamil would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.
  • Verteporfin and breast feeding Limited information indicates that maternal verteporfin doses of 6 mg per square meter produce low levels in milk. Withholding breastfeeding for 24 to 48 hours after verteporfin administration should minimize risk to the breastfed infant.
  • Vestronidase Alfa-vjbk and breast feeding No information is available on the clinical use of vestronidase alfa during breastfeeding. Because vestronidase alfa is a large protein molecule with a molecular weight of about 290,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract.
  • Vigabatrin and breast feeding Limited information indicates that maternal doses of vigabatrin up to 2000 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Until more data are available, vigabatrin should only be used with careful monitoring during breastfeeding.
  • Vilanterol and breast feeding Although no published data exist on the use of vilanterol during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk. Vilanterol is available only in combination products such as Breo Ellipta and Anoro Ellipta. The authors of several reviews agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use. Combination products such as Breo Ellipta and Anoro Ellipta are likely to be acceptable for similar reasons.
  • Vilazodone and breast feeding Because there is no published experience with vilazodone during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Vinblastine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It is probably impractical to resume breastfeeding after vinblastine therapy because of the drug's long half-life. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk. Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.
  • Vincristine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It is probably impractical to resume breastfeeding after vincristine therapy because of the drug's long half-life. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.
  • Vinorelbine and breast feeding Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. It is probably impractical to resume breastfeeding after vinorelbine therapy because of the drug's long half-life. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.
  • Vismodegib and breast feeding No information is available on the clinical use of vismodegib during breastfeeding. Because vismodegib is more than 99% bound to plasma proteins, the amount in milk is likely to be low. However, its half-life is 4 days and it might accumulate in the infant. The manufacturer recommends that breastfeeding be discontinued during vismodegib therapy and for 24 months after the final dose.
  • Vitamin K and breast feeding Vitamin K is naturally found in human milk. Maternal vitamin K supplementation increases milk vitamin K levels and can improve vitamin K status in breastfed infants who receive intramuscular vitamin K shortly after birth. Maternal vitamin K supplementation should not be considered a substitute for vitamin K prophylaxis administered directly to the newborn. Late vitamin K-deficiency bleeding, including intracranial hemorrhage, can occur from 2 to 12 weeks and up to 6 months postpartum in breastfed infants. When vitamin K is given by injection to a nursing mother, the U.S. manufacturer recommends the use of unpreserved phytonadione injection to avoid infant exposure to benzyl alcohol, although amounts in milk are likely to be trivial.
  • Von Willebrand Factor and breast feeding No information is available on the clinical use of von Willebrand factor during breastfeeding. Because it is a large protein molecule, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. Until more data become available, von Willebrand factor should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.
  • Vortioxetine and breast feeding Because there is no published experience with vortioxetine during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

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W

  • Warfarin and breast feeding Because of the very low milk levels with warfarin doses up to at least 12 mg daily, amounts ingested by the infant are small. No adverse reactions in breastfed infants have been reported from maternal warfarin use during lactation, even with a dose of 25 mg daily for 7 days. There is a consensus that maternal warfarin therapy during breastfeeding poses little risk to the breastfed infant. No special precautions are necessary.
  • Water O 15 and breast feeding Information in this record refers to the use of water O 15 as a diagnostic agent. No information is available on the use of water O 15 during breastfeeding. The International Commission on Radiological Protection states that breastfeeding need not be interrupted after administration of oxygen 15 radiopharmaceuticals because of the isotope's short half-life.

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.A | .B | .C | .D | .E | .F | .G | .H | .I | .J | .K | .L | .M

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X

  • Xenon Xe 133 and breast feeding Information in this record refers to the use of xenon Xe 133 as a diagnostic agent. Because of its low systemic bioavailability after inhalation, the International Commission on Radiological Protection and other experts state breastfeeding need not be interrupted after administration of xenon Xe 133.
  • Xenon and breast feeding Xenon is an inert gas that has ben used for general anesthesia. It was undetectable in breastmilk after extubation of the mothers. Breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse. When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure.

Y

  • Yellow Fever Vaccine and breast feeding Yellow fever encephalitis has been reported in breastfed newborns whose mothers received yellow fever vaccine. Administration of yellow fever vaccine to breast-feeding women should be avoided except in situations where exposure to yellow fever viruses cannot be avoided or postponed. Infants under 6 months appear to be at an increased risk of encephalitis from the vaccine and should not be vaccinated. Infants over 9 months of age should be vaccinated themselves if they will be traveling with their mother to a yellow-fever endemic area. Exposure to yellow fever vaccine via breastmilk would not increase the risk to an infant who also receives the vaccination.
  • Yttrium 90 Ibritumomab Tiuxetan and breast feeding Information in this record refers to the use of yttrium 90 ibritumomab tiuxetan as a therapeutic agent. No information is available on the use of yttrium 90 ibritumomab tiuxetan during breastfeeding. Because of the long half-life of yttrium 90, the manufacturer and expert opinion recommend not administering the drug in women who wish to continue breastfeeding. If the drug is administered to a nursing mother, breastfeeding should be discontinued. No restrictions on holding the infant after administration of the drug are necessary.

