Divalproex Anticonvulsant.
CATEGORY: D
1% to 2% risk of neural tube defect when used in first trimester.
Valproic acid embryopathy: Neural tube defects, brachycephaly, high forehead, epicanthal folds, strabismus, nystagmus, shallow orbits, flat nasal bridge, small up-turned nose,hypertelorism,long upper lip,thin upper vermilion
border, microstomia,long thin fingers,hypodspadias in males, low birth weight.
Crosses placenta.
BREAST FEEDING:Excreted into human breast milk in low concentration.Compatible.
NEONATAL SIDE EFFECTS: None reported.
Docusate sodium
Surfactant used as a laxative, stool softener, cerumenolytic. Sodium salt of
dioctyl sodium sulfosuccinate (DSS). Molecular weight: 444.56 CATEGORY:C
[1]
Metabolism studies indicate that dioctyl sodium sulfosuccinate (DSS) is
absorbed from the gastrointestinal tract and undergoes extensive metabolism. In
man the major route of excretion of DSS metabolites is in the feces [2, 3].
Results of The Collaborative Perinatal Project found no increase in the
incidence of major malformations among 116 pregnancies exposed during the first
trimester to dioctyl sodium sulfosuccinate [4].
The Boston Collaborative Drug Surveillance Program found no increase in the
incidence of major malformations among 792 pregnancies exposed during the first
trimester to dioctyl sodium sulfosuccinate [5,6]
In addition, Briggs et. al. reported that data from a surveillance study of
Michigan Medicaid recipients did not support an association between docusate
salt and major malformations (cardiovascular defects, oral clefts, spina bifida,
polydactyly, limb reduction defects, and hypospadias) in 232 newborns who had
been exposed to docusate salt during the first trimester [1] .
Schindler reported a case of symptomatic hypomagnesemia in the neonate of
woman who had used docusate sodium chronically throughout her pregnancy [7].
1. Briggs GG,Freeman RK, Yaffe SJ, Drugs in
Pregnancy and Lactation 6th edition,Baltimore, MD: Williams
& Wilkins,2002 p 436.
2. Eighteenth Report of the Joint FAO/WHO Expert Committee on Food Additives, Wld
Hlth Org. techn. Rep. Ser., 1974, No. 557.
3. FAO Nutrition Meetings Report Series, 1974, No. 54.
4. Heinonen OP et al.. Birth Defects and Drugs in Pregnancy. Littleton:Publishing
Sciences Group, 1977. p. 442.
5. Jick H, et al . First-trimester drug use and congenital disorders. JAMA.
1981;246:343-6.MEDLINE
6. Aselton P et al. First-trimester drug use and congenital disorders. Obstet
Gynecol. 1985;65:451-5. MEDLINE
7. Schindler AM. Isolated neonatal hypomagnesaemia associated with maternal
overuse of stool softener. Lancet. 1984 ;2:822. MEDLINE
Donepezil Acetylcholinesterase inhibitor
CATEGORY: C
There are no adequate or well-controlled studies in pregnant women
BREAST FEEDING:It is not known whether donepezil is excreted in human breast milk.
NEONATAL SIDE EFFECTS:
Doxazosin Alpha adrenergic receptor inhibitor
CATEGORY: C
There are no adequate and well-controlled studies in pregnant women.
BREAST FEEDING:It is not known whether this drug is excreted in human milk. However, doxazosin has been found to concentrate in the breast milk of animals.
NEONATAL SIDE EFFECTS:
Doxepin CATEGORY:C
BREAST FEEDING:The American Academy of Pediatrics has classified doxepin as a drug "for which the effect on nursing infants is unknown but may be of concern" [G3].
NEONATAL SIDE EFFECTS:Apnea
Doxycycline CATEGORY:D
Effects occur after 12 weeks EGA abnormalities
of decidual teeth. Associated with maternal renal failure and fatty liver
degeneration
BREAST FEEDING:Compatible [G3] NEONATAL SIDE
EFFECTS:
Enalapril Antihypertensive; ACE inhibitor
CATEGORY: C first trimester
CATEGORY: D second and third trimesters 2nd and 3rd trimester ACE inhibitor exposure is associated with hypocalvaria, and renal defects related to fetal hypotension and decreased
renal perfusion. The latter may result in oligohydramnios.
BREAST FEEDING:Compatible. Excretion into milk negligible. [G3]. NEONATAL SIDE EFFECTS:Possible renal failure and hypotension at delivery.
Escitalopram
Antidepressant. Selective serotonin reuptake inhibitor (SSRI) .S-enantiomer of
racemic citalopram.
Molecular weight: 414.40. CATEGORY:
C
"Escitalopram is metabolized to S-DCT and S-didemethylcitalopram (S-DDCT).
In humans, unchanged escitalopram is the predominant compound in plasma. At
steady state, the concentration of the escitalopram metabolite S-DCT in plasma
is approximately one-third that of escitalopram."
Oral administration of escitalopram to pregnant rats during the period of
organogenesis resulted in decreased fetal body weight and associated delays in
ossification at approximately >/=56 times the maximum recommended human dose
[MRHD]* of 20 mg/day. The developmental no effect dose of 56 mg/kg/day is
approximately 28 times the MRHD*. No teratogenicity was observed at any of the
doses tested (as high as 75 times the MRHD*).
When female rats were treated with escitalopram during pregnancy and through
weaning, slightly increased offspring mortality and growth retardation were
noted at approximately 24 times the MRHD*. The no effect dose was 12 mg/kg/day
which is approximately 6 times the MRHD*.
We were unable to locate reports describing the use of escitalopram during
human pregnancy.
BREAST FEEDING: No reports were located describing the use of escitalopram
during human lactation. However, racemic citalopram is excreted into human
breast milk. The manufacturer recommends the decision whether to continue or
discontinue either nursing or LEXAPRO therapy should take into account the risks
of exposure for the infant and the benefits of LEXAPRO treatment for the mother.
Ethosuximide
Anticonvulsant CATEGORY:C
BREAST FEEDING:Compatible [G3] NEONATAL SIDE EFFECTS:Close
clinical monitoring of the infant is recommended if it is decided to continue
breast feeding in mothers being treated with ethosuximide [1,2,3]
1. Hagg S, Spigset O. Anticonvulsant use during lactation.
Drug Saf. 2000; 22:425-40
MEDLINE
2. Nau H, Kuhnz W, Egger HJ, Rating D, Helge H. Anticonvulsants during pregnancy and lactation. Transplacental, maternal
and neonatal pharmacokinetics.
Clin Pharmacokinet.1982 7:508-43.
