neonatology 6th edition gomella section v: chapter 133 ...neonatology 6th edition gomella section v:...

Neonatology 6th Edition Gomella Section V: Chapter 133. Preg and Lactation

Copyright © 2009 by The McGraw-Hill Companies, Inc.- based on references listed at end of table

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A B C D

Drug (FDA Fetal Risk Category) Pregnancy Adverse Events and Comments Breast Feeding Compatibility

Effect on Lactation and Adverse Effects on Infant

Abacavir ( C)

Animal studies imply risk. Human studies do not imply structural anomoly risk, other risks require

study. US Dept. of Health and Human Services state HIV infected patients should continue antiviral

therapy during pregnancy(except for efavirenz). Maternal benefits outweigh potential fetal risks.

CINo human lactation studies. Drug likely excreted into

breast milk. CDC recommends HIV infected mothers not nurse.

Abatacept ( C)No human pregnancy studies,Best to avoid because lack of experience. Concern for autoimmune disease

later in life.-

No human lactation studies, Drug likely excreted into breast milk, amount unknown. Effects unknown,may

adversely affect developing immune system.

Abciximab (C)

Limited amount of medication reaches the fetus. The primary concern is maternal hemorrhage. If this

is controlled, maternal benefits outweigh embryo/fetal risk.

+ No human lactation studies, drug not likely excreted in breast milk in significant amounts.

Acamprosate ( C)

No human pregnancy studies, animal studies imply high risk. However, pregnant women with alcohol dependancy, the risk:benefit ratio may favor use of

acamprosate+

No human lactation studies, drug likely excreted into breast milk. Effects unknown. If mother requires the

medication to not drink then the maternal benefit outweighs risk to infant.

Acarbose (B)

Few human studies, animal studies imply low risk. ACOG recommends insulin for gestational diabetes not controlled by diet, type 1 and type 2 diabetes

occuring in pregnancy.-

No human lactation studies. Amount that would be in breast milk is insignificant. Best to avoid breastfeeding

until studies on safety have been done.

Acebutolol (B, D if 2nd and 3rd trimester)

IUGR and decrease in placental weight. May cause bradycardia and hypotension in infant exposed near

term. Carefully monitor blood pressure and heart rate.Can cause transient hypoglycemia, lower birth

weight, lower blood pressure..

-Excreted into breast milk. AAP considers it to be

associated with adverse effects in nursing infants. May cause bradycardia and hypotension. Observe for

symptoms of beta blockade.

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Breast Feeding Compatability Key: Category (+): Generally Compatible Category (-): Avoid with Breast-Feeding Category (CI): Contraindicated



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Acetaminophen (B)

Safe for short-term use in therapeutic doses. If medication is required to treat fever or pain, use

acetaminophen rather than aspirin.In long term and overdose situation: fetal death, neonatal death with

hepatorenal toxicity, fatal neonatal kidney.

+Excreted in the breast milk. Compatible. One maculopapular rash seen. The AAP considers

acetaminophen as compatible with breastfeeding.

Acetazolamide (C)Not associated with major or minor

malformations.Metabolic acidosis, hypomagnesemia and hypocalcemia seen in one newborn.

+ Excreted into breast milk. The AAP considers it compatible with breastfeeding.

Acetohexamide (C)

Animal studies showed embryotoxicity, Human studies did not show an increase in congenital malformations. ACOG recommends insulin for

gestational diabetes not controlled by diet, type 1 and type 2 diabetes occuring in pregnancy. Causes

symptomatic hypoglycemia resulting from hyperinsulinemia in newborn. Monitor infant’s

serum glucose for 5 days after birth. Can see prolonged hypoglycemia and seizures.

- No human lactation studies, effects unknown, Potential risk of hypoglycemia.

Acetylcysteine (B)

Animal studies do not show teratogenicity or embryotoxicity, few human studies do not show risk

to fetus when IV doses used for acetaminophen overdose. No studies of human pregnancy use as

mucolytic.

+ No human lactation studies, drug likely excreted into breast milk, probably compatible.

Acitretin (X)

Teratogen causing malformations. There is fetal risk during pregnancy and also for unknown time

thereafter.Contraception should be used 1 month before, during and 3 years after medication is

stopped.

- Potential for toxicity, AAP considers it compatible with breastfeeding.

Acyclovir (B)No adverse effects seen. No associations between

the drug and congenital malformations. Some consider it the DOC when indicated.

+AAP considers it compatible. No adverse effects seen in case reports, and acyclovir has been used successfully without any risks to newborns with herpes infections.

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Adalimumab (B)Few human studies do not show developmental

toxicity,, animal studies imply low risk. Avoid in 1st trimester. .

+Not known but likely excreted in breast milk because

other immunoglobulins are excreted. Effects unknown, two infants exposed without adverse effects.

Adefovir ©

Few human pregnancy studies, animal studies imply low risk. US Dept. of Health and Human Services

state HIV infected patients should continue antiviral therapy during pregnancy(except for efavirenz).

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No human lactation studies. Drug likely excreted into breast milk. If drug used in lactating mother to treat

Hepatitis B, potential risk for serious toxicity( nephrotoxicity) to nursing infant. CDC does not recommend breastfeeding in HIV-1 patients in

developed countries.

Adenosine ©

Animal studies did not show teratogenicity. No adverse effects in fetus or newborn reported with

treatment of maternal or fetal suprventricular tachycardia. High intravenous doses could

potentially produce fetal toxicity.

+No human lactation studies, IV drug, used in acute care

situations, Drug unlikely excreted into breast milk because of short half life.

Albendazole (C)Animal studies imply risk, poor oral bioavailability in humans imply low risk. Consider avoiding use in first

trimester+

No human lactation studies. Drug likely excreted into breast milk but not in clinically significant amounts. Effects unknown but probably compatible. Avoid

ingestion with high fat meal.

Albuterol (C)

Used to prevent premature labor, as is terbutaline and ritodrine. May cause fetal tachycardia (>160

beats/min) and hypoglycemia in newborn. Decreases incidence of neonatal respiratory distress

syndrome.Possible increase in polydactyly.Can see transient fetal hyperglycemia and transient fetal

atrial flutter.

+ No human lactation studies. Prob compatible based on other similar medications.

Aldesleukin (C)

No human pregnancy studies. Animal studies imply low risk. Best course is to avoid use during

pregnancy. If condition warrants use during pregnancy, consultation with physician is necessary.

+No human lactation studies. Drug unlikely, but may be excreted into breast milk. Effects unknown. Probably

compatible. Allow four hours after dose to elapse prior to breastfeeding to limit exposure.

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A B C D

Alemtuzumab (C)No human or animal pregnancy studies. Avoid

during pregnancy and six months after therapy is finished.

-No human lactation studies. Drug effects unlikely but

unknown.May be excreted. Risk of immunosuppression and severe adverse effects .

Alendronate (C)

Animal studies show maternal and fetal toxicity, no structural anomalies. Few human studies, one

showed lower BW and shortened gestations. No t recommended in pregnancy.

+ No human lactation studies. Drug likely excreted in minimal amounts into breast milk.

Alfentanil ( C,D if prolonged or high doses near term)

Risk in 3rd trimester. No adverse effects reported. Could cause respiratory depression, reversible with naloxone.Apnea and hypotonia seen in newborn.

+ Excreted into breast milk. Significance of amount is unknown.Prob compatible.

Allopurinol (C)Few human pregnancy studies. No adverse reports

in humans. + Drug excreted into breast milk. Effects unknown. AAP considers it compatible with breastfeeding

Almotriptan (C)No human pregnancy studies, animal studies imply

low risk. + No human lactation studies, drug likely excreted into breast milk.Effects unknown.

Alosetron (B)No human pregnancy studies, animal studies imply low risk . Few studies on similar medications do not

show teratogenicity. Can be used in pregnancy-

No human lactation studies, drug likely excreted into breast milk in minimal amounts. Effects unknown. Risk

of toxicity. Death has occurred in adults from GI sypmptoms. Best to avoid.

Alprazolam (D)Risk in animal and human studies. Freely crosses

placenta. Neonatal withdrawal may occur.

Drug excreted into breast milk Risk of withdrawal, lethargy, weight loss and adverse effects on

neurodevelopment. AAP considers its effect unknown but of concern.

Alteplase (C)Animal studies did not show teratogenicity. May be

used if mother’s condition warrants. Risk of hemorrhage in mother.

+Unknown if excreted into breast milk. Risk to infant minimal because of short half life and indication of

drug.

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A B C D

Amantadine (C)

Avoid in 1st trimester. Teratogenic and embryotoxic at certain doses in one animal species. In 1 reported case, exposure in first trimester may have caused a

single ventricle with pulmonary atresia. Another study had a high incidence of defects but study too

small to access risk.

CIDrug excreted into breast milk in low amounts. Risk of

toxicity: vomiting, rash and urinary retention. Manufacturer states not to breastfeed.

Amifostine (C)No human studies, animal studies imply risk. risk.

Maternal benefit appears to outweigh fetal risk. Use of informed consent recommended.

+No human lactation studies, Drug likely excreted into

breast milk in limited amounts. Effects unknown. Drug is given prior to chemotherapy or radiation so

breastfeeding would be unlikely.

Amikacin (C, D per manufacturer)

No reports of adverse effects on fetus. Testing for ototoxicity recommended because other

aminoglycosides (eg, kanamycin and streptomycin) have been associated with eighth cranial nerve

damage.

+Drug excreted into breast milk in low amounts. Observe

for changes in bowel flora, allergic reactions and use caution when interpreting culture results with sepsis

evaluation. Ototoxicity not a risk.

Amiloride (B, D if gestational hypertension)

Few human studies, low risk in animal studies. Hypospadias reported in 1 infant +

No human lactation studies. Drug likely excreted into breast milk, it is excreted into breast milk of lactating rats at higher concentrations than in blood. Probably

compatible.

Aminocaproic Acid (C)Few human studies. No fetal toxicity occurred in 1

patient given aminocaproic acid in second trimester. - No human lactation studies. Drug likely excreted into breast milk. Best to avoid breastfeeding.

Aminopterin (X)

Fetal malformations reported when medication was used to induce abortion unsuccessfully.

Malformations not found with 2nd and 3rd trimester use. Need long term studies.

CI Antineoplastic agent, contraindicated. No studies available.

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A B C D

Amiodarone (D)

Risk in animal and human studies (increase in VSD)Transient bradycardia and IUGR may occur. Also, because this drug contains iodine, there is potential concern regarding fetal thyroid gland. Test thyroid

function of newborn. Use with caution, if at all, during pregnancy. Prolonged QT interval, fetal

bradycardia and hypothroidism, SGA,goiter, transient hyperthyroidism can be seen.

-Excreted into breast milk. Breast feeding not

recommended because of iodine contained in each dose and possible accumulation of amiodarone in the

infant. Possible hypothyroidism. AAP considers its effect unknown but of concern.

Amitriptyline (C)

Some studies show an association with congenital malformations. Neonatal withdrawal and urinary

retention in neonate are potential problems. Most evidence indicates amitriptyline is relatively safe in

pregnancy and may be preferred over other antidepressants during gestation.

- Drug and metabolites excreted into breast milk. Use in breast feeding may be of concern.

Amlodipine (C)No human pregnancy studies. Risk in aminal studies:

increase in deaths, decrease in size of litter and longer gestation and labor.

+ No human lactation studies, drug likely excreted into breast milk. Effects unknown. Probably compatible.

Ammonium Chloride (B)

Three possible malformations (inguinal hernia if taken during first trimester, cataracts, and benign

tumors) reported. Acidoses may occur in mother and fetus when taken near term.

+ No human lactation studies, probably compatible

Amoxapine (C)

Embryotoxicity seen in two animal species. In one human study three major birth defects (type unknown) were reported from first-trimester

exposure. Study too small to access risk.- Drug and its metabolites excreted into breast milk. Use

in breast feeding may be of concern.

Amoxicillin (B)No congenital defects seen. No evidence of fetal or

neonatal risk. +Excreted in low amounts in breast milk. Observe for changes in bowel flora, allergic reactions, and use caution in interpreting culture results with sepsis

evaluation.

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A B C D

Amphetamine (C)

Not teratogenic. With amphetamine abuse, risk of increased morbidity in mom, fetus and newborn and

other significant risks. Prematurity, IUGR, intrauterine death and cerebral injuries seen.

CI The AAP considers it contraindicated during breastfeeding.

Amphotericin B (B) No adverse effects on fetus reported. + No human lactaion studies, probably compatible

No adverse effects on fetus reported. + No human data, probably compatible

Ampicillin (B)Probably not teratogenic.Maternal anaphylaxis

causing neonatal distress with neurologic sequelae in one case.

+Drug excreted into breast milk.Observe for changes in

bowel flora, allergic reactions, and use caution in interpreting culture results with sepsis evaluation. Monitor for diarrhea. Candidiasis was seen in one

infant.

Amprenavir (C)

Few human pregnancy studies, concern for developmental toxicity seen in animals. Antretroviral therapy should continue during pregnancy with the exception of efavirenz. Maternal benefit outweighs

fetal risk. Monitor for hyperglycemia.

CI No human lactation studies. CDC recommends HIV infected mothers in developved countries not nurse.

Amrinone (C)Few human studies, teratogenic in some animal

species. + No human lactation studies. Drug likely excreted into breast milk. Prob compatible.

Anagrelide (C)

Few (5)human pregnancy studies early on with normal outcomes. Animal studies show potential

risk. Best not to beomce pregnant while on medication.