Z

  • Zafirlukast and breast feeding No published information is available on the use of zafirlukast during breastfeeding; however, manufacturer's data indicate that the dose in milk is low. If zafirlukast is required by the mother, it is not a reason to discontinue breastfeeding. However, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. Zafirlukast has been used in children as young as 12 months of age.
  • Zaleplon and breast feeding Because of the low levels of zaleplon in breastmilk and its short half-life, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. No special precautions are required.
  • Zanamivir and breast feeding No information is available on the use of zanamivir during breastfeeding. One group of authors estimated that an exclusively breastfed 5 kg infant would receive about 0.075 mg daily in breastmilk after an inhaled maternal dose of 10 mg, which is less than 1% of the dose in older children. In addition, because zanamivir is poorly absorbed orally, it is not likely to reach the bloodstream of the infant in clinically important amounts.
  • Zidovudine and breast feeding In the United States and other developed countries, HIV-infected mothers should generally not breastfeed their infants. Zidovudine has been well studied during breastfeeding. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, World Health Organization guidelines recommend that all women with an HIV infection who are pregnant or breastfeeding should be maintained on antiretroviral therapy for at least the duration of risk for mother-to-child transmission. Mothers should exclusively breastfeed their infants for the first 6 months of life; breastfeeding with complementary feeding should continue through at least 12 months of life up to 24 months of life. The first choice regimen for nursing mothers is tenofovir, efavirenz and either lamivudine or emtricitabine. If these drugs are unavailable, alternative regimens include: 1) zidovudine, lamivudine and efavirenz; 2) zidovudine, lamivudine and nevirapine; or 3) tenofovir, nevirapine and either lamivudine or emtricitabine. Exclusively breastfed infants should also receive 6 weeks of prophylaxis with nevirapine. Breastfed infants whose mothers receive a highly active antiretroviral (HAART) regimen containing zidovudine have higher rates of neutropenia during the first month and severe anemia during the first 6 months of life.
  • Zileuton and breast feeding No published information is available on the use of zileuton during breastfeeding; however, manufacturer's data indicate that the dose in milk is low. Because there is no published experience with zileuton during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
  • Ziprasidone and breast feeding Because there is little published experience with ziprasidone during breastfeeding, other antipsychotic agents are preferred, especially while nursing a newborn or preterm infant.
  • Ziv-Aflibercept and breast feeding This record refers to the use of ziv-aflibercept for treating cancer. No information is available on the use of ziv-aflibercept during breastfeeding. Because ziv-aflibercept is a large protein molecule with a molecular weight of 115,000, the amount in milk is likely to be very low and absorption is unlikely because it is probably destroyed in the infant's gastrointestinal tract. However, ziv-aflibercept is usually used in combination with other potentially toxic chemotherapy agents and most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy. The manufacturer recommends avoiding breastfeeding during ziv-aflibercept therapy.
  • Zoledronic Acid and breast feeding Because no information is available on the use of zoledronic acid during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. However, absorption of zoledronic acid by a breastfed infant is unlikely.
  • Zolmitriptan and breast feeding Because there is no published experience with zolmitriptan during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant.
  • Zolpidem and breast feeding Because of the low levels of zolpidem in breastmilk and its short half-life, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Monitor infants for excess sedation, hypotonia, and respiratory depression.
  • Zonisamide and breast feeding Limited information indicates that maternal doses of zonisamide up to 400 mg daily produce high levels in milk and infant serum, but serum levels in neonates decrease during the first month of life while nursing. Although no adverse reactions have been reported in breastfed infants, the number of infants reported have been small. Alternative drugs are preferred, but if it must be given, monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger or exclusively breastfed infants and when using combinations of anticonvulsant drugs. Some clinicians recommend that mothers taking zonisamide only partially breastfeed in order to reduce the exposure of the infant to the drug and to consider monitoring infants' serum zonisamide concentrations.
  • Zoster Vaccine Live and breast feeding The Centers for Disease Control and Prevention and the several health professional organizations state that vaccines given to a nursing mother do not affect the safety of breastfeeding for mothers or infants and that breastfeeding is not a contraindication to Herpes zoster vaccine in the breastfeeding mother. It is unlikely that women in the target population of over 60 years of age would be nursing an infant.
  • Zuclopenthixol and breast feeding Zuclopenthixol is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Limited information indicates that maternal oral doses of up to 50 mg daily or depot injections of 72 mg every 2 weeks produce low levels in breastmilk and no detectable short-term adverse effects in the breastfed infants. No long-term data are available. Until more data are available, zuclopenthixol should be used with careful monitoring during breastfeeding. One international guideline recommends that women taking zuclopenthixol not breastfeed.
  • d-Xylose C14 and breast feeding Information in this record refers to the use of d-xylose C 14 as a diagnostic agent. Breastfeeding does not need to be suspended after administration of d-xylose C 14.
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