MEDLINE
3.
Rane A, Tunell R.Ethosuximide in human milk and in plasma of a mother
and her nursed infant. Br J Clin Pharmacol. 1981;12:855-8.MEDLINE
Etretinate CATEGORY:X Effects similar to isotretinoin, teratogenicity
may persist long after discontinuing drug [G2] BREAST FEEDING:
NEONATAL SIDE EFFECTS:
Fexofenadine
Anihistamine. Active metabolite of terfenadine.
Molecular weight: 538.13. Fexofenadine hydrochloride is 60% to 70% bound to
plasma proteins. CATEGORY:C
"There was no evidence of teratogenicity in rats or rabbits at
oral doses of terfenadine up to 300 mg/kg (which led to fexofenadine exposures
that were approximately 4 and 31 times, respectively, the exposure from the
maximum recommended daily oral dose of fexofenadine in adults)."[1].
Dose-related decreases in pup weight gain and survival were observed in rats
exposed to an oral dose of 150 mg/kg of terfenadine (approximately 3 times the
maximum recommended daily oral dose of fexofenadine hydrochloride in
adults based on comparison of fexofenadine hydrochloride AUCs) [1].
Because terfenadine is rapidly and nearly completely biotransformed to
its active metabolite fexofenadine [2] studies addressing the safety of terfenadine during pregnancy may be relevant in
assessing the safety of fexofenadine during human gestation.
The American College of Obstetricians and Gynecologists (ACOG) and The
American College of Allergy, Asthma and Immunology (ACAAI) have recommended
chlorpheniramine and tripelennamine as the antihistamines of choice for pregnant
women. Cetirizine and loratadine may be considered (preferably after the
first trimester) in patients who cannot tolerate or do not respond to maximal
doses of chlorpheniramine or tripelennamine [3]
BREAST FEEDING: Fexofenadine appears to be excreted into breast milk.
In a study of four healthy lactating mothers subjects received 60 mg
terfenadine every 12 hours over a period of 48 hours. Terfenadine was not
detected in milk or plasma. However, fexofenadine was found in milk and plasma.
The AUCmilk/AUCplasma (0-12) ratio for fexofenadine was
0.21 (range 0.12 to 0.28)
Newborn dosage estimates based on the highest measured concentration of
fexofenadine in milk suggest the maximum level of newborn exposure would not
exceed 0.45% of the recommended maternal weight-corrected dose [4].
1. Physicians
Desk Reference 57th ed. Montvale, NJ: Thomson PDR; 2004: 713-714
2.Honig PK, et al. The effect of fluconazole on the steady-state
pharmacokinetics and electrocardiographic pharmacodynamics of terfenadine in
humans.Clin Pharmacol Ther. 1993 Jun;53(6):630-6. MEDLINE
3. The use of newer asthma and allergy medications during pregnancy. Position
Statement. The American College of Obstetricians and Gynecologists (ACOG) and
The American College of Allergy, Asthma and Immunology (ACAAI). Ann Allergy
Asthma Immunol. 2000;84:475-480. MEDLINE
4. Lucas BD, et al. Terfenadine pharmacokinetics in breast milk in lactating
women.Clin Pharmacol Ther. 1995 Apr;57(4):398-402. MEDLINE
Fluconazole CATEGORY:C
More than 250 pregnancies exposed to one or
several doses of less than 150 mg showed no increase in malformation. However, Antley-Bixler
syndrome (craniosynostosis, choanal atresia, radiohumareal synostosis) was seen
with doses of > 400 mg/day.[G4]
BREAST FEEDING:Compatible
NEONATAL SIDE EFFECTS: None reported.
Fluoxetine
Antidepressant, antiobsessive-compulsive, and antibulimic. Also used for
premenstrual dysphoric disorder. Selective serotonin reuptake inhibitor (SSRI).
Molecular weight: 345.79 CATEGORY:C
Reproduction studies in rats and rabbits, following administration of up to
1.5 and 3.6 times the maximum recommended human dose on a mg/m 2 basis
(MRHD), respectively found no evidence of teratogenicity. However, in rat
reproduction studies, an increase in stillborn pups, a decrease in pup weight,
and an increase in pup deaths during the first 7 days postpartum occurred
following maternal exposure to 1.5 times the MRHD during gestation or 0.9 times
the MRHD during gestation and lactation. There was no evidence of developmental
neurotoxicity in the surviving offspring of rats treated with 12 mg/kg/day
during gestation [1].
Fluoxetine appears to cross the human placenta at term. In a study that
included 15 women taking fluoxetine 10 to 60 mg per day the mean cord to
maternal serum concentrations of fluoxetine and norfluoxetine were 0.64 (range
0.32 to 1.36 ) and 0.65 (range 0.12 to 1.58 ) respectively [2].
A meta-analytical review of epidemiological studies concluded that the use of
fluoxetine during the first trimester of pregnancy is not associated with
significant teratogenic effects in humans [3].
Studies including over 1200 women exposed to fluoxetine during the first
trimester did not demonstrate an increase in the rate of major malformations
above the expected baseline rate [4-7]. Only one of these studies noted a trend
toward a higher percentage of miscarriages in fluoxetine treated patients which
was not statistically significant [5].
Amongst the human studies included above Chambers et al. noted an increased
incidence of three or more minor anomalies in the infants of 228
fluoxetine-treated mothers. The authors suggested that the presence of three or
more minor anomalies increased the risk of having an occult malformation such as
defects in brain development not recognizable at birth [6].
Goldstein et al. found no consistent or recurring pattern of abnormalities
after first-trimester exposure to fluoxetine in 796 pregnancies [7].
In addition studies by Mattson et al. and Nulman et al. found no
adverse neurobehavioral development in 106 preschool and early-school aged
children who had been exposed in utero to fluoxetine [8,9]. Casper et al.
compared birth outcomes and postnatal neurodevelopmental functioning between
ages 6 and 40 months in 13 children whose mothers were diagnosed with major
depressive disorder in pregnancy and elected not to take medication with 31
children of depressed mothers treated with SSRIs.The Bayley mental developmental
indexes were similar in both groups. Children exposed to SSRIs during pregnancy
had lower APGAR scores and scored lower on the Bayley psychomotor development
indexes and the motor quality factor of the Bayley Behavioral Rating Scale than
unexposed children [10].
Chambers et al. also found that infants exposed to fluoxetine during the
latter part of pregnancy (after 25 weeks) demonstrated an increased rate of
prematurity, special care nursery admission, poor neonatal adaptation, and
persistent pulmonary hypertension compared to infants with only early pregnancy
exposure [6]. Birth weight was also lower in the exposed-late group. However,
when maternal weight gain was considered the latter result was no longer
statistically significant [6].
