3. TABLE 3. Maternal Medication Usually Compatible with Breast-Feeding
Drug Reported Sign or Symptom in Infant or Effect Reference
on Lactation
ANESTHETICS, SEDATIVES o
Alcohol Drowsiness, diaphoresis, deep sleep, weak- 26, 27
ness, decrease in linear growth, abnormal
weight gain; maternal ingestion of 1 g/kg
daily decreases milk ejection reflex
Barbiturate None; see antiepileptic drugs 28
Bromide Rash, weakness, absence of cry with mater- 29
nal intake of 5.4 g/d
Chloral hydrate Sleepiness 30
Chloroform None 31
Halothane None 32
Magnesium sulfate None 33
Methyprylon Drowsiness 34
Secobarbital None 35
ANTICOAGULANTS
Bishydroxycoumarin None 36
Warfarin None 37
ANTIEPILEPTICS
Carbamazepine None 38
Ethosuximide None 39
Phenobarbital Methemoglobmemia case); decreased
(1 re- 40, 41
sponsiveness, decreased weight gain, ex-
cessive sleeping if mother’s plasma level
30 g/mL
Phenytoin Methemoglobinemia (1 case) 41
Primidone None 40, 42
Thiopental None 28
Valproic acid None 43
ANTIHISTAMINES, DECONGESTANTS,
AND BRONCHODILATORS
Dexbrompheniramine maleate with d-iso- Crying, poor sleeping patterns, irritability 44
ephedrine
Diphenhydramine None 45
Dyphyllinet None 46
lodides Affects thyroid activity; see miscellaneous 47, 48
iodine
Theophylline Irritability 49, 50
Trimeprazine None 51
Tripelennamine None 52
ANTIHYPERTENSIVE AND CARDIO-
VASCULAR DRUGS
Atenolol None 53
Captopril None 54
Digoxin None 55
Disopyramide None 56
Guanethidine None 47
Hydralazine None 57
Methyldopa None 58
Metoprololt None 53
Nadololt None 59
Propranolol None 60-62
Quinidine None 63
Reserpine Galactorrhea 64
ANTIINFECTIVE DRUGS (ALL antibiotics
transfer into breast milk in limited
amounts)
Amantadine Urinary retention, vomiting, and skin rash 51
Cefadroxil None 65
Cefazolin None 66
Cefotaxime None 65
t Drug is concentrated in breast milk.
376 AGENTS TRANSFERRED INTO HUMAN BREAST MILK
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4. TABLE 3.-Continued
Drug Reported Sign or Symptom in Infant or Effect Reference
on Lactation
0 Chloramphenicol None 67, 68
Chloroquine None 69
Clindamycin None 70
Ethambutol None 71
Isoniazid None 72
Nalidixic acid Hemolysis in infant with glucose-6-phos- 73
phate deficiency (G-6-PD)
Nitrofurantoin Hemolysis in infant with G-6-PD 74
Pyrimethamine None 75
Quinine None 76
Rifampin None 71
Salicylazosulfapyridine (sulfasalazine) None 77, 78
Sulfapyridine Caution in infant with jaundice or G-6-PD, 77
and ill, stressed, or premature infant
Sulfathiazole None; nonabsorbable by mother 79
Sulfisoxazole Caution in infant with jaundice or G-6-PD, 80
and ill, stressed, or premature infant
Tetracycline None; negligible absorption by infant 81, 82
Trimethoprim None 83
ANTITHYROID DRUGS
Carbimazole Goiter 47, 51
Propylthiouracil None 84
CATHARTICS (Drugs that cause abdominal Abdominal cramping, colic-like syndrome
cramping in mother)
Danthron Increased bowel activity 85
DIAGNOSTIC AGENTS
Iodine Goiter; see miscellaneous, iodine 16
lopanoic None 86
Metrizamide None 87
0 DIURETICS
Bendroflumethiazide Suppresses lactation, thrombocytopenia (1 88
case)
Chlorothiazide May suppress lactation, therefore avoid 89, 90
prescribing in 1st month of lactation; this
may also apply to other thiazides; ques-
tionably dose related
Chlorthalidone Excreted slowly 91
Methyclothiazide None 92
Spironolactone None 93
HORMONES
Chlorotrianisene None 51
3H-norethynodrel None 94
19 norsteroid None 95
Contraceptive pill with estrogen/progester- Breast enlargement, dose related; decrease 96-101
one in milk production and protein content
Estradiol Withdrawal, vaginal bleeding 102, 103
MUSCLE RELAXANTS
Baclofen None 104
Carisoprodol Drowsiness, intestinal upset 105
Methocarbamol None 106
NARCOTICS, NON-NARCOTIC ANALGE-
SICS, ANTIINFLAMMATORY
AGENTS
Acetaminophen None 107-109
Butorphanol None 110
Codeine None 79
Flufenamic acid None 111
Heroin None 112
O Ibuprofen
Indomethacin None
Seizure (1 case) 113 115
114,
AMERICAN ACADEMY OF PEDIATRICS 377
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5. TABLE 3.-Continued
Drug Reported Sign or Symptom in Infant or Effect Reference
on Lactation
Mefenamic acid None 116
Meperidine None 51 0