-No human lactation studies, drug likely excreted into

breast milk. Effects unknown, but risk of thrombocytopenia as well as other adverse effects are

possible.

Anakinra (B)

No human pregnancy studies, animal studies imply low risk ,no structural defects, but embryo

implantation prevention in one review. However, avoid drug during gestation.

+ No human lactation studies, drug excreted into breast milk. probably compatible.

Anileridine (B/D if long term or high doses at term)

Risk in 3rd trimester. No associations with congenital malformations. Potential risk of withdrawal

syndrome and respiratory depression in infants.+ No studies available, probably compatible

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Anisotropine (C)Few human studies, irrelevant animal studies. A

possible association was found with minor malformations.

+ No studies available, probably compatible

Antazoline (C)

Antihistamines are generally associated with low risk of congenital anomalies, questionable association with cleft palates. Exposure in last two weeks of

pregnancy associated with retrolental fibroplasia in premies. Alternative is meclizine and cyclizine

according to FDA.

+No studies available, probably compatible. Newborn or

premature infants may show increased sensitivity to antihistamines. Manufacturer feels drug is

contraindicated oin nursing mothers.

Anthralin (C)No human or animal pregnancy studies, therefore no

risk of accessment can be made. - No human lactation studies, potential risk, should be avoided.

Aprotinin (B)No studies associated the drug with congential

defects. Crosses placenta and decreases fibrinolytic activity in the infant.

+ No human lactation studies, absorption of drug unknown but probably poor. Probably compatible.

Argatroban (B)

No human pregnancy studies, animal studies do not show risk .Risk of hemorrhage can not be accessed

based on lack of studies. Maternal benefit outweighs fetal risk.

+No human lactation studies, probably compatible. Drug

likely excreted into breast milk with poor absorption,effects unknown.

Aripiprazole (C)

Animal studies show developmental toxicty and possible tertogenicity. Few(only two) human studies do not allow risk assessment. Avoid in 1st trimester. If maternal condition requires treatment, use lowest dose possible. Infant needs to have long term follow

up.

-No human lactation studies, drug and or its metabolite are likely excreted in limited amounts into breast milk. .

Risk of CNS toxicity: CNS effects, orthostatic hypotension, seizures, dysphasia, nausea and vomiting.

Long term studies need to be done.

Asparaginase (C)

Risk in animal(teratogenicity) and human studies. Avoid during 1st trimester, does not seem to be a e

major risk to fetus if used during 2nd or 3rd trimester. Chromosomal damage and transient bone

marrow hypoplasia in a newborn.

- No human lactation studies,risks. Avoid breastfeeding.

Aspartame (B/C if PKU)Not a risk to fetus.If a mother has PKU, she needs to

watch her intake. + Use cautiously if mother or infant has of PKU.

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Aspirin (C,D if in 3rd trimester)

Risk in 1st and 3rd timester.May cause increased risk of hemorrhage, closure of ductus arteriosus, PPHN and prolonged labor. High 1st trimester doses may

cause increased perinatal mortality, teratogenic effects and IUGR . Risk is greatest in last 3 months of pregnancy. If medication required to treat fever or pain, use acetaminophen rather than aspirin. Can also see increase in intracranial hemorrhage and

decrease in clotting ability.

- Excreted into breast milk in low amounts.Use with caution. May affect platelet function.

Astemizole (C)

Few human and animal studies do not imply major teratogenicity.Of concern is one animal study

showed behavioral and anatomic changes in rat pups. Until more data available, best to avoid in 1st

trimester.

+ No human lactation studies, drug likely excreted into breast milk . Effects unknown. Probably compatible.

Atazanavir (B)

Few human pregnancy studies, animal studies imply low risk. US Dept. of Health and Human Services guidelines states HIV-1 infected patients should continue the use of antiretroviral agents during

pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential fetal risks.


breast milk. Risk of hyperbilirubinemia. CDC recommends HIV infected mothers in developed

countries do not breastfeed.

Atenolol (D)

May cause bradycardia and hypotension in infant exposed near term. Carefully monitor fro symptoms of B blockade for 48 hours after delivery. May cause

IUGR and lower birth weight.-

Excreted and accumulates in breast milk.Use with caution. Monitor for signs of B-blockade such as

bradycardia. Has been associated with significant effects in nursing infants (cyanosis and bradycardia).

Atorvastatin (X)Contraindicated, cholesterol and cholesterol products are important in fetal development CI Some of the drug likely exceted.. Breastfeeding is

contraindicated because of risk of toxicity.

Atovaquone (C)

Few human studies that do not include the 1st trimester, animal studies imply low toxicity. The

maternal benefit exceeds unknown embryo/fetal risk

-No human lactation studies Drug likely excreted into

breast milk in limited amounts. Risk for severe adverse effects: GI symptoms, rash, fever, headache, hepatic toxicity and carcinogenicity. Breastfeeding should be

avoided.

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Atracurium (C)

Teratogenic in one animal species.No adverse effects reported in humans.Safe to use in the last part of pregnancy, studies have not been done in early

pregnancy.+

No human lactation studies- probably compatible. Probably only a small amount would be excreted into breast milk and it would be rapidly degraded.Safe to

nurse.

Atropine (C)

No association with malformations reported in 1 large survey. In another survey, possible association with limb reduction in 2 infants. Parasympatholytics

are associated with minor malformations.+

Few studies disagree if it is excreted into breast milk. No adverse effects reported. AAP considers it compatible

with breast feeding.

Azacitidine (D)

No human studies, animal studies imply risk. Avoid during 1st trimester. Men should be advised not to father a child while taking this drug and for several

months after. CI

No human lactation studies. Drug likely excreted into breast milk. Effects unknown.Risks may be severe:

nausea, anemia, thrombocytopenia, vomiting, pyrexia, leukopenia, diarrhea, fatigue, constipation, neutropenia

and ecchymosis seen in adults. Contraindicated.

Azatadine (B)Few human studies, low risk in animal studies.No

association found between the drug and birth defects.

+ No human lactation studies, probably compatible.

Azathioprine (D)

Risk in animal and human studies. Most investigators have found azathioprine to be relatively safe. In a

few cases, however, abnormalities reported, including leukopenia and thrombocytopenia,

immunosuppression,IUGR, transient chromosomal aberrations, and congenital defects. Interferes with effectiveness of intrauterine contraceptive device.

-There is the potential for toxicity with the active

metabolites( 6-MP and toxic TGNs) of the drug.TGN or 6-MP was not detected in any milk samples in a two

studies.

Azelastine (C)No human pregnancy studies.Animal studies imply

low risk. There are newer asthma and allergy medication available that are preferred.

+ No human studies, drug likely excreted into breast milk in insignificant amounts. Pprobably compatible.

AzithromycinFew human studies, animal studies imply low risk.

Macrolide antibiotics are not considered major human teratogens. More study needed.

+ Few human lactation studies. The drug accumulates in breast milk.Probably compatible.

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A B C D

Aztreonam (B)No human pregnancy studies, animal studies imply

low risk of teratogenicity, embryotoxicity, or fetotoxicity. No reports of adverse effects located.

+Drug excreted into breast milk in low amounts. Effects

unlikely, because of low amounts and poor oral absorption. AAP considers it compatible..

Bacampicillin (B) No studies of fetal risk available. +Compatible. Potential problems however rare are changes in of bowel flora, allergic reactions and use

caution in interpreting culture results with sepsis evaluation.

Bacitracin (C) Not associated with congenital malformations. + No human lactation studies.. Topical use compatible.

Baclofen ©Few human studies, low risk in animal studies. No

reports of adverse effects located. +Few human lactation studies. Animal studies found the

drug was an inhibitor of prolactin release. AAP considers it compatible with breastfeeding.

Balsalazide (B)No human pregnancy studies, animal studies do not imply major risk. Mesalamine is the primary active metabolite which is safe to use during pregnancy.

-No human lactation studies, potential toxicity.

Diarrhea in nursing infant has been observed. Observe infants for changes in bowel function.

Basiliximab (B)

No human pregnancy studies, animal studies imply low risk. Manufacturer states women of childbearing age should use effective birthcontrol during therapy

and 4 months afterward.+

No human lactation studies .Drug likely excreted into colostrum and mature milk. Digestion by GI tract likely.

Effects unknown.

Beclomethasone (C)According to ACOG and ACAAI, considered inhaled

steroid of choice during pregnancy. + Few human studies, drug likely excreted into breast milk because other corticosteroids are.Probably compatible.

Belladonna (C)

Associated with fetal malformations of varying severity and with minor malformations when used in first trimester. Increased risk of hypospadias, eye

and ear malformations, and respiratory tract anomalies with 1st trimester use.

+ No human lactation studies, prob compatible. See Atropine.

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Benazepril (C 1st tri, D 2nd,3rd tri)

Teratogenic in 2nd and 3rd trimester: hypocalvaria, and renal defects, IUGR, prematurity and severe

neonatal hypertension. Oligohydramnios caused by anuria can cause: limb contractures, persistent PDA, craniofacial deformation, pulmonary hypoplasia and

death.

+No human lactation studies, probably compatible.

Other ACE inhibitors are excreted into breast milk in low amounts with no adverse effects on nursing infants.

Benztropine (C)

Possible association between benztropine and minor malformations. Another study showed a possible association between the drug and cardiovascular

defects. Paralytic ileus was seen

No human lactation studies, probably compatible.

Bepridil (C)No human pregnancy studies, animal studies imply

low risk.. + No human lactation studies, drug excreted into breast milk. Probably compatible.

Betamethasone (C/D if 1st trimester. )

Use of corticosteroids in 1st trimester associated with orofacial clefts.Stimulates fetal lung maturation,

thus reducing incidence and severity of respiratory distress syndrome. Hypoglycemia, leukocytosis, adrenal suppression, LBW with decrease in head circumferance, transient constriction of ductus

arteriosus.lower birth weight and decreased head circumferance seen.

+ No human lactation studies, Drug likely excreted into breast milk., probably compatible.

Betaxolol (C, D if 2nd or 3rd trimester)

Use in 2nd and 3rd trimester may cause IUGR or reduced placental weight. If used close to time of delivery, monitor infant closely for 24-48 hours for

signs and symptoms of beta blockade.-

No human lactation studies. Drug excreted in sufficient amounts in breast milk to produce beta blockade. If

used observe for hypotension and bradycardia.

Bethanechol (C) No reports of fetal risk available, but studies limited. -Few human studies.Drug likely excreted into breast

milk. Abdominal pain and diarrhea reported in breast feeding infant.

Bevacizumab (C)

No human pregnancy studies, animal studies imply risk. Avoid use during pregnancy; potential risks to embryo/fetus include growth restriction, structural

anomalies and death.-

No human lactation studies,drug likely excreted into breast milk. Avoid breastfeeding because of risk of

severe toxicity.

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A B C D

Bexarotene (X) Use during pregnancy is contraindicated -No human lactation studies, drug likely excreted into

breast milk.Avoid breastfeeding because of risk of toxicity.

Bisacodyl (C)

No human and animal pregnancy studies. Bulk-forming (methylcellulose) or surfactant (docusate) laxatives preferred for use in pregnancy over this

stimulant laxative.+

No human lactation studies, Drug likely excreted into breast milk, but only small amounts are absorbed into

maternal circulation. Therefore effects on nursing infant would be negligible.

Bismuth Subsalicylate (C)Contains salicylates. Use only in 1st half of

pregnancy. See Aspirin. - Use with caution because of potential for adverse effects from salicylates. Should be avoided.

Bisoprolol (C, D if 2nd or 3rd trimester)



No human lactation studies,, drug excreted into milk of lactating rats. If used , infant should be observed for

hypotension, bradycardia and other signs and symptoms of beta-blockade.

Bleomycin (D)

Human and animal studies imply risk. If possible, avoid during pregnancy.Leukopenia with

neutropenia and alopecia and chromosomal aberrations seen.

- No studies available. Potential toxicity, avoid breastfeeding.

Blue cohosh (C)Herbal product that is not standardized and has

uterine stimulant properties. Teratogenic and toxic in some animal species. Avoid in 1st trimester.

-No human lactation studies. Drug likely to be excreted in breast milk.Effects unknown. Avoid use because of toxicity and estrogenic effects. during breastfeeding.

Bortezomib (D)No human pregnancy studies., animal studies

showed growth restriction and death. Avoid use. - No human studies, drug likely excreted into breast milk. Best to avoid because the drug is cytotoxic.

Botulinum Toxin Type A (C)

Few human studies, low risk in animals. Risk is low based on the fact that it does not cross the placenta in the last half of pregnancy and IM injections do not

appear in circulation.+

No human studies, probably compatible, toxin not likely to be in circulation and therefore will not appear

in breastmilk.

Bretylium (C)No human pregnancy studies. May cause maternal

hypotension, with potential risk to fetus from reduced uterine blood flow and hypoxia.

- No studies available. Avoid breastfeeding.

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Bromfenac ophthalmic ©No human studies, animal studies imply low risk. Very little, if any drug would enter the circulation,

therefore little risk.+ No human studies, probably compatible. Systemic

NSAIDs are compatible with breastfeeding.

Bromocriptine (B) Not a risk to the fetus. CI Suppresses lactation.AAP states to use with caution.

Brompheniramine (C)

Increased risk of fetal malformations if taken during first trimester. Increased risk of retrolental fibroplasia in premature infant exposed to

antihistamines during last 2 weeks in utero.+

One case report of infant with irritability, sleeping pattern disturbance, and excessive crying. AAP

considers it usually compatible.