Cohen LS, et al. found SSRI exposure during pregnancy to be a risk factor for
special care nursery admission [11], and Simon GE et al. reported higher rates
of preterm birth amongst women exposed to SSRIs [12]. However, a study by
Goldstein was unable to confirm an increase in neonatal problems after third
trimester exposure to fluoxetine in 115 infants [13]. It should be noted
that underlying maternal depression also appears to play a role in the above
complications [14,15].
BREAST FEEDING: Fluoxetine and its active metabolite norfluoxetine are
excreted into human milk.
Reported milk:plasma ratio for fluoxetine = 0.14 to
0.88 [16-19]
Reported milk:plasma ratio for norfluoxetine =
0.09 to 0.82 [16-19]
In a study that included 10 nursing women taking a mean maternal dose of
0.39 mg/kg/day ( range 0.17 to 0.85 mg/kg/day ) Taddio et al. reported peak milk
concentrations of 293 ng/mL and 379.1 ng/mL fluoxetine and
norfluoxetine respectively. The authors of the study estimated the average
infant doses of fluoxetine and norfluoxetine, for an exclusively breast-fed
infant ingesting 1000 mL of milk per day, were 0.077 mg and 0.084 mg
respectively. The total dose of fluoxetine and norfluoxetine (expressed as
fluoxetine equivalents) was 0.165 mg, which was equivalent to 10.8% of the
maternal dose, adjusted on a mg/kg basis in a 4-kg infant [19].
Yoshida et al. studied four mothers who took fluoxetine and their breast-fed
infants. Fluoxetine and norfluoxetine were detected in all samples of maternal
plasma (range of total concentration 138-427 ng/ml) and in breast-milk (range
39-177 ng/ml). Amounts of both fluoxetine and norfluoxetine in infants' plasma
and urine were below the lower limit of detection. All infants were observed to
be developing normally and showed no abnormal findings on neurological
examination [20].
A retrospective cohort study of infants breastfed by 26 mothers taking
fluoxetine( 20 mg to 40 mg per day) demonstrated a growth curve
significantly below that of infants who were breastfed by mothers who did
not take the drug. The average deficit in measurements taken between 2 weeks and
6 months of age was 392 g [21].
Irritability, decreased sleep, vomiting and watery stools were reported in
one nursing mother while taking fluoxetine [22].
The manufacturer recommends that fluoxetine not be used by nursing mothers in
accordance with a 1994 FDA advisory [23].
The American Academy of Pediatrics has classified fluoxetine as a drug "for
which the effect on nursing infants is unknown but may be of concern" [24].
A review by Nordeng et al. of the literature on selective serotonin
reuptake inhibitors and excretion in breast milk concluded the relative dose to
the breastfed infant is lowest for fluvoxamine and sertraline,
somewhat higher for paroxetine and highest for citalopram
and fluoxetine. Fluoxetine should not be the first line alternative. High doses
of citalopram should also be used with caution. However, when the use of
an SSRI is clearly indicated in a breastfeeding woman, available data generally
indicate that the positive effects of breast-feeding outweigh the risks for
pharmacological effects in the infant [25].
NEONATAL SIDE EFFECTS:
Nordeng H, et al. have reported symptoms suggestive of medication withdrawal
within a few days after birth in one infant whose mother had taken fluoxetine 20
mg daily during pregnancy. Symptoms included irritability, constant crying,
shivering, increased tonus, eating and sleeping difficulties and convulsions[26].
In another case report central nervous system toxicity in a term newborn was
attributed to measurable cord blood levels of fluoxetine and norfluoxetine. The
mother had been taking 20 mg /day throughout her pregnancy. Symptoms included
continuous crying, tachypnea, increased muscle tone, tremors, and hyperactive
Moro reflex. The total drug concentration in cord blood was 80 ng/mL. The
fluoxetine level, 26 ng/mL, is below the adult therapeutic level; the
norfluoxetine cord blood level, 54 ng/mL, is at the adult therapeutic level. At
96 hours the fluoxetine level was not measurable and the norfluoxetine level was
55 ng/mL. The neonate was asymptomatic at 96 hours of age[27].
SSRIs prescribed for the treatment of depression have the potential to cause
abnormal hemostasis by blocking serotonin reuptake in platelets. In one study
pregnant rats were administered 5.62 mg/kg fluoxetine by oral gavage beginning
on day 7 of gestation and ending the day of birth. At birth, fluoxetine exposed
pups showed a statistically higher frequency of skin hematomas when compared to
controls [28].
Mhanna et al. described a newborn delivered at term from a woman treated with
fluoxetine 60 mg/day. The infant was jittery and had scattered petechiae on the
face and trunk as well as a cephalohematoma. Serum fluoxetine and norfluoxetine
concentrations were 129ng/mL and 227ng/mL respectively. Reports of
abnormal bleeding in infants following in utero exposure to fluoxetine appear to
be otherwise uncommon [29]. It is possible that bleeding events may occur
as an idiosyncratic reaction to fluoxetine treatment or in infants predisposed
to bleeding.
1. Physicians
Desk Reference 57th ed. Montvale, NJ: Thomson PDR; 2004: 1841-43
2. Hendrick V, et. al. Placental passage of antidepressant medications. Am J
Psychiatry. 2003;160:993-6. MEDLINE
3. Addis A and Koren G.Safety of fluoxetine during the first trimester of
pregnancy: a meta-analytical review of epidemiological studies.Psychol Med.
2000;30:89-94. MEDLINE
4.Rosa F. Medicaid antidepressant pregnancy exposure outcomes. Reprod Toxicol
1994;8:444-445.