Methadone None if mother receiving 20 mg/24 h 117
Morphine None 76
Naproxen None 118
Phenylbutazone None 119
Prednisolone, prednisone None 120, 121
Propoxyphene None 122
Salicylates Metabolic acidosis (dose related); may af- 123, 124
fect platelet function, rash
PSYCHOTROPIC AGENTS
Antianxiety
Chlordiazepoxide Conflicting reports of drowsiness 47, 125-127
Clorazepate
Diazepam
Meprobamatet 51
Oxazepam
Prazepamt
Antidepressants
Amitriptyline None 51, 128-132
Amoxapine
Desipramine
Dothiepin
Imipramine
Lithium 133-135
Tranylcypromine 51
Antipsychotic
Chlorpromazine Galactorrhea in adult; drowsiness and leth- 136, 137
argy in infant
Haloperidol None 138
Mesoridazine None 139
Piperacetazine
0
Prochlorperazine
Thioridazine
Trifluoperazine
Other
Marijuanat Unknown, only 1 report in literature 140
STIMULANTS
Amphetamine Irritability, poor sleeping pattern 141
Caffeine Irritability, poor sleeping pattern excreted 50, 142, 143
slowly
Nicotine (excess) Shock, vomiting, diarrhea, rapid heart rate, 27
restlessness; decreased milk production
VITAMINS
B1 None 45
B12 None 144
D Increased calcium levels 145
Folic acid None 146
K1 None 147
Pyridoxine None 148, 149
Riboflavin None 150
Thiamin None 150
MISCELLANEOUS
Atropine, scopolamine None 79, 151
Bethanechol Abdominal pain, diarrhea 34
Diphenoxylate with atropine None 152
Iodine (providone-iodine/vaginal douche) Elevated iodine levels in breast milk, odor 48
of iodine on infant’s skin
Tolbutamide Jaundice 153
0
378 AGENTS TRANSFERRED INTO HUMAN BREAST MILK
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6. TABLE 4. Food and Environmental Agents: Effect on Breast-Feeding
Agent Reported Sign or Symptom in Infant or Effect on Lactation Reference
Aspartame Caution in patient carrier of phenylketonuria 154
Bromide (photographic labora- Potential absorption and bromide transfer into milk;
29, 155
see “Anesthetics, Sedatives”
0 tory)
Chlordane None reported 156
Chocolate Irritability or increased bowel activity if excess
50, 157
amounts ( 16 oz/d) consumed by mother
Cyclamate None 158
DDT, benzenehexachlorides, None 159-162
dieldrin, aldrin, hepatachlore-
poxide
Fava beans Hemolysis in patient with glucose-6-phosphate defi- 163
ciency (G-6-PD)
Fluorides None 164
Hexachlorobenzene Skin rash, diarrhea, vomiting, dark urine, neurotoxic- 165
ity, death
Hexachlorophene None; contamination of milk from nipple washing 166
Lead Neurotoxicity 167
Methyl mercury Affects neurodevelopment 168, 169
Monosodium glutamate (MSG) None 170
Polychlorinated biphenyls and Lack of endurance, hypotonia, sullen expressionless 171-173
polybrominated biphenyls facies
Saccharin None 51
Tetrachlorethylene (cleaning Obstructive jaundice, dark urine 174
fluid)
Vegetarian diet Signs of B12 deficiency 175
t Drug is concentrated in breast milk.
at the end of the tables in accordance with the 4th ANTIEPILEPTICS
Edition AMA Drug Evaluation. The reference list carbamazepine-Tegretol
ethosuximide-Zarontin
is not inclusive of all articles published.
phenytoin-Dilantin
Physicians who encounter adverse effects in in- primidone-Mysoline
fants fed breast milk due to exposure to drugs that thiopental-Pentothal
are not included here are urged to document the valproic acid-Depakene
effects in a communication to the Committee on
Drugs of the American Academy of Pediatrics in ANTIHISTAMINES, DECONGESTANTS, AND
Evanston. Such communication should include: the BRONCHODILATORS
clemastine-Tavegil, Tavist
generic and brand name of the drug; the maternal
dexbrompheniramine maleate with d-isoephedrine-Drix-
dose and mode of administration; the concentration oral, Disophrol Chronotab
of the drug in breast milk and maternal and infant diphenhydramine-Benadryl, Benylin cough syrup
blood in relation to time of ingestion; the age of the dyphylline-Dilor
infant; and the method used for laboratory identi- theophylline-Theo-Dur, Elixophyllin, Slo-Phyllin, Bron-
kodyl
fication. Such reports may significantly increase
trimeprazine tartrate-Temaril
the pediatric community’s fund of knowledge re- tripelennamine-Pyribenzamine
garding drug transfer into breast milk and the
potential risk to the infant.