Buclizine (C)

Possible increased risk of fetal malformations. Increased risk of retrolental fibroplasia in premature infant exposed to antihistamines during last 2 weeks

in utero.+ No human studies, probably compatible

Budesonide (B for inhaled /C for oral)

Inhaled budesonide does not appear to be a significant risk for congenital defects.There may be a

small risk between nasal budesonide and cardiac defects. Corticosteroids cause a small increased risk

for cleft lip with or without cleft palate.

+No human lactation studies. Drug likely excreted in low amounts. Oral potency is 25 times more glucocorticoid

activity than hydrocortisone, however, the clinical significance is unknown. Manufacturer suggests to not

breast feed if using the Pumicort turbuhaler.

Bumetanide (C, D if gestational hypertension)

No human studies.. Diuretics are not recommended for use for the treatment of gestational

hypertension.+ No human studies- probably compatible.

Buprenorphine (C)

Few human studie, animal studies imply low risk. One case report of neonatal withdrawal when dose

given as narcotic substitute for heroin . No reports of congenital anomalies, just behavioral changes in

animals. There are other narcotic analgesics that can be used, especially during early gestation.

-Excreted into breast milk. May cause infant to ingest less milk and then have lower weight gains. Mothers should avoid breastfeeding if taking buprenorphine

Bupropion (B)Human and animal studies imply low risk. One study

showed increased risk of spontaneous abortions. Long term studies not done.

- Drug is excreted into breast milk. Effects unknown but of concern.

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A B C D

Buspirone (B)Few human studies, animal studies imply low risk. Congenital malformatins were not seen after 1st

trimester. Studies too limited to access risk.-

Few human studies. Drug and its metabolites are excreted into the milk of lactating rats. Potential exists for CNS impairment. AAP considers its effects unknown

but concern for effects on developing brain.

BusulfanContraindicated in 1st trimester. Congenital

malformations seen. IUGR and chromosomal damage can be seen.

CI No human lactation studies. Contraindicated because of risk of serious toxicity .

Butalbital (C/D if prolonged periods or in high doses at term)

Few human pregnancy studies. No congenital malformations seen. Observe for neonatal

withdrawal.- No studies available.

Butorphanol (C,D if prolonged or high doses near term)

Risk in 3rd trimester. No association with fetal malformations reported; however, respiratory

depression and withdrawal syndrome may occur. Sinusoidal fetal heart rate pattern seen.

+Few human studies- probably compatible. Excreted

into breastmilk in levels that are probably not clinically significant.

Caffeine (B)

Moderate consumption of caffeine probably does not pose risk to fetus; even so, prudent to avoid or

limit consumption. Consumption of 6–8 cups of coffee/day may be associated with decreased fertility

and spontaneous abortion. High caffeine with cigarette smoking may cause low birth weight. Can

see in infant: low birth weight, fine tremors, tachypnea, fetal sleep pattern and behavioral

changes, PACs, and tachyarrhythmias.

+Excreted into breast milk. Amounts in milk prob low

with little clinical significance, unless heavy amounts are used. Monitor for irritability and poor sleeping pattern.

No effect with moderate intake(2-3cups/day)

Calcitonin-salmonNo reports of congenital defects have been reported. Increase in calcitonin concentration in fetal serum. + No human studies,drug not likely excreted into breast

milk.May inhibit lactation.

Calcitriol (C, D if doses above RDA)

Vitamin D analog. High doses of vitamin D teratogenic in animals but not in humans. Because

vitamin D raises calcium levels, it may be associated with supravalvular aortic stenosis syndrome, which is often associated with hypercalcemia of infancy Can

see mild transient hypercalcemia in infant.

+High dose supplementation in mothers can lead to

elevated levels of Vitamin D2 in breastmilk and subsequently lead to hypercalcemia in breast fed

infants. Caution is advised.

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A B C D

Candesartan (C 1st tri, D 2nd,3rd tri)

Use during 2nd and 3rd trimester may cause teratogenicity and severe toxicity similar to ACE inhibitors. Monitor newborn renal function and blood pressure closely. Anuria, skull hypoplasia,

oligohydramnios,and abnormal US of kidneys seen in three infants.

+ No human studies, drug likely excreted into breast milk. Effects unknown.

Captopril (C 1st tri, D 2nd,3rd tri)

Teratogenic in 2nd and 3rd trimester. Hypocalvaria, renal defects, IUGR, prematurity and severe neonatal hypotension can be seen. Monitor renal function and

blood pressure in infant. Can see IUGR, renal dysplasia, anuria , renal failure, limb contractures,

pulmonary hypoplasia, intrauterine fetal death and oligohydramnios in infants.

+ Drug is excreted in low amounts. Available studies showed no effects. AAP considers it compatible.

Carbachol (C ) ophthalmic medication No studies of fetal risk available. + No studies available. Probably compatible.

Carbamazepine (D)

Associated with increase in major and minor malformations: cleft palate,CV defects, urinary tract defects, and NTDs. A fetal carbamazepine syndrome( fingernail hypoplasia, minor craniofacial defects and

questionable developmental delay) has been discussed. Vit K deficiency with hemorrhagic disease of the newborn , lower serum cord Vit D levels, and

transient cholestatic hepatitis has been seen.

+ Risk of bone marrow suppression if taken chronically.

Carbarsone (D)Contains arsenic, which has been associated with CNS lesions. If possible, avoid during pregnancy. CI Contraindicated- no studies available.

Carbenicillin (B)Has been used in a large number of pregnancies; no

malformations associated with use. +

No studies available, however, drug likely excreted because other penicillins are excreted into breast milk

in low concentrations. Adverse effects unlikely, monitor infant for allergic reaction, changes in bowel flora and use caution in interpreting culture results with sepsis

evaluation..

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A B C D

Carbidopa (C)Few human studies, therapy should not be withheld

during pregnancy + No human lactation studies. Probably compatible.

Carbimazole (D)

May cause aplasia cutis (scalp defects) and other congenital malformations( esophageal atresia with

TE fistula, hypoplastic or absent nipples,psychomotor delay, facial anomalies, choanal atresia, and

radioulnar synostosis. For treatment of hyperthyroidism during pregnancy, use

propylthiouracil rather than carbimazole or methimazole.

+Older studies found it may cause thyroid dysfunction in

infant. Newer studies do not show toxicity.AAP considers it compatible.

Carboplatin (D)Drug is mutagenic and cacinogenic. Avoid during 1st

trimester. CINo human lactation studies. Drug likely excreted into breast milk. Carcinogenic and mutagenic properties-

breastfeeding is contraindicated.

Carisoprodol ©Few human studies, questionable low risk of oral

clefts. Best to avoid during 1st trimester +Drug and its metabolite excreted in higher

concentrations in breast milk than in maternal plasma. Few human studies, risk low. probably compatible,

observe nursing infant for sedation and other behavioral changes.

Carmustine (D)

Considered a potential teratogen, avoid use during organogenesis or conception during treatment.Bone

marrow depression seen when multiple chemotherapy agents used near delivery.

CI No human lactation studies. Drug likely excreted into breast milk. Avoid breastfeeding because of high risk.

Carteolol (C, D if 2nd or 3rd trimester)



No human studies, excreted into milk of lactating rats. If used during breastfeeding, nursing infant should be

observed for hypotension, bradycardia and other signs and symptoms of beta-blockade.

Carvedilol (C, D if 2nd or 3rd trimester)



No human studies, excreted into milk of lactating rats. If used during breastfeeding, nursing infant should be

observed for hypotension, bradycardia and other signs and symptoms of beta-blockade.

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A B C D

Casanthranol (C)No reports of fetal anomalies reported in 109 infants

exposed to this drug during pregnancy. Another study showed no association with congenital defects.

+ Few human studies, probably compatible, observe nursing infant for diarrhea.

Cascara Sagrada (C)Higher risk for benign tumors in 1 study, but

confirmation needed. + Few human studies, probably compatible, observe nursing infant for diarrhea.

Cefaclor (B)Increased risk of congenital defects, but other factors

may be involved. +Excreted into breast milk in low amounts. Observe

infant for changes in bowel flora, allergic reactions and use caution in interpreting culture results with sepsis

evaluation. Compatible.

Cefadroxil (B) No association with congenital defects. +Excreted into breast milk in low amounts. Observe



Cefamandole (B) No teratogenic risk seen +Excreted into breast milk in low amounts. Observe



Cefatrizine (B) No studies of fetal risk available + No reports of use during human lactation. Compatible.

Cefazolin (B) No adverse effects seen.

Excreted into breast milk in low amounts. Observe infant for changes in bowel flora, allergic reactions and use caution in interpreting culture results with sepsis


Cefdinir (B) No studies of fetal risk available. +No human lactation studies. Drug likely excreted in low amounts in breast milk. Observe infant for changes in

bowel flora, allergic reactions and use caution in interpreting culture results with sepsis evaluation.

Compatible.

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A B C D

Cefditoren (B) No studies of fetal risk available. +No human lactation studies. Drug likely excreted in low amounts in breast milk. Observe infant for changes in


Compatible.

Cefepime (B) No studies of fetal risk available. +Excreted into breast milk in low amounts. Observe



Cefixime (B)Only one study available: 2 spontaneous abortions, 1

elective, 1 unknown outcome and 1 premature infant, 6 normal newborns.

+No human lactation studies. Drug likely excreted in low amounts in breast milk. Observe infant for changes in


Compatible.

Cefmetazole (B) No studies of fetal risk available. +No human lactation studies.Drug likely excreted in low amounts in breast milk. Observe infant for changes in


Compatible.

Cefonicid (B) No studies in pregnancy. +Excreted into breast milk in low amounts. Observe



Cefoperazone (B) No adverse newborn effects noted. +Excreted into breast milk in low amounts. Observe



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A B C D

Ceforanide (B) No studies in pregnancy . + No human lactation studies. Drug likely excreted in low amounts in breast milk because other cephaolsporins are. Observe infant for changes in bowel flora, allergic reactions and use caution in interpreting culture results

with sepsis evaluation. Compatible.

Cefotaxime (B) No teratogenic risk seen. +Excreted into breast milk in low amounts. Observe



Cefotetan (B) Cephalosporins are usually considered safe during

pregnancy. +Excreted into breast milk in low amounts. Observe



Cefoxitin (B) No adverse newborn effects noted. +Excreted into breast milk in low amounts. Observe



Cefpodoxime (B) No studies of fetal risk available. +Excreted into breast milk in low amounts. Observe



Cefprozil (B) No studies of fetal risk available. +Excreted into breast milk in low amounts. Observe

infant forchanges in bowel flora, allergic reactions and Use caution in interpreting cultrue results with sepsis


Ceftazidime (B) No reports of fetal risk. +Excreted into breast milk in low amounts. Observe

infant for changes in bowel flora, allergic reactions and Use caution in interpreting culture results with sepsis

evaluaion. Compatible.

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A B C D

Ceftibuten (B) No reports of fetal risk. +Drug likely excreted into breast milk in low amounts.

Observe infant for changes in bowel flora, allergic reactions and use caution in interpreting culture resultw

with sepsis evaluaion. Compatible.

Ceftizoxime (B) No reports of fetal risk. +Excreted into breast milk in low amouonts. Observe



Ceftriaxone (B)Possible association between the medication and

cardiovascular defects. Usually safe to use in pregnancy.

+Excreted into breast milk in low amounts. Observe



Cefuroxime (B) No adverse newborn effects noted. +Excreted into breast milk in low amounts. Observe



Celecoxib (C,D if 3rd trimester or near delivery)

No human pregnancy studies. Use of 1st generation NSAIDs during 2nd and 3rd trimester have been

associated with oligohydramnios, premature closure of ductus arteriosus, persistent pulmonary

hypertension of the newborn. NSAIDS have been associated with congenital malformations. Can inhibit labor and prolong pregnancy.Transient

decrease in amniotic fluid seen.

-Excreted into breast milk. Best to avoid breastfeeding because of potential risks. Observe infant for diarrhea,

nausea, headache, dizziness, and abdominal pain.

Cephalexin (B)Increased risk of congenital defects, but other factors


infant for changes in bowel flora, allergic reactions use caution in interpreting culture results with sepsis

evaluation. Observe for diarrhea. Compatible.

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A B C D

Cephalothin (B) No adverse newborn effects noted. +Excreted into breast milk in low amounts. Observe



Cephapirin (B)No studies available, but considered safe for use in

pregnancy. +Excreted into breast milk in low amounts. Observe

infant for changes in bowel flora, allergic reactions and use caution in interpreting culutre results with sepsis


Cephradine (B)Increased risk of congenital defects, but other factors




Cerivastatin (X)Cholesterol and products synthesized by cholesterol

are important during fetal development. Use contraindicated during pregnancy.

CI Drug excreted into breast milk. Avoid breastfeeding because of risk of adverse effects.

Cetirizine (B)No reports of fetal risk available, unlikely to be

teratogenic. Consider use of 1st generation antihistamine during pregnancy.

+ Drug excreted into breast milk. Effects unknown, but observe for sedation.

Cetuximab (C)No studies available, risk potential exists for embryo and fetal harm. Avoid pregnancy during treatment is

recommended.-

Drug unlikely but may be excreted into breastmilk. Potential risk for immunosuppression and other severe

adverse effects .