5.Pastuszak A, et al. Pregnancy outcome following first-trimester exposure to
fluoxetine (Prozac)JAMA. 1993 5;269:2246-8. MEDLINE
6.Chambers CD, et al. Birth outcomes in pregnant women taking fluoxetine. N Engl
J Med 1996;335:1010-1015. MEDLINE
7. Goldstein DJ, et al.. Effects of first- trimester fluoxetine exposure on the
newborn. Obstet Gynecol 1997;89:713-8.21. MEDLINE
8. Mattson, SN et al. "Neurobehavioral Follow-up of Children
Prenatally Exposed to Fluoxetine." Teratology.1999 59:376
9. Nulman I, et al.. Child development following exposure to tricyclic
antidepressants or fluoxetine throughout fetal life: a prospective, controlled
study. Am J Psychiatry. 2002;159:1889-95. MEDLINE
10.Casper RC,et al Follow-up of children of depressed mothers exposed or not
exposed to antidepressant drugs during pregnancy.J Pediatr. 2003;142:402-8. MEDLINE
11. Cohen LS, et al: Birth outcomes following prenatal exposure to fluoxetine.
Biol Psychiatry 2000;48:996-1000. MEDLINE
12.Simon GE et al., Outcomes of prenatal antidepressant exposure. Am J
Psychiatry. 2002;159:2055-61. MEDLINE
13. Goldstein DJ. Effects of third trimester fluoxetine exposure on the
newborn.J Clin Psychopharmacol. 1995;15:417-20. MEDLINE
14.Steer RA, et al Self-reported depression and negative pregnancy outcomes. J
Clin Epidemiol. 1992;45:1093-9. MEDLINE
15.Orr ST and Miller CA. Maternal depressive symptoms and the risk of poor
pregnancy outcome. Review of the literature and preliminary findings.Epidemiol
Rev. 1995;17:165-71. MEDLINE
16. Burch KJ and Wells BJ Fluoxetine/norfluoxetine concentrations in human milk.
Pediatrics. 1992;89:676-7. MEDLINE
17. Isenberg KE. Excretion of fluoxetine in human breast milk.J Clin Psychiatry.
1990;51:169. MEDLINE
18. Kristensen JH, et al. Distribution and excretion of fluoxetine and
norfluoxetine in human milk. Br J Clin Pharmacol. 1999;48:521-7. MEDLINE
19. Taddio A, et al Excretion of fluoxetine and its metabolite, norfluoxetine,
in human breast milk. J Clin Pharmacol. 1996;36:42-7. MEDLINE
20. Yoshida K, et al. Fluoxetine in breast-milk and developmental outcome of
breast-fed infants. Br J Psychiatry. 1998;172:175-8. MEDLINE
21. Chambers CD, et al. Weight gain in infants breastfed by mothers who take
fluoxetine.Pediatrics. 1999;104:e61. MEDLINE
22. Lester BM, et al. : Possible association between fluoxetine hydrochloride
and colic in an infant.J Am Acad Child Adolesc Psychiatry. 1993 Nov;32(6):1253-5.
MEDLINE
23. Nightingale SL. Fluoxetine labeling revised to identify phyenytoin
interaction and to recommend against use in nursing mothers. JAMA 1994;271:1067.
MEDLINE
24. Transfer
of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89.
25. Nordeng H,et al. [The transfer of selective serotonin reuptake inhibitors to
human milk]Tidsskr Nor Laegeforen. 2001;121:199-203. MEDLINE
26. Nordeng H, et al. Neonatal withdrawal syndrome after in utero exposure to
selective serotonin reuptake inhibitors. Acta Paediatr. 2001;90:288-91. MEDLINE
27. Spencer MJ. Fluoxetine hydrochloride (Prozac) toxicity in a neonate.
Pediatrics. 1993;92:721-2. MEDLINE
28. Stanford MS and Patton JH In utero exposure to fluoxetine HCl
increases hematoma frequency at birth.Pharmacol Biochem Behav. 1993;45:959-62. MEDLINE
29. Mhanna MJ et al Potential fluoxetine chloride (Prozac) toxicity in a
newborn.Pediatrics. 1997 ;100:158-9. MEDLINE
e Corticosteroid
CATEGORY: C
There are no adequate and well-controlled studies in pregnant women.
BREAST FEEDING: It is not known whether fluticasone propionate is excreted in human breast milk.
NEONATAL SIDE EFFECTS:
Fosinopril Antihypertensive; Ace Inhibitors
CATEGORY: C first trimester
CATEGORY: D second and third trimesters 2nd and 3rd trimester ACE inhibitor exposure is associated with hypocalvaria, and renal defects related to fetal hypotension and decreased
renal perfusion. The latter may result in oligohydramnios.
BREAST FEEDING:Excreted into breast milk. Not considered compatible with breast feeding by the manufacturer.
NEONATAL SIDE EFFECTS:Possible renal failure and hypotension at delivery.
Gabapentin Anticonvulsant
CATEGORY: C
There are no adequate and well-controlled studies in pregnant women.
BREAST FEEDING:It is not known if gabapentin is excreted in human milk.
NEONATAL SIDE EFFECTS:
Glipizide Blood Glucose Regulator, Sulfonylurea
CATEGORY:C. No increase above baseline
anomaly rate in diabetics. Crosses placenta.
BREAST FEEDING: Contraindicated
NEONATAL SIDE EFFECTS: Possible hypoglycemia
Glyburide Blood Glucose Regulators, Sulfonylurea
CATEGORY:C
1st trimester exposure in 37 fetuses
resulted in no increased rate of major or minor anomalies.
BREAST FEEDING: NEONATAL SIDE EFFECTS:
Guaifenesin Expectorant
CATEGORY:C
1st trimester exposure in 382 fetuses
resulted in no increased rate of major or minor anomalies.
BREAST FEEDING:
NEONATAL SIDE EFFECTS:
Haloperidol Tranquilizer
CATEGORY:C
BREAST FEEDING: The American Academy of Pediatrics has classified haloperidol as a drug "for which the effect on nursing infants is unknown but may be of concern" [G3].
NEONATAL SIDE EFFECTS:
Hydroxychloroquine
Antimalarial Agent
CATEGORY:C
Treatment of 49 pregnancies throughout
gestation in patients with SLE resulted in no fetal or newborn adverse
effects. Discontinuation of the drug in patients at risk for lupus flare
is not recommended [1].
BREAST FEEDING:Compatible
[G9]
NEONATAL SIDE EFFECTS: Potential for
accumulation of drug.
Ibuprofen Nonsteroidal Antiinflammatory Agent
CATEGORY:B, (D if used in third trimester) Borderline association with gastroschisis [1].
All NSAIDs used near term may cause premature closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class.
BREAST FEEDING: Compatible [G3]. NEONATAL SIDE EFFECTS:
Imipramine Antidepressant
CATEGORY:D
BREAST FEEDING:The American Academy of Pediatrics has classified imipramine as a drug "for which the effect on nursing infants is unknown but may be of concern" [G3].
NEONATAL SIDE EFFECTS:
Indomethacin Nonsteroidal Antiinflammatory Agent
CATEGORY:B ,(D if used for longer than 48 hours or after 34 weeks gestation) All NSAIDs used near term may cause closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class.
BREAST FEEDING:Compatible [G3]. NEONATAL SIDE EFFECTS:1 case of seizure
(questionable association)
Ipratropium Antimuscarinic, Antispasmodic
CATEGORY:B
No adequate or well controlled studies have been conducted in pregnant women.