Drugs cited in Tables 1 to 4 are listed here by ANTIHYPERTENSIVE AND CARDIOVASCULAR
AGENTS
category, in alphabetical order by generic name. For
atenolol-Tenormin
convenience, one or more examples are also given. captopril-Capoten
digoxin-Lanoxin, SK-Digoxin
ANESTHETICS, SEDATIVES disopyramide-Norpace
methyprylon-Noludar guanethidine sulfate-Ismelin
secobarbital-Seconal, Seco-8 hydralazine-Apresoline
methyldopa-Aldomet
ANTICOAGULANTS metoprolol-Lopressor
bishydroxycoumarin-Dicumarol nadolol-Corgard
0 phenindione-Hedulin, Eridione propranolol-Inderal
warfarin-Coumadin, Panwarfin reserpine-Serpasil, Reserpoid, Hiserpia
AMERICAN ACADEMY OF PEDIATRICS 379
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7. ANTIINFECTIVE AGENTS prednisolone-Delta-Cortef, Sterane
amantadine-Symmetrel propoxyphene-Darvon, SK65, Dolene
cefadroxil-Duricef PSYCHOTROPIC AGENTS
cefazolin-Ancef, Kefzol amitriptyline-Elavil, Endep
cefotaxime-Claforan amoxapine-Asendin 0
chloramphenicol-Chloromycetin chlordiazepoxide-Librium, Libritabs, Menrium, SK-Ly-
chloroquine-Aralen gen
clindamycin-Cleocin chlorpromazine-Thorazine
ethambutol-Myambutol clorazepate-Tranxene
isoniazid-INH desipramine-Norpramin, Pertofrane
metronidazole-Flagyl diazepam-Valium
nalidixic acid-NegGram dichloralphenazone-Fenzal, Welldorm
nitrofurantoin-Furadantin, Nitrofor, Macrodantin dothiepin-Prothiaden
pyrimethainine-Daraprim haloperidol-Haldol
quinine-Quine imipramine-Tofranil, SK-Pramine, Imavate
rifampin-Rifamycin, Rifadin, Rimactane meprobamate-Equanil, Miltown, Meprospan, 5K-Ba-
salicylazosulfapyridine-Azulfidine mate
sulfisoxazole-Gantrisin mesoridazine-Lidanar
tetracycline-Achromycin, SK-Tetracycline oxazepam-Serax
trimethoprim with sulfamethoxazole-Bactrim, Septra, piperacetazine-Quide
Septra DS prazepam-Centrax
ANTITHYROID AGENTS prochlorperazine-Compazine
carbimazole-Neo-mercazole thioridazine-Mellaril
methimazole-Tapazole tranylcypromine-Parnate
propylthiouracil-Propacil trifluoperazine-Stelazine
thiouracil-Thiouracil STIMULANTS
CANCER CHEMOTHERAPY AGENTS amphetamine (dexamphetamine sulfate)-Dexedrine
amethopterin-Methotrexate bromocriptine-Parlodel
cyclophosphamide-Cytoxan ergotamine tartrate with caffeine-Cafergot
MISCELLANEOUS
CATHARTICS
acetamide-Colchicine
danthron-Dorbane, Modane
bethanechol chloride-Urecholine
DIAGNOSTIC AGENTS cimetidine-Tagamet
iopanoic acid-Telepaque diphenoxylate with atropine-Lomotil 0
metrizamide-Amipaque tolbutamide-Orinase, SK-Tolbutamide
DIURETICS FOOD ADDITIVES
bendroflumethiazide-Naturetin monosodium glutamate-MSG
chlorothiazide-Diuril, Chlotride saccharin-Sucaryl
chlorthalidone-Hygroton, Combipres
methyclothiazide-Aquatensen, Enduron
COMMITTEE ON DRUGS, 1982-1983
spironolactone-Aldactone
Albert W. Pruitt, MD, Chairman
HORMONES
Walter R. Anyan, Jr, MD
chlorotrianisene-TACE
estradiol-Estrace Reba M. Hill, MD
3H-norethynodrel-Enovid Ralph E. Kauffman, MD
prednisone-Deltasone, Meticorten, SK-Prednisone Howard C. Mofenson, MD
Harvey S. Singer, MD
MUSCLE RELAXANTS
baclofen-Lioresal Stephen P. Spielberg, MD, PhD
carisoprodol-Rela, Soma
Liaison Representatives
methocarbamal-Robaxin
John C. Ballin, PhD
NARCOTICS, NON -NARCOTIC ANALGESICS,
Charlotte Catz, MD
ANTIINFLAMMATORY AGENTS
acetaminophen-Tylenol, Tylenol Extra Strength, Tern- Louis Farchione, MD
pra, Phenaphen Martha M. Freeman, MD
butorphanol-Stadol Jennifer Niebyl, MD
flufenamic acid-Arlef Dorothy L. Smith, PharmD
gold sodium thiomalate-Myochrysine
Sam A. Licata, MD
ibuprofen-Motrin
indomethacin-Indocin
Godfrey Oakley, MD
mefenamic acid-Ponstel Steven Sawchuk, MS
meperidine-Demerol, Pethadol
Section Representatives
methadone-Westadone
naproxen-Naprosyn Earl J. Brewer, MD 0
phenylbutazone-Azolid, Butazolidin John A. Leer, MD
380 AGENTS TRANSFERRED INTO HUMAN BREAST MILK
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