Cevimeline (C)No human or animal studies to access embryo/fetal

risk. -No human lactation studies, drug likely excreted into

breast milk. Because of lack of studies, avoid use during breastfeeding.

Chamomile (C)

Avoid excessive use ,herb felt to be a uterine stimulant, emmenagogue and have abortifacient properties. Best course of action is to avoid use

during pregnancy even though risk is low.+

No human lactation studies. Chamomile-containing teas have been used in infants and children to treat

colic. Probably compatible.

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A B C D

Chloral Hydrate (C) No adverse effects reported. + Drug and its metabolite excreted into breast milk. AAP considere it compatible. Observe infant for drowsiness.

Chlorambucil (D)

Contraindicated in 1st trimester. Drug is carcinogenic and mutagenic. Reports of unilateral agenesis of

kidney and ureter and cardiovascular anomalies. May cause low birth weight.

CINo human lactation studies. however because of

potential risks avoid breastfeeding when taking this medication.

Chloramphenicol (C)No congenital defects reported. Avoid at term

because of risk for gray syndrome (cardiovascular collapse).

-

Excreted into breast milk. Risk and safety unknown. Risk of bone marrow depression .Observe for changes in

bowel flora and use caution in interpreting culture results with sepsis evaluation. AAP considers its effect unknown but of concern. One study recommended it

not be used. Observe for vomiting after feeding, intestinal gas, refusing to breast feed and falling asleep

at the breast.

Chlordiazepoxide (D)

Some studies found increased risk of fetal malformations; however, others have not confirmed this. When given at term, neonatal depression with

hypotonia persisting for up to 1 week reported. Neonatal withdrawal syndrome may occur.

-No human lactation studies. Drug likely excreted into

breast milk. Use should be avoided because other benzodiazepines have produced adverse effects in

nursing infants.

Chlorhexidine (B)No reports of adverse effects in the newborn have

been reported. + No studies of excretion into breastmilk available. Rinse nipples with if used to cleanse them. Compatible.

Chloroquine (C)

Teratogenic and embryotoxic in one animal species. Generally considered safe, but there may be a small

increased risk of birth defects in human studies. Cochleovestibular paresis seen in 2 infants.

+Drug excreted into breast milk, but in insufficient amounts to provide adequate protection against

malaria. AAP considers it compatible.

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A B C D

Chlorothiazide (C, D if used in gestational hypertension)

Thiazide-related diuretics may cause increased risk of congenital defects in mothers with cardiovascular

disorders taken during first trimester. May also cause hypoglycemia, thrombocytopenia, hyponatremia, hypokalemia, hemolytic anemia and death. May

inhibit labor. Use in pregnancy only if required for patients with heart disease. Monitor infant’s

electrolytes, platelet count, and serum glucose carefully after birth.

+May suppress lactation, especially in the first month. Adverse effects have not been reported, but infant's

electrolytes and platelets should be monitored.

Chlorpromazine

Increase in congenital defects in one study and a case report of ectromelia. Occasional use in low

doses is safe for both mother and fetus. Avoid use near term due to potential for maternal hypotension

and adverse effects in newborn.Paralytic ileus, extrapyramidal syndrome and neonatal hypotonia,

lethargy, and jaundice seen.

-Excreted into breastmilk in low amounts. Observe

nursing infants for sedation. AAP considers its effect unknown but of concern because of drowsiness and

lethargy and because of galactorrhea induced in adults.

Chlorpheniramine (B)

Possible association with fetal malformations reported( hydrocephaly, congenital dislocatio of the

hip, eye and ear defects, GI defects, polydactly in african americans, malformations of the female genitalia) , but statistical significance unknown.

Increased risk of retrolental fibroplasia in premature infant exposed to antihistamines during last 2 weeks

in utero.

+ No studies available.

Chlorpropamide (C)

Pregnant diabetics should be managed with insulin, not oral hypoglycemics. Causes symptomatic

hypoglycemia as a result of hyperinsulinemia in newborn. Monitor infant’s serum glucose for 5 days

after birth. Can see Hyperbilirubinemia, polycythemia and hyperviscosity.

- Excreted in the breast milk and may cause hypoglycemia.

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A B C D

Chlortetracycline (D)

Tetracyclines should be avoided during pregnancy because they may cause adverse effects, including yellow staining of teeth, inhibition of bone growth,

maternal liver toxicity, and congenital defects.+

Excreted into breast milk in low concentrations. Theoretical dental staining and inhibition of bone

growth is remote. Observe infant for changes in bowel flora, allergic reactions use caution in interpreting culture results with sepsis evaluaion. Compatible.

Chlorthalidone (B, D if gestational hypertension)

Increased risk for congenital malformations. May also cause hypoglycemia, thrombocytopenia,

hyponatremia, hypokalemia, and death. May inhibit labor. Use in pregnancy only if required for patients

with heart disease. Carefully monitor infant’s electrolytes, platelet count, and glucose.

+May suppress lactation, especially in the first month. Adverse effects have not been reported, but infant's

electrolytes and platelets should be monitored.

Chlorzoxazone (C)No human pregnancy studies. No studies to

support association between drug and congenital effects.

- No human lactation studies, drug likely excreted into breast milk.Effects unknown.

Cholecalciferol (C/Dis used in doses above RDA)

High doses of vitamin D teratogenic in animals but not in humans. Because vitamin D raises calcium

levels, it may be associated with supravalvular aortic stenosis syndrome, which is often associated with

hypercalcemia of infancy.

+

Compatible with breastfeeding. Drug excreted into breast milk in small amounts.. The Committee on

Nutrition, American Academy of Pediatrics recommends vitamin D supplementation in breastfeed infants if

maternal intake is low or exposure to ultraviolet light is insufficent. Monitor serum calcium levels of nursing

infant if mother is taking pharmacologic doses of vitamin D.

Cholestyramine (B)

Not systemically absorbed but may bind fat-soluble vitamins in GI tract and cause vitamin deficiency in fetus, although this effect not reported.Case report

of fatal fetal subdural hematoma.+

Nonabsorbable resin that binds fat soluble vitamins. No lactation studies. Long term use may cause vitamin

deficiency in the mother and infant.

Chondroitin (C)

No human pregnancy studies. Animal studies imply low risk. Chondrotin is an endogenous substance found in human tissues, so use during pregnancy

does not appear to be a risk.+ No human lactation studies. Little if any drug is likely to

be excreted.. Probably compatible.

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A B C D

Ciclopirox (B)No human pregnancy studies. No adverse effects

reported. +No human lactation studies. Very small amounts are

absorbed systemically from occlusive dressings. Exposure to nursing infants would be negligible.

Cidofovir (C)No human lactation studies. Drug likely crosses the

placenta to fetus. Potential risk to fetus exists based on few animal studies.

CI

No human lactation studies. Animal studies showed carcinogenicity: mammary cancer with low doses.

Should not be used during breastfeeding because of risk of severe toxicity in nursing infant. Only approved

indication for drug in CMV retinitis in HIV-1 infected patients. HIV-1 infected mothers in developed

countries should not breastfeed

Cimetidine (B)

In human studies there were no increase risk of congenital malformations. One report of transient

liver impairment in newborn not confirmed by other investigators. Has antiandrogenic effects;

feminization observed in some animals and in nonpregnant humans. More data needed. Transient

liver impairment seen in case report of infant.

+Use with caution. May suppress gastric acidity in infant,

inhibit drug metabolism, and cause CNS stimulation. AAP considers it compatible.

Cinacalcet (C)

No human pregnancy studies. Animal studies show growth restriction. If maternal condition warrants

use of drug during pregnancy it should not be withheld.

-No human lactation studies. Drug likely excreted into breast milk.Effects unknown. Nausea, vomiting and

hypocalemia are potential adverse effects.

Cinoxacin (C)No human pregnancy studies. Do not use in pregnancy because of risk of drug induced

arthropathy in fetus.-

No human lactation studies. Drug caused lameness in immature dogs. Manufacturer recommends that drug

not be used in lactating women.

Ciprofloxacin (C)

Questionable association with some congenital anomalies.Use with caution in 1st trimester. Use a

safer alternative in pregnancy because of arthropathy in immature animals.

+Few human lactation studies. Drug likely excreted into

breast milk in insignificant amounts. AAP considers compatible with breastfeeding. However, the

manufacturer recommends that mother should wait 48 hours after last dose before breast-feeding.

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A B C D

Cisplatin (D)Few studies. A few case reports document normal

infants after use of cisplatin during pregnancy. Leukopenia with neutropenia seen.

CIBased on the data from three studies available, cisplatin

was found in breast milk. Breastfeeding is contraindicated when undergoing chemotherapy with

cisplatin.

Citalopram (C,D if 2nd and 3rd trimester.

Not a major teratogen. SSRI antidepressants have been associated with low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral

syndrome(withdrawal), possibly sustained abnormal neurobehavior beyond neonatal period, respiratory

distress, and PPHN.

-

Doses > 20 mg/day or concurrent use of other sedative agents may increase risk of adverse effects to nursing

infants. Observe for toxicity. Long-term effects on neurobehavoiral development are unknown. Avoid

nursing around peak maternal concentrations- about 4 hours after a dose. AAP considers SSRIs effects

unknown but of concern.

Clarithromycin (C) Few human studies, animal studies imply high risk. +No human lactation studies.. Drug likely excreted into

breast milk. Based on experience with other antibiotics risk to nursing infant is probably minimal. Use caution

until further studies.

Clavulanate (B) No adverse effects on fetus reported. + No human lactation studies Drug likely excreted into breast milk. Effects unknown.

Clemastine (C)

Possible association with limb reduction defects, but other factors may have been involved. Increased risk

of retrolental fibroplasia in premature infant exposed to antihistamines during last 2 weeks in

utero.

- Excreted into breast milk. AAP states use with caution. Drowsiness and CNS effects may occur.

Clindamycin (B) No adverse effects reported. +Excreted into breast milk . Observe infant for changes

in bowel flora, allergic reaction and use caution in interpreting culture results with sepsis evaluation.

Compatible. AAP classifies as compatible.

Clofibrate (C)

No human or animal studies. No adverse effects reported; however, data limited. Avoid

administration near term, especially in preterm infant, because of limited capacity for

glucuronidation of this compound.


breast milk and an active metabolite has been measured in it. Avoid breastfeeding because of

potential risks.

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A B C D

Clomiphene (X)

May cause neural tube defects(questionable) and other fetal malformations. Causes congenital

malformations if mother received clomiphene before conception. Start each new course after pregnancy

excluded.

- No human lactation studies. May reduce lactation.

Clonazepam (D)

Animal studies show teratogenicity in one study only. Risk of fetal and neonatal toxicity.Best to avoid in 1st trimester.May cause apnea and paralyic ileus of the

small bowel.-

Excreted in breast milk and elimation prolonged. Test serum levels in infant and monitor for apnea and

respiratory and CNS depression.

Clonidine (C)Animal studies imply risk: decrease in survival of two species. Few human studies-can not define risk. Data

limited; however, no adverse effects reported.+

Excreted in breast milk. Infants did not have hypotension with serum evidence of clonidine. Long

term follow up of these infants unknown.

Clopidogrel (B)Animal studies show no teratogenicity in two

species, only one human case report. Benefits to mother outweighs risk to fetus.

+ No human lactation studies. Drug likely excreted into breast milk. Effects unknown.

Clorazepate (D)Multiple anomalies with first-trimester exposure in one case. Congenital malformations associated with

in utero exposure to other benzodiazepines.-

No human lactation studies. Drug likely excreted into breast milk because other other benzodiazepines

accumulate in human milk. Adverse effects have been reported in nursing infants exposed to other

benzodiazepines. AAP states its effects unknown but of concern.Observe for sedation and drowsiness.

Clotrimazole (B)Questionable association with a decrease in the

prevalence of undescended testis. + Minimal absorption from skin and vagina. Unlikely levels of this antifungal agent appear in breastmilk.

Cloxacillin (B)Possible association with cardiovascular defect.

Other studies show no associations. +No studies available. Drug likely excreted into breast

milk because other penicillins are excreted into breast milk. Adverse effects unlikely, monitor infant for

allergic reaction, changes in bowel flora and use caution in interpreting culture results with sepsis evaluation.

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A B C D

Clozapine (B)

Few human studies, animal studies imply low risk.. Folic acid 4 mg/day is recommended for women

taking atypical antipsychotics because they may have a higher risk of neural tube defects .

- Concentrated in breast milk. Avoid breastfeeding. AAP states its effect is unknown but of concern.

Cocaine (CM/X if nonmedicinal use)

Major toxicity in the fetus and newborn. May cause withdrawal syndrome, multisystem abnormalities as

a result of vasoconstrictive properties of the drug, including urogenital anomalies, prematurity,

spontaneous abortions, fetal growth retardation, neurobehavioral deficits, electroencephalogram

abnormalities, cerebral infarctions, cardiorespiratory pattern abnormalities, and abruptio

placentae.Congenital abnormalities include: heart, limbs, face, GU tract and bowel atresias. Increase in

SIDS and severe neurophysiologic abnormalities.

CIContraindicated. Causes cocaine intoxication in infant

from maternal intranasal use (hypertension, tachycardia, mydriasis, and apnea) and from topical use

on mother’s nipples (apnea and seizures).

Codeine (C/D if prolonged periods or high doses near term)

No data to support the association of codeine with congenital malformations. If mom is addicted or uses high doses in the 2nd or 3rd trimester or at delivery,

toxicity can occur. Respiratory depression and withdrawal syndrome can be seen.