BREAST FEEDING: the minimal systemic absorption makes it unlikely that ipratropium bromide would reach the infant in an amount sufficient to cause a clinical effect.
NEONATAL SIDE EFFECTS:
Irbesartan Antihypertensive; Angiotensin II receptor (AT 1 subtype) antagonist
CATEGORY: C first trimester
CATEGORY: D Second and third trimesters Drugs that act directly on the renin-angiotensin system have been associated with hypocalvaria, and renal defects related to fetal hypotension and decreased
renal perfusion when used during the 2nd and 3rd trimester. Oligohydramnios has been complication.
BREAST FEEDING:
NEONATAL SIDE EFFECTS:
Isoniazid Antituberculosis Agent
CATEGORY:C
BREAST FEEDING:Compatible[G3]. Mom should
be on pyridoxine
NEONATAL SIDE EFFECTS:Rash, diarrhea, constipation.
Isosorbide
Mononitrate
Vasodilating Agent
CATEGORY: C
BREAST FEEDING:It is not known whether this drug is excreted in human milk.
NEONATAL SIDE EFFECTS:
Ketorolac Nonsteroidal Antiinflammatory Agent
CATEGORY:C
All NSAIDs used near term may cause closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class.
BREAST FEEDING: Excreted into human milk.
Compatible [G3]. NEONATAL SIDE EFFECTS:
Lamotrigine Anticonvulsant
CATEGORY:C
Crosses placenta.
BREAST FEEDING: Excreted into breast milk in considerable amounts. Contraindicated [1]
NEONATAL SIDE EFFECTS: None reported.
1.Ohman I, Vitols S, Tomson T. Lamotrigine in pregnancy: pharmacokinetics during delivery, in the neonate, and during lactation.
Epilepsia. 2000 Jun;41(6):709-13.
MEDLINE
Lansoprazole Control of stomach acid,Proton Pump Inhibitor
CATEGORY:B
BREAST FEEDING:It is not known whether
lansoprazole is excreted into human milk.
NEONATAL SIDE EFFECTS:
Latanoprost (Xalatan ® Ophthalmic Solution) Treatment of Glaucoma
CATEGORY:C
BREAST FEEDING:It is not known whether this drug or its metabolites are excreted in human milk.
NEONATAL SIDE EFFECTS:
Antiepileptic. Levetiracetam is chemically unrelated to existing
antiepileptic drugs (AEDs). Molecular weight is 170.21. CATEGORY:C
"In animal studies, levetiracetam produced evidence of developmental
toxicity at doses similar to or greater than human therapeutic doses.
Administration to female rats throughout pregnancy and lactation was
associated with increased incidences of minor fetal skeletal abnormalities and
retarded offspring growth pre- and/or postnatally at doses >/=350 mg/kg/day (approximately
equivalent to the maximum recommended human dose of 3000 mg [MRHD] on a mg/m 2
basis) and with increased pup mortality and offspring behavioral
alterations at a dose of 1800 mg/kg/day (6 times the MRHD on a mg/m 2 basis).
The developmental no effect dose was 70 mg/kg/day (0.2 times the MRHD on a mg/m 2
basis). There was no overt maternal toxicity at the doses used in this
study.
When pregnant rats were treated during the period of organogenesis, fetal
weights were decreased and the incidence of fetal skeletal variations was
increased at a dose of 3600 mg/kg/day (12 times the MRHD). 1200 mg/kg/day (4
times the MRHD) was a developmental no effect dose. There was no evidence of
maternal toxicity in this study. Treatment of rats during the last third of
gestation and throughout lactation produced no adverse developmental or maternal
effects at doses of up to 1800 mg/kg/day (6 times the MRHD on a mg/m 2 basis)[1].
Treatment of pregnant rabbits during the period of organogenesis resulted in
increased embryofetal mortality and increased incidences of minor fetal skeletal
abnormalities at doses >/=600 mg/kg/day (approximately 4 times MRHD on a mg/m
2 basis) and in decreased fetal weights and increased incidences of
fetal malformations at a dose of 1800 mg/kg/day (12 times the MRHD on a mg/m 2
basis). The developmental no effect dose was 200 mg/kg/day (1.3 times the
MRHD on a mg/m 2 basis). Maternal toxicity was also observed at 1800
mg/kg/day.
Long described three infants whose mothers had been treated throughout all
three trimesters with levetiracetam (750 to 3000 mg daily) monotherapy. The
infants were delivered uneventfully and showed no evidence of birth defects or
cognitive alterations at 6 months postpartum[2].
There are no adequate and well-controlled studies in pregnant women. Keppra ®
should be used during pregnancy only if the potential benefit justifies
the potential risk to the fetus [1].
Pregnancy Exposure Registry To facilitate monitoring fetal
outcomes of pregnant women exposed to Keppra ® , physicians should
encourage patients to register, before fetal outcome is known (e.g., ultrasound,
results of amniocentesis, etc.), in the Antiepileptic Drug Pregnancy Registry by
calling (888) 233-2334 (toll free).
BREAST FEEDING: A milk:maternal plasma ratio of 3.09 was
reported in one woman receiving levetiracetam [3]. The manufacturer states
that because of the potential for serious adverse reactions in nursing infants
from Keppra ® , a decision should be made whether to discontinue
nursing or discontinue the drug, taking into account the importance of the drug
to the mother. [1]
1. Physicians
Desk Reference 57th ed. Montvale, NJ: Thomson PDR; 2004: 3230-3232
2. Long L. Levetiracetam monotherapy during pregnancy: a case series.Epilepsy
Behav. 2003;4:447-8. MEDLINE
3. Kramer G et al. Levetiracetam accumulation in breast milk. Epilepsia
2002;43(suppl7):105
Levodopa CATEGORY:C
BREAST FEEDING:Contraindicated. Inhibits
prolactin release
NEONATAL SIDE EFFECTS:
Levofloxacin Anti-infective;Quinolone
CATEGORY:C
BREAST FEEDING: Based upon data from ofloxacin, it can be presumed that levofloxacin will be excreted in human milk.
Contraindicated
[G1]. NEONATAL SIDE EFFECTS:Potential for
arthropathy.
Lisinopril Antihypertensive; ACE inhibitor
CATEGORY: C first trimester
CATEGORY: D second and third trimesters 2nd and 3rd trimester ACE inhibitor exposure is associated with hypocalvaria, and renal defects related to fetal hypotension and decreased
renal perfusion. The latter may result in oligohydramnios.
BREAST FEEDING:
NEONATAL SIDE EFFECTS:
There was no evidence of animal teratogenicity in studies performed in rats
and rabbits at oral doses up to 96 mg/kg (approximately 75 times and 150 times,
respectively, the maximum recommended human daily oral dose on a mg/m2
basis) [1].
In an observational study of newly marketed drugs prescribed in England
loratadine was taken during the first trimester in 18 pregnancies. Two patients
chose to have an elective abortion. The remaining mothers delivered 16 normal
term infants [2].
Kallen B et al. reported fifteen cases of hypospadias among 2780 children of
women who had taken loratadine during pregnancy in the Swedish Birth Registry
(5.6 expected) [3]. However, data from the National Birth Defects Prevention
Study (NBDPS) found no increased risk for second- or third-degree hypospadias
among women who used loratadine in early pregnancy [4].
Diav-Citrin O, et al. found no increase in the rate of major anomalies in the
infants of 126 women who had used loratadine during first trimester
when compared to nonexposed controls [5].
In addition, a prospective study using data from four countries compared the
outcomes of 161 loratadine exposed pregnancies with the outcomes of an equal
number of unexposed control subjects. All patients were exposed at least during
the first trimester (13 weeks) of pregnancy. Among the loratadine exposed cohort
there were 140 live births, 18 spontaneous abortions, 3 elective abortions, and
1 fetal death. Data included 1 set of twins in each group. Exposure to
loratadine did not appear to significantly increase the rate of major
malformations above that found amongst unexposed controls. The live birth rate,
gestational age at delivery, and birth weights were also not different between
the 2 groups [6].
The American College of Obstetricians and Gynecologists (ACOG) and
The American College of Allergy, Asthma and Immunology (ACAAI) recommend
chlorpheniramine and tripelennamine as the antihistamines of choice for pregnant
women. Cetirizine and loratadine may be considered (preferably after the
first trimester) in patients who cannot tolerate or do not respond to maximal
doses of chlorpheniramine or tripelennamine [7]
BREAST FEEDING: Loratadine and its metabolite,
descarboethoxyloratadine, are excreted into human milk . The AUCmilk/AUCplasma
ratio for loratadine and descarboethoxyloratadine were 1.17 and 0.85
respectively in 6 lactating women after ingestion of a single 40 mg dose of
loratadine. The peak milk concentration, 29.2 ng/mL, occurred within 2 hours of
the dose. A 4-kg infant ingesting the loratadine and descarboethoxyloratadine
excreted would have received a dose equivalent to 0.46% of the loratadine dose
received by the mother on a mg/kg basis[8].
The American Academy of Pediatrics has classified loratadine as a drug "Usually
Compatible With Breastfeeding" [9].
1.Claritin TSR package insert. http://www.fda.gov/cder/pediatric/labels/Lorat.pdf
(PDF file)
Accessed 4/7/04
2. Wilton LV, Pearce GL, Martin RM, et al.: The outcomes of pregnancy in women
exposed to newly marketed drugs in general practice in England. Br J Obstet
Gynaecol 105:882- 889, 1998. MEDLINE
3. Kallen B, Otterblad Olausson P. Monitoring of maternal drug use and infant
congenital malformations: does loratadine cause hypospadias? Int J Risk Safety
Med 2001;14:115-9
4. Evaluation of an association between loratadine and hypospadias--United
States, 1997-2001.MMWR Morb Mortal Wkly Rep. 2004 19;53:219-21. MEDLINE
5. Diav-Citrin O, et al. Pregnancy outcome after gestational exposure to
loratadine or antihistamines: a prospective controlled cohort study.J Allergy
Clin Immunol. 2003; 111: 1239-43.MEDLINE
6. Moretti ME, et al. Fetal safety of loratadine use in the first trimester of
pregnancy: a multicenter study. J Allergy Clin Immunol. 2003;111:479-83. MEDLINE
7. The use of newer asthma and allergy medications during pregnancy. Position
Statement. The American College of Obstetricians and Gynecologists (ACOG) and
The American College of Allergy, Asthma and Immunology (ACAAI). Ann Allergy
Asthma Immunol. 2000;84:475-480. MEDLINE
8.Hilbert J, et al. Excretion of loratadine in human breast milk.
J Clin Pharmacol. 1988;28:234-9. MEDLINE
9. Transfer
of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89.
Review.
Lorazepam CATEGORY:D
BREAST FEEDING: The American Academy of Pediatrics has classified lorazepam as a drug "for which the effect on nursing infants is unknown but may be of concern" [G3].
NEONATAL SIDE EFFECTS: Sedation
Losartan Antihypertensive, Angiotensin II receptor antagonist
CATEGORY: C first trimester
CATEGORY: D second and third trimesters Drugs that act directly on the renin-angiotensin system have been associated with hypocalvaria, and renal defects related to fetal hypotension and decreased
renal perfusion when used during the 2nd and 3rd trimester. Oligohydramnios has been a common complication.
BREAST FEEDING:
NEONATAL SIDE EFFECTS:
Lovastatin CATEGORY:X
Inadvertent exposure in 134 pregnancies to lovastatin or simvastatin resulted in no increased risk of anomaly [1].
BREAST FEEDING: Contraindicated
[G1]
NEONATAL SIDE EFFECTS:
Marijuana Hallucinogen
CATEGORY: Illicit drug.
The majority of studies have shown no increased rate of major or minor anomalies after in utero exposure to marijuana.
One case-control study reported an increased rate of childhood acute nonlymphoblastic leukemia after prenatal exposure to marijuana. The authors of the study
pointed out that the presence of herbicides or pesticides on the marijuana could not be ruled out.[1].
Reports on the effects of prenatal marijuana exposure on the length of gestation, fetal growth, and neurobehavioral effects
are conflicting. Confounding factors such as possible impurities in the drug and
concomitant tobacco smoking
may be responsible for these inconsistent reports.
BREAST FEEDING: Excreted into breast milk. Contraindicated.
NEONATAL SIDE EFFECTS: None reported.
1.Robison LL et al.Maternal drug use and risk of childhood nonlymphoblastic leukemia among offspring. An epidemiologic investigation
implicating marijuana (a report from the Childrens Cancer Study Group). Cancer. 1989; 63:1904-11.Medline
Mebendazole CATEGORY:C
The manufacturer recommends against
use in pregnancy . However, inadvertent exposure during first trimester
has not resulted in an increased rate of spontaneous abortions nor congenital
anomalies.
BREAST FEEDING: Compatible [G1] NEONATAL SIDE EFFECTS:
Mefenamic acid Nonsteroidal Anti-Inflammatory
CATEGORY:C
All NSAIDs used near term may cause premature closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class.