-Short term therapy- 1 or 2 days with close monitoring is compatible in healthy full term infants, however, long-

term therapy in not compatible with breastfeeding. Observe infant for sedation, lethargy and poor feeding.

AAP considers it compatible.

Colchicine (D)

Teratogenic in animals. Few studies in humans but no malformations seen. Questionable association of

Downs syndrome and colchicine . Can cause azospermia. Use with caution. Limited data.

+Excreted into breast milk. No adverse effects have been observed. Waiting 8 to 12 hours after dose to

breastfeed minimizes exposure .

Colistimethate (C)Animal studies show risk . No adverse effects

reported. +Drug excreted into breast milk in low concentrations.

Observe infant for changes in bowel flora, allergic reaction and use caution in interpreting culture results

with sepsis evaluation. Compatible.

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Corticotropin (C)No adverse effects reported. Concern because

conticosteroids may cause congenital malformations. + No studies available . Probably compatible.

Cortisone (C/D if 1st trimester.)

Teratogenic and toxic in animal studies: cataracts, cleft palate, IUGR, polycystic kidney disease, and spontaneous abortion seen.In human studies an

increase in cleft lip with or without palate, decrease in birth weight, and questionable association with

cataracts is seen.

+No studies on whether the drug is excreted into breast

milk. Prednisone is excreted in small amounts and is compatible with breastfeeding. Compatible.

Cromolyn Sodium (B) Generally considered safe for use in pregnancy. No

associations between the medication and congenital defects.

+ No human lactation studies.

Cyclacillin (B)Has been used in a large number of pregnancies and

has not been associated with malformations. +No studies available, drug likely excreted into breast

milk because other penicillins are excreted into breast milk. Adverse effects unlikely, monitor infant for

allergic reaction, changes in bowel flora and use caution in interpreting culture results in sepsis evaluation.

Cyclamate (C)Thought to cause cytogenetic effects in lymphocytes. There was no association between these effects and

congenital malformations.+ No studies available.

Cyclizine (B)

Teratogenic in animals but not in humans. Increased risk of retrolental fibroplasia in premature infant exposed to antihistamines during last 2 weeks in

utero.+ No studies available.

Cyclobenzaprine (B)No human pregnancy studies. No association

between the drug and congenital defects. -No reports of excretion into breastmilk. Drug likely

excreted into breast milk. Risk of toxicity, breast feeding not recommended.

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A B C D

Cyclophosphamide (D)

May cause fetal malformations from first-trimester exposure, possible pancytopenia, leukopenia, IUGR,

anemia, bone marrow hypoplasia and low birth weight. Stillbirth and neonatal death have been

seen.Use by father before conception may cause malformations in infant.

CIRisk of adverse effects relating to immune suppression ,growth, and carcinogenesis. May cause neutropenia and thrombocytopenia .AAP considers it a drug that

may interfere with cellular metabolism. Contraindicated.

Cycloserine (C) Few human studies, animal studies show risk. No adverse fetal effects reported. Use with caution.

Limited studies.+ Excreted into breastmilk. Compatible, no risks seen .

Cyclosporine ©

Few human studies( not a teratogen) animal studies show risk( toxicity not teratogenicity).

Thrombocytopenia, keukopenia, DIC, hypoglycemia and IUGR have been seen in infants.

-Excreted into breast milk. Possible immune

suppression; unknown effect on growth or association with carcinogenesis. AAP considers it as a medication

that could interfere with cellular metabolism.

Cyproheptadine (B)

Few human studies, animal studies imply low risk: one study showed no fetal toxicity, one showed toxicity and increased mortalitiy. Questionable

association with oral clefts and hypospadius. +

No human lactation studies. Contraindicated because of increase in sensitivity of infants to antihistamines. Monitor for agitation, poor sleeping pattern, and

feeding problems.

Cytarabine (D)

Teratogenic in two animal species.May cause chromosomal abnormalities and congenital

anomalies with maternal or paternal use before conception and low birth weight; however, normal infants have been delivered. Pancytopenia , LBW chromosomal aberrations and intrauterine fetal

death have been seen.

CI No human lactation studies. Contraindicated because of potential risks.

Dacarbazine (C)No human pregnancy studies. Animal studies showed

risk: cleft palates, skeletal reduction defects and encephaloceles.

-No human lactation studies. Avoid use during breast

feeding because of risk of toxicity: hemopoietic depression..

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A B C D

Daclizumab (C)

No human pregnancy studies. Risk of developmental toxicity. Manufacturer recommends women of childbearing age use contraception during and 4

months after therapy.+

No human lactation studies. Probably excreted the first 2-3 days after birth and may also be excreted into mature milk due to long half life.Effects unknown.

Dactinomycin (C)

Few human studies, animal studies imply risk of teratogenicity and fetal toxicity. Low birth weight

and stillbirth have been reported, however, normal infants have been delivered.

- No human lactation studies. Women should avoid breastfeeding because of risk of toxicity to infants.

Dalteparin (B)Less risk than from standard unfractionated heparin

or no therapy. +No human lactation studies. Drug not likely excreted into breast milk, any amount would be inactivated in

the GI tract. Risk is negligible.

Danaparoid (B) Few human pregnancy studies. Probably limited risk. +No human lactation studies. Drug not likely excreted

into breast milk, and any that did would be inactivated in the GI tract. Risk is negligible.

Danazol (X)May cause virilization with disorder of sex

development of female infants. May cause female pseudo hermaphroditism.

CI No human lactations studies. Women taking this drug should avoid breastfeeding because of potential risks.

Dantrolene (C)

Few human pregnancy studies, esp in 1st and 2nd trimester. No fetal or newborn adverse effects

reported when used in a limited number of patients shortly before delivery.

- Excreted into breast milk. Wait 2 days after last dose to breast feed.

Dapsone (C)Not a major risk to newborn or fetus. Hemolytic anemia and hyperbilirubinemia seen in an infant. - Excreted into breast milk. May cause hemolytic anemia

in G6PD deficiency.

Daptomycin (B)No human pregnancy data, animal studies imply low risk..High molecular weight will limit drug exposure.

Antibiotics are considered low risk.+

No human lactation studies. If drug excreted into breast milk it would be in limited amounts. Changes in bowel flora, diarrhea and other GI symptoms could occur in

the infant.

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A B C D

Darbepoetin Alfa (C)

No human pregnancy studies, animal studies imply low risk(increase in abortions observed). Severe

hypertension and renal disease observed with epoetin alpha which could be seen with darbepoetin.

+No human lactation studies. Drug not likely to be

excreted into breast milk. Risk to nursing infant appear to be negligible.

Darifenacin (C)No human pregnancy studies, animal studies imply

low risk.The drug is not recommended for use in pregnancy.

+No human lactation studies. Drug likely excreted into breast milk in low amounts. Observe infant for: dry

mouth, constipation, abdominal pain and nausea.

Darunavir (B)

Few human studies, animal studies imply low risk. US Dept. of Health and Human Services guidelines

states HIV-1 infected patients should continue use of antiviral therapy pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential

fetal risks.

CINo human lactation studies. Drug likely excreted into breast milk. Effect unknown. CDC recommends HIV

infected mothers in developed countries do not breastfeed.

Dasatinib (D)No human pregnancy studies, animal studies imply

risk. . Women of reproductive age should use contraception.

-No human lactation studies.Drug likely excreted in

breast milk but in limited amounts. Effects unknown, there is risk of toxicity to multiple systems..

Daunorubicin (D)

Teratogenic and toxic in animals. Successful pregnancies with normal infants reported; however,

abnormalities such as low birth weight, anemia, hypoglycemia, questionable birth defects,

intrauterine death, and myocardial necrosis may occur. Paternal use may result in congenital defects in infant. Severe transient bone marrow hypoplasia seen in case report. Two cases of neutropenia seen.

CI No human lactation studies. Contraindicated because of toxicity risk in infant.

Decitabine (D)

No human pregnancy studies, animal studies, imply risk. Drug not recommended,esp in 1st trimester.

Men should not father a child during and for 2 months after this treatment.

CI

No human lactation studies. Drug likely excreted into breast milk in limited amount due to short half

life.Effects unknown.Risk of toxicity: thrombocytopenia, fatigue, nausea, cough, diarrhea, petechiae,

hyperglycemia, neutropenia, and constipation seen in adults..

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A B C D

Deferasirox (B)

No human pregnancy studies, animal studies imply low risk. Deferoxamine is the preferred agent for

iron overload during pregnancy because it has been used in pregnancy without toxiciy to the fetus.

-No human lactation studies. Drug likely excreted into breast milk. With the potential to deplete infants iron

stores, breast feeding should be avoided during therapy.

Deferoxamine (C)

Teratogenic and toxic in some animal species. The few human studies have not shown any adverse

effects. May cause low iron levels in infant, requiring iron supplementation.


Delavirdine (C)

Few human studies, animal studies imply risk. US Dept. of Health and Human Services guidelines

statesHIV-1 infected patients should continue use of antiviral therapy during pregnancy, with the

exception of efavirenz. Maternal benefits outweigh potential fetal risks.

CINo human lactation studies. Drug likely excreted into breast milk.Effects unknown. CDC recommends HIV


Demeclocycline (D)

Contraindicated in 2nd and 3rd trimester. Tetracyclines should be avoided during pregnancy because they may cause adverse effects, including yellow staining of teeth, inhibition of bone growth,

maternal liver toxicity, and congenital defects.

+Excreted into breast milk in low amounts.Remote

theoretical possibility of dental staining and inhibition of bone growth. Observe infant for changes in bowel flora, allergic reaction and use caution in interpreting

culture results with sepsis evaluation. Compatible.

Desflurane (B)

No human pregnancy studies, animal studies (none early in gestation) show no teratogenicity.

Depression can occur in infants that can last for more than 24 hours.

+ Drug excreted into breast milk 24 hours after anesthesia was not clinically significant. Compatible.

Desipramine (C)No congenital malformations reported. Withdrawal syndrome reported after use throughout pregnancy. -

Drug excreted into breast milk. Review found no data suggesting adverse effects from exposure. Effects on

infant unknown but may be of concern.

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A B C D

Desloratadine (C)

No human pregnancy studies, animal studies imply low risk. Loratadine or its major metabolite,

desloratadine are not major teratogens. May be better to use first generation antihistamines.

+No human lactation studies. Desloratadine and

loratadine are excreted into breast milk. Probably compatible.

Desmopressin (B) No adverse effects reported. + Compatible with breast feeding.

Dexamethasone (C/D if 1st trimester.)

Animal studies show a decrease in fetal head circumference, fetal adrenal gland, fetal thymus

weght, and placental weight. In human studies, an association between systemic corticosteroids and nonsydromic orofacial clefts was seen. Benefits of this therapy : decrease in incidence and severity of

RDS, decrease in incidence and mortality from intracranial hemorrhage, and increased survival of

premies. Given in premature labor to stimulate fetal lung maturation. Newborn leukocytosis seen.

+ No human lactation studies. Drug likely excreted into breast milk. Probably compatible.

Dexbrompheniramine (C)

One study showed an association with the drug and congenital malformations, another study did not. An

increase in retrolental fibroplasia is seen in premature infants if antihistamines are taken in the

last two weeks of pregnancy.

+AAP considers it compatible. One case report showed

symptoms of irritability, disturbance of sleeping pattern, excessive crying. A manufacturer feels it should

be contraindicated.

Dexchlorpheniramine (B)

Limited human pregnancy studies, animal studies do not show teratogenicity. Studies do not show an

association between the medication and congenital defects.

+No human lactation studies. Probably compatible.

Monitor for agitation, poor sleeping pattern and feeding problems.

Dexmethylphenidate (C)

No human pregnancy studies. Animal studies showed teratogenicity intwo species. Closely related

drug, methylphenidate is not a major risk to fetus. Safest course is to avoid use ,esp in 1st trimester, or

use lowest dose possible.

-No human lactation studies. Drug likely excreted into breast milk, short half-life should limit the amount.

Effects unknown. Observe nursing infant for: abdominal pain, fever, anorexia, nausea, etc.

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A B C D

Dexpanthenol (C)No human or animal studies during pregnancy. Safest course of action is to avoid drug during

pregnancy, esp 1st trimester.-

No human lactation studies. Drug likely excreted into breast milk. Risk of causing colic and diarrhea in nursing infant. Avoid breastfeeding while taking

medication.

Dexrazoxane (C)No human pregnancy studies.Animal studies show

developmental toxicity. Maternal benefit may outweigh risk to embryo/fetus.

+No human lactation studies. Drug likely excreted into

breast milk. Effects unknown. Short IV infusion decreases risk of exposure to nursing infant to

negligible amount.

Dextroamphetamine ©

Risk in human and animal studies.Medical usage does not appear teratogenic or a risk. Withdrawal can occur. Illicit use causes increase risk of :IUGR, premature birth, increase in morbidity. Cerebral

injuries can occur in utero.

-Amphetamine concentrated in breast milk. No adverse

effcts seen with amphetamines. AAP considers amphetamines as compatible.

Dextromethorphan (C) Not a major teratogen. +No human lactation studies. Drug likely excreted into

breast milk. Probably compatible- use alcohol free preparation.

DiatrizoateMay suppress fetal thyroid function when given by

intra-aminotic injection. Monitor for hypothyroidism.

+ In one study, not detected in breast milk. Probably compatible.

Diazepam (D)

Controversial if diazepam is associated with congenital malformations. (risk low) May cause

floppy infant syndrome( hypotonia, lethargy, sucking difficulties) and withdrawal syndrome. Can also

cause decreased fetal movements and loss of beat to beat variability.