BREAST FEEDING: Excreted into human milk. Compatible [G3] NEONATAL SIDE
EFFECTS:
Meperidine CATEGORY:B,D
All narcotics may produce withdrawal
syndrome in neonates with prolonged use
BREAST FEEDING: Compatible [G3]. NEONATAL SIDE EFFECTS:
Possible
lethargy
Mesalamine Anti-inflammatory agent for gastrointestinal use. 5-aminosalicylic acid
CATEGORY:B
1st trimester exposure in 242 infants resulted in no increase in major or minor anomalies.[1, 2]
BREAST FEEDING: The American Academy of Pediatrics has classified 5-aminosalicylic acid as a drug that "should be given to nursing mothers with caution" [G3].
NEONATAL SIDE EFFECTS: Diarrhea.
1.Diav-Citrin O, Park YH, Veerasuntharam G, Polachek H, Bologa M, Pastuszak A, Koren G. The safety of mesalamine in human pregnancy: a prospective controlled cohort study.
Gastroenterology. 1998 Jan;114(1):23-8.
MEDLINE 2. Marteau P, Tennenbaum R, Elefant E, Lemann M, Cosnes J.Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules.
Aliment Pharmacol Ther. 1998 Nov;12(11):1101-8. MEDLINE
Metformin Blood Glucose Regulator
CATEGORY:B
No increase in anomaly rate above baseline for diabetic.
BREAST FEEDING: A small study of nursing mothers taking metformin (median
dose of 1500 mg) found the mean infant exposure to the drug was only 0.28%
of the weight-normalized maternal dose. This is well below the 10% level of
concern for breastfeeding [1] NEONATAL SIDE EFFECTS: None reported [1]
Methadone CATEGORY: Assigned to category C in past.
Presently carries the following precautions: Safe use in pregnancy has not been established in relation to possible adverse effects on fetal development. Therefore, methadone should not be used in pregnant women unless, in the judgment of the physician, the potential benefits outweigh the possible hazards.
BREAST FEEDING:Compatible [G3]. NEONATAL SIDE EFFECTS:Sedation,withdrawal
All narcotics may produce withdrawal
syndrome in neonates with prolonged use
Methylphenidate Respiratory and Cerebral Stimulant
CATEGORY:C
BREAST FEEDING: It is not known whether methylphenidate is excreted in human
milk. NEONATAL SIDE EFFECTS:
Methylprednisolone
Glucocorticoid. 6-methyl derivative of prednisolone. Anti-inflammatory.
Molecular weight: 374.48
Methylprednisolone crosses the human placenta [1].
Some studies suggest a possible increased risk of oral cleft when
corticosteroids are used during the first trimester of pregnancy in humans [2,
3].
Methylprednisolone has been used to treat hyperemesis gravidarum during early
pregnancy. Safari et al. treated 20 women for hyperemesis gravidarum beginning
at 7 to 12 weeks with methylprednisolone 16 mg orally 3 times a day for 3
days, followed by a tapering regimen (halving of dose every 3 days) to none
during the course of 2 weeks. Birth information was available for 12 patients.
One patient delivered an infant with Smith-Lemli-Opitz syndrome at 35 weeks'. No
birth defects were reported in the other 11 infants [4]
Yost NP et al., compared the outcomes of 56 pregnant women treated for
hyperemesis gravidarum with methylprednisolone to a control group of 54 women
who received a placebo. The gestational ages at randomization were between
8 to 14 weeks' . Women in the corticosteroid group received with
methylprednisolone 125 mg IV followed by an oral prednisone taper (40 mg for 1
day, 20 mg for 3 days, 10 mg for 3 days, 5 mg for 7 days). During the trial
there was one stillborn fetus, at 29 weeks, in a woman who received
corticosteroids. One woman in the placebo group delivered a premature infant
with microcephaly at 27 weeks. No other birth defects were reported [5].
The National Asthma Education Program Working Group on Asthma and Pregnancy
does not consider the indications for the use of methylprednisolone in the
control of severe asthma exacerbations to be altered by pregnancy [6].
BREAST FEEDING: We were unable to locate studies specifically
addressing the use of methylprednisolone during breastfeeding. Based on studies
of prednisolone transfer to breast milk infant exposure to corticosteroid would
be expected to be minimal [7,8].
1. Anderson GG, Rotchell Y, Kaiser DG.Placental
transfer of methylprednisolone following maternal intravenous administration. Am
J Obstet Gynecol. 1981;140:699-701.MEDLINE
2. Rodriguez-Pinilla E and Martinez-Frias ML. Corticosteroids during pregnancy
and oral clefts: a case-control study. Teratology. 1998;58:2-5.MEDLINE
3. Carmichael SL; Shaw GM: Maternal corticosteroid use and risk of selected
congenital anomalies. Am J Med Genet 1999;86:242-4. MEDLINE
4. Safari HR, et. al., The efficacy of methylprednisolone in the treatment of
hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J
Obstet Gynecol. 1998;179:921-4. MEDLINE
5. Yost NO et al. A randomized, placebo-controlled trial of corticosteroids for
hyperemesis due to pregnancy. Obstet Gynecol. 2003;102:1250-4. MEDLINE
6. Clark SL. Asthma in pregnancy. National Asthma Education Program Working
Group on Asthma and Pregnancy. National Institutes of Health, National Heart,
Lung and Blood Institute.Obstet Gynecol. 1993;82:1036-40.MEDLINE
7. McKenzie SA, et al., Secretion of prednisolone into breast milk. Arch Dis
Child. 1975;50:894-6. MEDLINE
8. Greenberger PA, et al. ,Pharmacokinetics of prednisolone transfer to breast
milk.Clin Pharmacol Ther. 1993;53:324-8.MEDLINE
Metoclopramide Treatment of emesis, gastric reflux, and gastroparesis
CATEGORY:B
BREAST FEEDING: The American Academy of Pediatrics has classified
metoclopramide as a drug "for which the effect on nursing infants is unknown but may be of concern" [G3].
NEONATAL SIDE EFFECTS:
Metoprolol CATEGORY:C
BREAST FEEDING: Compatible [G3]. However, drug is
concentrated in human milk. NEONATAL SIDE EFFECTS: Observe infants for
possible beta-blockade.
Metronidazole Anti-infective Agent, Antiprotozoal and antibacterial.
CATEGORY:B
BREAST FEEDING:The American Academy of Pediatrics has classified
metronidazole as a drug "for which the effect on nursing infants is unknown but may be of concern".