-May cause infant sedation and weight loss. May

accumulate in breast-fed infants. AAP states its effects are unknown but of concern. Not recommended to

breast feed.

Diazoxide (C)

Risk in 3rd trimester.Can cause maternal hypotension. May cause transient fetal bradycardia

and hyperglycemia .Alopecia , hypertrichosis lanuginosa and a decrease in ossification of the wrist

can be seen if used in the last 19-69 days of pregnancy. Use with caution or not at all.

- No studies during human lactation.

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A B C D

Diclofenac (B, D if 3rd trimester or near delivery)

May close ductus arteriosus in utero, cause PPHN, inhibition of labor, and spontaneous abortion. NSAIDS have been associated with congenital

malformations.+

No studies during human lactation. Drugl likely excreted into breast milk. AAP considers other NSAIDs

in the same class as compatible.

Dicloxacillin (B) No congenital malformations seen. +No studies available, however, other penicillins are

excreted in low amounts in breast milk. Adverse effects rare, monitor infant for allergic reaction, changes in bowel flora and use caution in interpreting culture

results with sepsis evaluation.

Dicyclomine (B) Not teratogenic. Compatible for use during

pregnancy. - One case of apnea reported. Avoid breast feeding.

Didanosine (B)

Increased risk of congenital malformations seen with 1st trimester use. CDC recommends that

antiretrovirals be continued during pregnancy with the possible exception of the first trimester.

CINo human lactation studies. Drug likely excreted into breast milk. Effects unknown. CDC recommends HIV


DienestrolIncrease frequency of cardiovascular defects, eye

and ear anomalies, and Down's syndrome with estrogen use. Contraindicated during pregnancy.

+No adverse effects reported. Only risk is a possible decrease in nitrogen and protein content and milk

voulume.

Diethylpropion (B)No reports of congenital defects. Animal studies do

not show any teratogenicity or fetotoxicity. - Drug excreted into breast milk. No adverse effects reported.

Diethylstilbestrol(DES) X

May result in complications of reproductive system of the female, including carcinoma of cervix and vagina. Hirsutism and irregular menses may also result. Complications of the reproductive system

and genitourinary abnormalities, including neoplasms, may also occur in male offspring. An

increase in psychiatric illness (depression and anxiety) was seen in both males and females.

CINo human lactation studies. Possible decreased milk volume and decreased nitrogen and protein content

could occur.

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A B C D

Diflunisal (C, D if 3rd trimester or near delivery)

May close ductus arteriosus in utero, cause PPHN, inhibition of labor, and spontaneous abortion.

NSAIDS are associated with congenital anomalies.+ Excreted into breast milk. No human lactation studies,

probably compatible.

Digoxin (C)No congenital defects reported. Neonatal death has

resulted from maternal overdose of digitoxin. + Excreted into breast milk in small amounts. Compatible.

Digoxin Immune FAB (C)No information available as to risk to embryo/fetus, howeve rthe benefit of the treatment of maternal

digoxin overdose outweighs any potential risk.+

No human lactation studies. Drug likely excreted into breast milk in insignificant amounts. Risk is nonexistent

because amount would be digested in the GI tract.. Maternal benefits outweigh unknown risk.

Dihydroergotamine (X)

Animal studies show risk: IUGR. Few studies in 1st trimester, can not access risk of teratogenicity.Has

oxytocic and sypatholytic properties. Contraindicated.

CINo human lactation studies. Drug likely excreted in

limited amounts into breast milk. Concern for symptoms of ergotism- vomiting, diarrhea, and convulsions in nursing infants. Breast feeding is

contraindicated.

Dihydrotachysterol (A/D if above the RDA)

High doses of vitamin D teratogenic in animals but not in humans. Because vitamin D raises calcium

levels, it may be associated with supravalvular aortic stenosis syndrome, which is often associated with


+ Compatible with breastfeeding. Monitor for increased calcium levels if mother is taking pharmacologic doses.

Diltiazem (C)

Few human pregnancy studies, high risk in animal studies( increased mortality and abnormalities in

skeletal system). Questionable association with CV defects in one study. Another study showed no

increase in major congenital malformations.

+ Excreted into breast milk. Two nursing infants were not affected. Probably compatible.

Dimenhydrinate (B)

Questionable association with CV defects and inguinal hernia. No association with large categories

of major or minor fetal malformations. May have oxytocic effect. Increased risk of retrolental fibroplasia in premature infant exposed to

antihistamines during last 2 weeks in utero.


breast milk. Probably compatible. Caution- newborns and premature infants have increased sensitivity to

antihistamines.

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Dimercaprol (C)No human pregnancy studies. Animal studies imply

low risk. NO studies done in the 1st trimester. Maternal benefit outweighs unknown fetal risk.


breast milk. Effects unknown. Breast feeding is contraindicated because the metals are excreted into

the milk and are toxic.

Diphenhydramine (B)

May cause cleft palate, withdrawal. Probably safe for use in pregnancy. Increased risk of retrolental

fibroplasia in premature infant exposed to antihistamines during last 2 weeks in utero. Diphenhydramine taken concurrently with

temazepam has resulted in stillbirth; avoid this combination. Risk of toxicity in premature infants

exposed within two weeks of their birth.

+Drug excreted into breast milk in doses not high enough

to affect the nursing infant. Manufacturer states it is contraindicated because of the increase in sensitivity of

newborns to antihistamines. Probably compatible.

Diphenoxylate ( C)

Few animal studies showed no teratogenicity. No congenital abnormalites seen in one human study. Another study showed no association between the

congenital defects and the medication. -

Active metabolite likely excreted into breast milk. Potential toxicity of the metabolite and atropine. AAP

considers atropine as compatible.

Dipyridamole (B)

Few human studies, animal studies imply low risk. No congenital defects seen. Some studies have shown a

decrease in the incidence of stillbirth, IUGR, placental infarction.

+ Excreted into breast milk, effect unknown on nursing infant- probably compatible.

Disopyramide ( C)

Risk in 3rd trimester. No congenital abnormalities seen in humans or animals. Safe but not

recommended as routine therapy. Has oxytocic effects therefore not recommended in 3rd trimester.

+ Excreted into breast milk. No adverse effects seen. Compatible with breast feeding.

Disulfiram (C)Not a teratogen in animals. Not a major teratogen in humans. Of course, alcohol should not be consumed

while on this drug.- No human lactation studies. Drug likely excreted into

breast milk. Effects unknown.

Diptheria and tetanus vaccine No adverse effects. + No data available- probably compatible.

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Dobutamine (B)Few human pregnancy studies. Animal studies show low risk. Short term use in one pregnancy showed no

adverse effects.+ No studies available. probably compatible.

Docusate (calcium, potassium, sodium) (C)

No congenital malformations seen. Possible hypomagnesemia with use throughout pregnancy. + Probably compatible, monitor nursing infant for

diarrhea.

Dofetilide (C)No human pregnancy studies. Teratogenic and toxic

in animals. Maternal benefits outweigh unknown risk.


breast milk. Effects unknown.Best to avoid breastfeeding until more studies have been done.

Dolasetron (B)No human pregnancy studies. Two animal studies

showed no toxicity. Low risk if any to the fetus. + No human lactation studies. Drug likely excreted into breast milk. Effects unknown.

Domperidone (C)No human pregnancy studies, few human studies..

Severe adult dose-related toxicity. Not FDA approved for use in US.

+Drug excreted into breast milk in small amounts, no

adverse effects in nursing infants reported. AAP considere it compatible with breast feeding. Use safer

alternative, because of risk of toxicity in mother.

Donepezil (C)No human pregancy studies, animal studies imply

low risk. -No human lactation studies.. Drug and its metabolites

likely excreted into breast milk in limited amounts. Effects unknown.

Dopamine (C)

Few human pregnancy studies. Increases and decreases in uterine blood flow are seen in animal studies. In the few patients that the drug was used,

no adverse risks were seen.+ No studies available- probably compatible.

Dornase Alfa (B)No human pregnancy studies, animal studies imply low risk for developmental toxicity. Negligible risk. +

No human lactation studies. Inhaled Dornase alfa not likely excreted into breast milk. Negligible risk to

nursing infant.

Doxepin

No congenital malformations have been reported. Questionable association with polydactyly. One case

of paralytic ileus reported. One study showed IQ(significantly) and language was negatively

associated with the number of depression episodes after delivery.

-

Drug and its active metabolite excreted into breast milk. Adverse effects reported in nursing infants- drowsiness,

shallow respirations, hypotonia, poor suckling and swallowing, vomiting and hyperbilrubinemia. Avoid breast feeding. AAP considers the medication whose

effect is unknown but of concern.

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Doxapram (B)

Very little amounts would pass into the placenta. No congenital malformations seen. May cause

premature labor. Transient muscular weakness has been seen in 20% of newborns whose mothers have

myasthenia gravis.


breast milk. Potential concern to nursing infants, especially if continuous infusion. Additional concern is

preservative- 0.9% benzyl alcohol.

Doxazosin (C)No human pregnancy studies, animal studies imply

low risk. - No human lactation studies. Based on animal studies, drug expected in breast milk. Avoid breast feeding.

Doxorubicin (D)

Contraindicated in 1st trimester. Teratogenic and embryotoxic in some animal studies. Normal

pregnancies have occurred in mothers treated with this drug; however, fetal malformations have also

been reported.

CIConcentrated in milk. May cause immune suppression

and other adverse effects.AAP considers it as a medication that has the possibility of interfering with

cellular metabolism of the infant.

Doxycycline (D)



+

Excreted into breast milk in low concentrations. Theoretical dental staining and inhibition of bone

growth is remote. Observe for changes in bowel flora, allergic reactions use caution in interpreting culture

results with sepsis evaluation. AAP considers it compatible with breast feeding.

Doxylamine (A)

Probably safe in pregnancy, including 1st trimester.An increase in congenital malformations was seen, but are not felt to be secondary to the

medication. +

No human lactation studies. Drug likely excreted into breast milk. Effects unknown. Monitor for sedation

and other antihistamine actions .

Droperidol (C)Few human and animal studies imply a low risk to

infant. No adverse effects reported. +No human lactation studies. Drug likely excreted into

breast milk, limited amounts expected. Effects unknown..

Drotrecogin Alfa (C)Lack of human and animal pregnancy studies- unable

to assess risk to embryo/fetus. Potential for maternal hemorrhage.

+No human lactation studies. Based on indication for

use of drug, likelihood of breast feeding during therapy is negligible. If excretion into breast milk occurred it

would be digested by infant's GI tract.

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A B C D

Duloxetine (C, D if during 2nd or 3rd trimester.)

Drug causes developmental toxicity but no structural anomalies in animal studies. Similar medications can cause: SABs, low birth weight, prematurity, neonatal

serotonin syndrome, neonatal behavioral syndrome(withdrawal), possibly sustained abnormal neurobehavior beyond neonatal period, respiratory

distress and PPHN.

-

No human lactation studies. Drug likely excreted in limited amounts into breast milk. Effects unknown.

Long-term effects (esp on cognitive development and neurobehavior)of other similar antidepressants have

not been studied. Avoid breast feeding. AAP considers effects of antidepressants unknown but of concern.

Echinacea (C) Safety in pregnancy needs to be established. - Avoid use during breastfeeding.

Econazole (C) Not teratogenic in three animal species.Topical use

is not a risk to the human fetus. + Very little systemic absorption, exposure to nursing infant negligible. Compatible with breast feeding.

Edrophonium (C)

Very little amounts would pass into the placenta. No congenital malformations seen. May cause

premature labor. Transient muscular weakness has been seen in 20% of newborns whose mothers have

myasthenia gravis.

+No human lactation studies. Drug not likely to be

excreted, but the non-ionized drug fraction may be. Effects unknown.

Efavirenz (C)

Few human studies, animal studies, imply risk. US Dept. of Health and Human Services guidelines states

HIV-1 infected patients should continue antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential

fetal risks.

CINo human lactation studies. Drug likely excreted into breast milk. Effects unknown. CDC recommends HIV


Eletriptan (C)No human pregnancy studies, animal studies imply

risk. Actual risk to human fetus not known until more studies are done.

+ Excreted into breast milk in low concentrations, effects unknown. Compatible with breast feeding.

Emtricitabine (B)

Human and animal studies imply low risk. US Dept. of Health and Human Services guidelines states HIV-1

infected patients should continue use of antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential

fetal risks.



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A B C D

Enalapril (C 1st tri, D 2nd,3rd tri)

Risk in 2nd and 3rd trimester. Teratogenic : renal defects and hypocalvaria. Can also see: IUGR, fetal

hypotension, limb contractures, anuria in the newborn, oligohydramnios and death. Monitor renal

function and blood pressure in the newborn.

+Drug excreted into breast milk in such small amounts,

that the risk is insignificant. AAP considers it compatible with breast feeding.

Encainide (B)Not teratogenic in animals or few human studies.

Maternal benefit exceeds fetal risk. +Drug and its active metabolites are excreted into breast

milk, at levels comparable to maternal levels.Effects unknown, prob compatible.

Enflurane (B)

Teratogenic in mice. No studies done in 1st trimester in humans. Halothane, another halogenated

inhalation anesthetic, has not shown teratogenicity. Can cause depression in newborn for 24 hours or

more.