Discontinue breastfeeding for 12-24 h to allow excretion of drug. [G3].
NEONATAL SIDE EFFECTS: Diarrhea
"Congenital anomalies sometimes associated with fetal death have been reported subsequent to the unsuccessful use of misoprostol as an abortifacient, but the drug's teratogenic mechanism has not been demonstrated. Several reports in the literature associate the use of misoprostol during the first trimester of pregnancy with skull defects, cranial nerve palsies, facial malformations, and limb defects.
Cytotec is not fetotoxic or teratogenic in rats and rabbits at doses 625 and 63 times the human dose, respectively"[1]
The American College of Obstetricians and Gynecologists states that
misoprostol is an acceptable agent for the induction of labor. Misoprostol is
not recommended for patients with prior uterine surgery [2].
BREAST FEEDING: The manufacturer recommends Cytotec should not be
administered to nursing mothers because the potential excretion of misoprostol
acid could cause significant diarrhea in nursing infants [1].
1. Physicians Desk Reference 57th ed. Montvale, NJ: Thomson PDR;
2003: 3111
2. ACOG Committee Opinion. Induction of Labor with Misoprostol. Number 228, November 1999. The American College of
Obstetricians and Gynecologists, 409 12th Street SW PO Box 96920, Washington, DC 20090-6920
Mometasone Anti-Inflammatory Agent, Topical dermatological or nasal spray CATEGORY:C
[1] BREAST FEEDING: It is not known if mometasone furoate is excreted in human
milk. NEONATAL SIDE EFFECTS:
Montelukast Leukotriene Receptor Antagonist CATEGORY:B
ACOG and ACAAI suggest
zafirlukast or montelukast "...could be considered in patients with recalcitrant
asthma who have shown a uniquely favorable response prior to becoming
pregnant."[1] BREAST FEEDING: It is not known if montelukast is excreted in human milk.
NEONATAL SIDE EFFECTS:
1. The use of newer asthma and allergy medications during pregnancy. Position
Statement. The American College of Obstetricians and Gynecologists (ACOG) and
The American College of Allergy, Asthma and Immunology (ACAAI). Ann Allergy
Asthma Immunol. 2000;84:475-480. MEDLINE
Morphine CATEGORY: C,
( D in prolonged doses)
[G1] All narcotics may produce withdrawal
syndrome in neonates with prolonged use
BREAST FEEDING:Compatible [G3] NEONATAL SIDE EFFECTS: Withdrawal, sedation
Nabumetone Nonsteroidal Anti-Inflammatory
All NSAIDs used near term may cause premature closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class.
CATEGORY:C ( D third trimester)
[G1] BREAST FEEDING: It is not known whether nabumetone or its metabolites are
excreted in human milk. The manufacturer recommends Relafen not be administered
to nursing mothers because of the possible adverse effects of
prostaglandin-synthesis-inhibiting drugs on neonates. [1]. NEONATAL SIDE
EFFECTS:
Naproxen Nonsteroidal Anti-Inflammatory
CATEGORY:B, (D in third trimester)[G1] All NSAIDs used near term may cause premature closure of the ductus arteriosus, and inhibit labor. Oligohydramnios after prolonged use is a common complication with NSAIDs as a class. Intrauterine exposure after 34 weeks has resulted in premature closure of the ductus arteriosus, renal dysfunction, and coagulopathy.
BREAST FEEDING: Compatible.[G3] NEONATAL SIDE EFFECTS:
1. Physicians Desk Reference 57th ed. Montvale, NJ: Thomson PDR;
2003: 2776
2. Luck W, Nau H, Hansen R, Steldinger R. Extent of nicotine and
cotinine transfer to the human fetus, placenta and amniotic fluid of smoking
mothers.
Dev Pharmacol Ther. 1985;8:384-95.MEDLINE
3. Dempsey DA, Benowitz NL. Risks and benefits of nicotine to aid smoking
cessation in pregnancy.Drug Saf. 2001;24:277-322.
MEDLINE
4. Dahlstrom A, Lundell B, Curvall M, Thapper L.
Nicotine and cotinine concentrations in the nursing mother and her infant.
Acta Paediatr Scand. 1990;79:142-7.MEDLINE
5. Luck W, Nau H.Nicotine and cotinine concentrations in serum and
milk of nursing smokers.Br J Clin Pharmacol. 1984;18:9-15.MEDLINE
Nifedipine Antihypertensive Agent, Cardiac Drug
CATEGORY:C
BREAST FEEDING: Compatible [G3] NEONATAL SIDE EFFECTS:
Nitrofurantoin Urinary Anti-Infective
CATEGORY:B
BREAST FEEDING: Excreted into breast milk. Compatible [1,G3]
NEONATAL SIDE EFFECTS: Hemolysis in G6PD deficiency [G3]
1.Pons G, Rey E, Richard MO, Vauzelle F, Francoual C, Moran C, d'Athis P, Badoual J, Olive G. Nitrofurantoin excretion in human milk.
Dev Pharmacol Ther. 1990;14(3):148-52. MEDLINE
Nitroglycerin Vasodilating Agent
CATEGORY: B
[G1] BREAST FEEDING: It is not known whether nitroglycerin is excreted in human
milk. NEONATAL SIDE EFFECTS:
Nizatidine H2-receptor antagonist
CATEGORY:B
BREAST FEEDING: Excreted into breast milk. Compatible [1] NEONATAL SIDE
EFFECTS:
GENERAL REFERENCES
G1.Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy
and Lactation 6th edition,Baltimore, MD:
Williams & Wilkins,,2002 G2. Cunningham GF, MacDonald PC et al (eds);Williams Obstetrics,20th
ed,Stamford ,CT:.Appleton and Lange, 1997
G3. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Review. G4 .Shepard TH. Catalog of Teratogenic Agents. 9th ed.Baltimore,
MD: Johns Hopkins University Press, 1998
G5. Gleicher Norbert ed. Principles & Practice of
Medical Therapy in Pregnancy. 3rd ed. Stamford, CT: Appleton & Lange,
1998
G6. Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Company,2000
G7. Centers for Disease Control & Prevention. General Recommendations on Immunization:
Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 43 (No.
RR-1): 20-21, 1994.
G8. The WHO Working Group, Bennet PN (ed).: Drugs and Human Lactation. Elsevier, Amsterdam, New York, Oxford, 1988. pp. 391.
G9.Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human breast milk. Pediatrics 93:137-150, 1994.
G10.Heinonen OP, Slone D, Shapiro S: Birth defects and drugs in pregnancy. Littleton:Publishing Sciences Group, 1977