+Drug likely excreted into breast milk,Effects unknown

but risk is low. AAP considers halothane, another halogenated inhalation anesthetic, as compatible with

breast feeding.

Enfuvirtide (B)

Human and animal studies imply low risk to developing fetus. US Dept. of Health and Human Services guidelines states HIV-1 infected patients should continue use of antiviral therapy during


CINo human lactation studies. Drug ,not likely, but may

be excreted into breast milk. Effect unknown. CDC recommends HIV infected mothers in developed


Enoxacin (C)

Use with caution in 1st trimester. Other medications in this class may cause birth defects. Fetal cartilage

damage and arthropathies have been seen in animal studies and some human case reports. Consider

using safer agent as alternative.


breast milk. Effects unknown. Questionable risk of arthropathy and other toxicity when drug first released. AAP considers other fluoroquinolones(Ciprofloxacin and

Ofloxacin) compatible with breast feeding.

Enoxaparin (B)Not teratogenic or embryotoxic in animals. Because of relatively high molecular weight, not expected to

cross placenta to fetus.+

No human lactation studies. Drug unlikely excreted into breast milk based on high molecular weight and GI

inactivation.Risk to infant insignificant.

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Entecavir (C)No human pregnancy studies, animal studies imply low risk. Because of severity of Hepatitis B disease,

therapy should not be withheld.

CI w/ HIV and + w/

Hepatitis B

No human lactation studies. Drug likely excreted into breast milk. Effects unknown. Infants of HBs-Ag-

positive or HBeAG-positive mothers should receive HBIG at birth and Hepatitis B vaccine soon after birth.

Then breast feeding is permitted. Breast feeding is contraindicated in HIV-1 positive mothers.

Ephedrine (C)

Teratogenic in some animals. Minor fetal malformations( clubfoot, inguinal hernia and others)

may be associated with use during first trimester. May cause fetal tachycardia and increase in beat to

beat variability.

-Few human lactation studies.. Observe nursing infant for irritability, excessive crying and disturbed sleeping

patterns. Avoid breast feeding is recommended.

Epinephrine (C)

May cause fetal malformations with first-trimester use and inguinal hernia with use any time during

pregnancy. May cause decreased uterine blood flow. Epinephrine given to mom for hypotension secondary to an allergic reaction may have

contributed to the infants death at 34 weeks( possible intrauterine anoxia and intracranial

hemorrhage).

- No studies available.

Epirubicin (D)Antineoplastic agent. Contraindicated.Transient

leukopenia, stillbirth and death in a newborn. CINo human lactation studies, drug likely excreted into breast milk. Risk for toxicity: immunosuppression,

carcinogenesis, neutropenia, and unknown effects on growth. Breast feeding is contraindicated.

Epoetin Alfa (C)

No major risk to fetus, but experience limited.Abruptio placentae at 23 weeks with fetal

death. Thrombosis is a complication for mother on treatment.

+ No human lactation studies, excretion in breast milk not likely. No risk to nursing infant expected.

Epoprostenol (B)

Not teratogenic in animals, few human studies. Transplacental passage of this drug is unlikely.

Benefits of this drug in treating maternal pulmonary hypertension appear to outweigh potential risks to

fetus.

+No human lactation studies. Amount in breast milk

probably insignificant based on its rapid breakdown in the gut.

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Eprosartan (C 1st tri, D 2nd,3rd tri)

No human pregnancy studies.. Teratogenicity and fetal and neonatal toxicity may be seen in 2nd and 3rd trimester. Can see anuria, hypocalvaria, IUGR, prematurity, PDA, and oligohydramnios. Monitor

newborn renal funtion and blood pressure.

+No human lactation studies available. Srug likely excreted into breast milk, effects unknown. AAP

considers ACE inhibitors, a similar class of agents, compatible with breast feeding.

Ergotamine (X)

Small amounts of medication are not teratogenic. Larger doses, or more frequent doses, can cause fetal

toxicity and teratogenicity.Use during 1st trimester was associated with an increase in major birth

defects.May cause intrauterine fetal death from drug-induced increase in uterine motility and placental vasoconstriction. The combination of ergotamine,

caffeine, and propranolol potentiates vasoconstriction. Can cause fetal distress.

CICauses vomiting, diarrhea, and convulsions. May hinder

lactation. Breast feeding is contraindicated.AAP considers it to be associated with significant adverse

effects and should be used with caution.

Erlotinib (D)No human pregnancy studies, animal studies imply risk. Manufacturer recommends avoid pregnancy

and for 2 weeks after treatment completed.-

No human lactation studies, drug likely excreted into breast milk but inlimited amounts.. Effects unknown,

but risk for toxicity exists- Avoid breast feeding.

Ertapenem (B)No human pregnancy studies, no teratogenticity in animal studies. No reports of B-lactam antibiotics

causing developemental toxicity.+

Drug excreted into breast milk in low concentrations. Effects unknown but not significant. Observe infant for

changes in bowel flora, allergic reaction and use caution in interpreting culture results with sepsis


Erythromycin (B)No reports of congenital malformations. Avoid the

esolate salt of erythromycin: can induce hepatotoxicity in pregnant patients.

+Excreted into breast milk in low concentrations. No adverse effects seen. Observe for changes in bowel

flora, allergic reaction and use caution in interpreting culture results with sepsis evaluation. Compatible.

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Escitalopram (C,D if taken in 2nd or 3rd trimester.)

Risk in 3rd trimester. Few human studies, animal studies imply low risk. Drugs in this class have been

associated : SABs, low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral


distress, and PPHN.

-

No human lactation studies. Drug likely excreted into breast milk, effects unknown. Adverse effects have

been seen with similar agent- Citalopram- expect similar effects. Closely monitor nursing infants. AAP considers other SSRIs as drugs for which effect on nursing infants

unknown but may be of concern.

Esmolol (C)

May decrease uterine blood flow, resulting in fetal hypoxia. Bradycardia, hypoglycemia, poor feeding, and hypotonia may occur. B Blockade in fetus and

infant.+

No human lactation studies. Indication and route of administration of drug suggest that breast feeding

during therapy would not occur.

Esomeprazole (B)

No human pregnancy studies. Animal and human pregnancy studies with omeprazole imply low risk.

Until more studies available- suggest use of omeprazole.

-

No human lactation studies. Drug likely excreted into breast milk, effects unknown. Risk of toxicity:

headache, diarrhea and abdominal pain, suppression of gastric acid secretion . Waiting 5-7.5 hours after dose and emptying both breasts, should eliminate 97% of

drug from plasma.

Estazolam (X)

No human pregnancy studies. Effects similar to other benzodiazepines. Use near delivery- potential

for motor depression and withdrawa in the newborn.


breast milk, effects unknown. Effects on CNS are unknown. AAP consideres quazepam and temazepam, similar agents, as those whose effects are unknown and

may be of concern.

Estradiol (X)

Estrogenic hormones contraindicated during pregnancy. In utero exposure may cause developmental changes in psychosexual

performance of boys, less heterosexual experience, and fewer masculine interests.

+Less than 10% of vaginal dose of 50 or 100 mg appeared in breast milk. AAP considers it compatible with breast

feeding.

Estrogens, Conjugated (X)

Estrogenic hormones contraindicated during pregnancy. May cause fetal malformations(increase

in Downs syndrome, CV defects and eye and ear abnormalities).

+ No adverse effects in nursing infants reported. May decrease milk volume, nitrogen and protein content.

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Estrone (X)Estrogenic hormones contraindicated during pregnancy. May cause fetal malformations. + No adverse effects in nursing infants reported. May

decrease milk volume, nitrogen and protein content.

Etanercept (B)Few human pregnancy studies- no evidence of

embryo/fetal harm. Some suggest avoid use during pregnancy- anticytokine activity theoretical concern.

+No human lactation studies. Effects unknown, but

medication would probably be digested by infants' GI tract and not absorbed.

Ethacrynic Acid (B, D if used in gestational hypertension)

IUGR seen in one animal study.May decrease placental perfusion and may cause ototoxicity im

mother and newborn. Not recommended for use in pregnancy.

+ No human lactation studies, manufacturer recommends that ethacrynic acid not be used if breast feeding.

Ethambutol (B)No abnormalities reported.Concern for long term

ocular damage. + Excreted into breast milk. AAP considers it compatible with breast feeding.

Ethanol (D/X if excessive amounts and for long periods)

Teratogen, use during 1st two months after conception associated with significant risk of fetal

alcohol syndrome. Moderate use can cause behavior and developmental dysfunction in the infant.

Abstinence recommended as safest action during pregnancy.

-

Drug excreted into breast milk in levels similar to those in maternal serum. Because of risk of toxicity in nursing infant, safest course is to hold breast feeding for 1 to 2 hous for each ounce of alcohol consumed.Long term

exposure to alcohol in breast milk had an adverse effect on psychomotor development of the infants. Best to

restrict alcohol intake to a max of 0.5g/kg per day.

Ethinyl Estradiol (X)

Increase in congenital malformation when used in 1st trimester.Estrogenic hormones contraindicated

during pregnancy. In utero exposure may cause developmental changes in psychosexual

performance of boys, less heterosexual experience, and fewer masculine interests.

+Drug excreted into breast milk in small amounts. May decrease milk volume, nitrogen and protein content.

Choose lowest dose of contraception. Follow weight in infant..

Ethosuximide (C)

May cause congenital anomalies( PDA, cleft lip and or palate, short neck, altered palmar crease and

accessory nipple, hydrocephalus, mongoloid facies and spontaneous hemorrhage in a neonate.

+ Drug excreted into breast milk. No adverse effects seen. AAP considers it compatible.

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Etidronate (C)

Limited human studies, low risk in animal studies.Drug retained in bone and eventually

released back into systemic circulation. Use in women who may become pregnancy or during

pregnancy is not recommended.One case report revealed the infant had rickets, pathologic fractures

and bone demineralization. One case report of spontaneous hemorrhage in the neonate.

+No human lactation studies, drug excreted into breast

milk in small amounts. Risk to nursing infant is unknown but thought to be insignificant..

Etodolac (C,D if 3rd trimester or near delivery)

Risk in 1st or 3rd trimester. May close ductus arteriosus in utero, cause PPHN, inhibition of labor,

and spontaneous abortion. NSAIDS have been associated with congenital malformations.

-No human lactation studies. Drug likely excreted into breast milk.. Other NSAIDS( diclofenac, fenoprofen, flurbiprofen, ibuprofen, ketoprofen, ketorolac and

tolmetin) considered safer.

Etoposide (D)

Teratogenic in animals and suspected teratogen in humans. Growth retardation(5 infants) , severe

myelosuppression(3 infants) and alopecia(1infant) occured . No studies during organogenesis. IUGR,

anemia, leukopenia with neutropenia, oligohydramnios, senorineural hearing loss at one

year of age.

CIExcreted into breast milk. Potential for risk: bone

marrow depression, alopecia, carcinogenicity. Stop breast feeding for at least 55 hours after last dose.

Etretinate (X)

Contraindicated. Muliple malformations can be seen: facial dysmorphia, low set ears, high palate, decrease

in cranial volume, alterations of cervical vertebrae, and skull, syndactylies, meningomyelocele, multiple

synostoses, malformations of hip, forearm and ankle, and meningoencephalocele. Caused pronounced

jaundice in an infant.

-Excretion into breast milk is unknown. Manufacturer states breast feeding contraindicated due to potential

risks..

Evening primrose oil (C)

Few human pregnancy studies. Used for labor induction-. No adverse effects seen. (prob

compatible) Use during pregnancy has no studies and risk unknown. Some recommend avoid use in

pregnancy.

+ No adverse effects reported.

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Exenatide (C)No human pregnancy studies, few animal studies

imply moderate risk( structural anomalies and neonatal death). Avoid use during pregnancy.


breast milk, but will probably be digested in GI tract so risk will be negligible.

Ezetimibe (C)

No human pregnancy studies, animal studies imply low risk. If treament required ezetimibe is better choice than either a HMG-CoA reductase inhibitor

which are contraindicated or fenofibrate.-

No human lactation studies. Drug likely excreted into breast milk but in low amounts. Effects unknown.

Observe infant for -headache, diarrhea, pharyngitis, sinusitis, arthralgia.

Famciclovir (B)Few human pregnancy studies, animal studies imply carginogenicity risk but no risk for embryo toxicity or

teratogenicity. Considered low risk in animals.-

No human lactation studies. Drug likely excreted into breast milk. Risk for toxicity: tumorigenicity in animal

studies. Avoid breast feeding.

Famotidine (B)Few human pregnancy studies, low risk in animal studies. No adverse effects reported, but studies

limited.+

Drug excreted into breast milk,effects unknown. Potential risk for adverse effects, however, AAP

considers cimetidine as compatible with breast feeding. Famotidine may be preferred because of less amount

found in breast milk.

Felbamate (C)

Few human pregnancy studies.Risk in animal studies. Not teratogenic in rats or rabbits. Serious adult

toxicity- fatal cases of aplastic anemia and acute liver failure reported.

-Drug excreted into breast milk, no studies on effects on infants. Risk of toxicity: aplastic anemia and liver failure.

Avoid or use with caution.

Felodipine (C)

Limited human studies, teratogenic in rabbits. Compared with controls, no increase in the risk of major congenital malformations was found in 78

women exposed to calcium channel blockers in the first trimester. Low birth weights seen but were not

felt to be secondary to felodipine.

+ No human lactation studies. Drug likely excreted into breast milk.

Fenofibrate (C)No human pregnancy studies. Best to avoid because

of risk in animal studies. -No human lactation studies. Drug likely excreted into

breast milk. Effects unknown. Avoid breastfeeding because it was carcinogenic in rats..

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A B C D

Fenoprofen (B/D if used in 3rd trimester or near delivery)

Risk in 1st and 3rd trimester. NSAIDS may cause congenital malformations. May cause constriction of

ductus arteriosus in utero, PPHN, and inhibition of labor.

+Drug excreted into breast milk in small amounts. Effects

unknown. AAP considers another NSAID in the same subclass as compatible with breast feeding.

Fentanyl (C, D if used for long term or at high doses near term)

Risk in 3rd trimester. No malformations reported in human studies. Embryotoxic in one animal study. May cause respiratory depression and withdrawal

syndrome.Loss of fetal heart variability.+

Drug excreted into breast milk with low colostrum concentrations and low oral bioavailability. AAP

considers it compatible with breast feeding.

Ferrous sulfate (A) No adverse effects. + Compatible. Reports state that with supplementation approximately 0.25 mg/day excreted into breast milk.

Fexofenadine (C)

No human pregnancy studies. Animal studies imply risk and toxicity. Consider 1st generation

antihistamine use during pregnancy. Cetirizine or loratadine are also acceptable.

+ Drug excreted into breast milk, effects unknown. AAP considers it compatible.

Filgrastim (C)

Human and animal studies do not show major risk or congenital malformations. In 2nd and 3rd

trimesters, crosses human placenta in amounts to produce biological effect on fetus.


breast milk but then probably digested by GI tract. Risk to nursing infant will be very low.

Flecainide (C)

Risk in animal studies. No congenital defects reported. May cause hyperbilirubinemia. Several

publications report successful use of flecainide for treatment of fetal tachycardia. Can see loss of fetal

heart rate variability and accelerations.

+Drug excreted into breast milk, effects unknown.

Probably not toxic and AAP considers it compatible with breast feeding.

Fluconazole (C)

Few human studies. Continuous first trimester doses of 400 mg/day or more may be teratogenic(

congenital malformation is similar to Antley Bixler syndrome). Low doses appear to be safe.

+ Excreted into breast milk, no toxicity has been reported. AAP considers it compatible with breast feeding.

Flucytosine (C)Contraindicated in 1st trimester. No defects

reported, although its metabolite (fluorouracil) may produce fetal malformations.

- No human lactation studies. Because of potential serious risks , breast feeding should be avoided.

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A B C D

Flumazenil (C)Few human studies, animal studies imply low risk.

Maternal benefit outweighs embryo/fetal risk. +No human lactation studies. Drug excreted into breast

milk in small amounts. Do not breast feed for a few hours after last dose because of adverse effects seen in

adults.:g fatigue, nausea/vomiting, agitation and cutaneous vasodilation..

Flunisolide inhaler (C)

Few human studies,risk in animal studies. Systemic corticosteriods have a risk for nonsyndromic oral

clefts if used in 1st trimester. Fetal growth retardation occurs if they are used long term and

later in pregnancy. Beclomethasone or budesonide are the preferred inhaled steriods of choice during

pregnancy.

+Excreted into breast milk in low amounts, effects on nursing infants unknown. Compatible with breast

feeding.

Fluocinolone (C)

Few human studies, risk in animal studies. Systemic corticosteroids can cause growth restriction and

structural anomalies in animals and humans. Use a less potent agent if require long term therapy.

-No human lactation studies.. Drug likely excreted into breast milk if it reaches systemic circulation.. Amount absorbed from topical administration is unknown. For

long term topical therapy , use a less potent agent.

Fluorouracil (D/X according to manufacturer)

Avoid in 1st trimester. May cause fetal malformations (first-trimester use), cyanosis and jerking extremities (third-trimester use), and low

birth weight (used any time during pregnancy).Also transient leukopenia, IUGR, death seen.

CI No human lactation studies. Drug likely excreted into breast milk.Contraindicated because of risk of toxicity..

Fluoxetine (C, D if taken 2nd or 3rd trimester.)

Human and animal studies show that fluoxetine is not a major teratogen but minor anomalies were seen and a small increase in some birth defects.

Changes in the fetal brain were seen in one animal study. SSRI are associated with: low birth weight,

prematurity, withdrawal, respriatory distress, PPHN, neonatal serotonin syndrome, possible abnormal

neurobehavior later on.

-

Long term studies have not been done on neurobehavior and development. Manufacturer does

not recommend breast feeding. AAP considers its effect unknown but may be of concern. Maternal benefits

may outweigh risks to nursing infant if treating postpartum depression. Reduced weight gain seen.

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A B C D

Fluoxymesterone (X)Fluoxymesterone is contraindicated during pregnancy. May cause nonadrenal female

pseudohermaphroditism.CI No human lactation studies. Inhibits lactation and use

is contraindicated .

Fluphenazine (C)

Risk in 3rd trimester. Extrapyramidal effects; possible congenital malformations in 2 infants. Can see upper respiratory distress and rhinorrhea, difficulty feeding

and vomiting, choreoathetoid movements and arching of the body.

-No human lactation studies. Phenothiazines are

excreted into breast milk, therefore the drug is likely excreted into breast milk. AAP considers the effects of

other antipsychotic phenothiazine agents unknown but may be of concern.

Flurazepam (X)

Drug and active metabolite crosses placenta. Sleepiness, drowsiness and lethargy if given preceding delivery. No congenital anomalies

reported; however, other mdeidcations in this class may cause fetal abnormalities.Questionable

association of seizures in an infant.

-No human lactation studies. Drug and long acting active

metabolite likely excreted into breast milk. AAP considers other benzodiazepines as agents whose

effects are unknown but may be of concern.

Flurbiprofen (B, D if used in 3rd trimester or near delivery)

Risk in 1st and 3rd trimester. May close ductus arteriosus in utero, cause PPHN, inhibition of labor, fetal renal function suppression and spontaneous

abortion. NSAIDS have been associated with congenital malformations.

+Drug excreted into breast milk in small amounts and

pose very little if any risk to nursing infant. AAP considers another NSAID in the same subclass as

compatible with breast feeding.

Fluticasone inhaler (C)No human pregnancy studies.High risk in animal

studies. Beclomethasone or budesonide are the drug of choice during pregnancy.

+No human lactation studies, low concentrations following inhalation and poor oral bioavailability

suggest that clinically significant amounts of drug would not be available to breast feeding infants.

Fluvastatin (X)Contraindicated, cholesterol and cholesterol products are important in fetal development CI No human lactation studies. Excreted into breast milk.

Contraindicated because of potential risks.

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nm

Not a major teratogen in few animal and human studies. Drugs in this class have been associated

with - SABs, low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral


distress, and PPHN.

-

Excreted into breast milk. Best to limit frequency, do not nurse 4 hours after dose ( peak maternal

concentration)or stop breastfeeding. The long term effects( esp on neurobehavior) of this drug are

unknown. AAP considers other SSRIs as drugs for which effect is unknown but may be of concern.

Folic Acid (A/C if above RDA)

Folate deficiency may result in fetal anomalies(neural tube defects most common),

abortions, placenta previa, low birth weight, premature delivery, placental abruption.

+Excreted into breast milk. No adverse effects reported

in nursing infants. AAP considers it compatible with breast feeding.

Fomepizole ( C)One human pregnancy case reported. Maternal benefits outweigh fetal risk which is unknown. -

No human lactation studies. Drug likely excreted into breast milk.Effects unknown. Headache, dizziness and bad/metallic taste seen in adults. Hold breast feeding

for at least 24 hours after last dose.

Fondaparinux (B)Few human pregnancy studies, low risk in animal

studies. Studies reveal that the drug does not croos the placenta therefore risk to fetus low.


breast milk. Effects unknown but not thought to be significant..

Formoterol (C)

Few human studies, low risk in animal studies. Mayy cause premature births, inhibition of uterine

contraction and labor, maternal hyperglycemia resulting in newborn hypoglycemia and maternal pulmonary edema. Albuterol or salmeterol are better choices- more safety data during human

pregnancy.

+No human lactation studies, Drug likely excreted into

breast milk in minimal amounts. AAP considers terbutaline (another beta-adrenergic agonist) as

compatible with breast feeding. Probably compatible.

Fosamprenavir (C)

Few human studies, low risk in animals. Antiretroviral therapy should continue during

pregnancy with the exception of efavirenz. Maternal benefit outweighs fetal risk. Monitor for

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Foscarnet (C)Renal toxicity seen in adults.Observe for fetal renal

toxicity by monitoring amniotic fluid volume. CINo human lactation studies. Drug likely excreted into

breast milk.Contraindicated because of possible toxicity risk in infant.

Fosfomycin (B)Not teratogenic in animal studies.Studies in human

pregnancy low risk. +No human lactation studies. Drug likely excreted into breast milk-Effects unknown. Observe for changes in

bowel flora in infant.

Fosinopril (C 1st tri, D 2nd,3rd tri)Risk in 2nd and 3rd trimester. Renal defects,

hypocalvaria, IUGR, hypotension and premature birth can be seen.

+No human lactation studies. Drug excreted into breast

milk, effects unknown. AAP considers two similar medications- captopril and enalapril as compatible with

breast feeding.

Frovatriptan (C)No human pregnancy studies, animal studies imply

low risk. + No human lactation studies. Drug likely excreted into breast milk. Effects unknown.

Furazolidone (C)No congenital defects reported. Could cause

hemolytic anemia in G6PD-deficient infant if given at term.


Furosemide (C, D if used in gestational hypertension)

Questionable association with hypospadius. Generally not indicated in pregnancy except in

patients with cardiovascular disorders.+ Excreted into breast milk. No adverse effects.

Gabapentin (C)

Few human studies, animal studies imply risk.Possiible developmental toxicity. Jaundice and

intermittent tremors in an infant.Jaundice and intermittent tremors seen in infant for 5 days after

birth.

+ No human studies- probably compatible. Drug likely excreted into breast milk but effect unknown.

Gadopentetate dimeglumine (MRI contrast) (C)

Few human studies, animal studies imply risk. + Drug excreted into breast milk and little absorbed. AAP considers it compatible with breast feeding.

Ganciclovir (C)

Toxic effects in animals. Potential for fetal toxicity. Reserve use for CMV retinitis or prevention of CMV

disease in immunocompromised patients or in solid organ transplant recepients.

- No human lactation studies- potential risks. Avoid breast feeding.

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Gefitinib (D)Few human pregnancy studies, animal studies imply

risk( restriction of growth and death). Avoid pregnancy if taking this drug.

-No human lactation studies. Drub likely excreted into breast milk. Effects unknown. Adverse effects seen in

adults: diarrhea, rash, acne, dry skin, nausea and vomiting. Avoid use during breast feeding.

Gemifloxacin (C)No human pregnancy studies, growth retardation

occurred in animal fetuses, avoid use during pregnancy, other safer antibiotics available.

+No human lactation data available, probably excreted

into breast milk. Effects on nursing infants are unknown. AAP classifies as compatible with breast

feeding.

Gemtuzumab Ozogamicin (D)No human pregnancy studies, animal studies imply risk. Safest course is to avoid use during pregnancy. -

No human lactation studies.. Immunosuppression and other severe adverse effects are potential risks. Breast

feeding should be avoided.

Gentamicin (C)

One congenital defect reported ( mother also on prednisolone): renal cystic dysplasia. Potentiation of

magnesium sulfateinduced neuromuscular weakness. Monitor infant for ototoxicity because this

has occurred with other aminoglycosides (eg, kanamycin and streptomycin).

+Drug is excreted into breast milk in small amount.

Observe for bloody stools and diarrhea. AAP considers it compatible with breast feeding.

Ginkgo Biloba (C)No human pregnancy studies done. Few animal

studies. Controversial recommendations. Best to avoid.

-No human lactation studies. Herbal product which is not standardized and may contain other compounds.

Safest course is to avoid breast feeding.

Ginseng (B)

Herbal product, limited human and animal pregnancy studies. Little or no quality control in

production of products. Ginseng acts on multiple organ systems. Hypertension and hypoglycemia

have been reported. Safest course is to avoid during pregnancy.

-No human lactation studies. Herbal product which is not standardized and may contain other compounds.

Safest course is to avoid breast feeding.

Glimepiride (C)No studies of use during human pregnancy, Insulin is treatment of choice for diabetes during pregnancy-

provides better glucose control. +

No human lacatation studies.Drug likely excreted into breast milk. Risk of neonatal hypoglycemia. Breast

feeding women should consider insulin.

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Glipizide (C)

Few human pregnancy studies. Insulin is treatment of choice for diabetes during pregnancy- provides better glucose control. Risk of prolonged neonatal

hypoglycemia with glipizide. If used during pregnancy, discontinue prior to delivery

+ Minimal to nondetectable levels in breast milk. Normal glucose levels in nursing infants.

Glucagon (B) Few human and animal studies suggest risk is low. +No human lactation studies. If any drug excreted into breast milk, it would be digested by infant's GI tract.

Risk appears low.

Glucosamine (C)Few human and animal studies . Questionable

studies tha suggest glucose metabolism might be altered.

+No human lactation studies. Little if any drug likely

excreted into breast milk. Probably compatible.

Glyburide ( C)

May cause neonatal hypoglycemia. Insulin is drug of choice for treating diabetes during pregnancy.

Hypoglycemia, hyperbilirubinemia and polycythemia seen in infants.

+ Nondetectable levels in breast milk. Normal glucose levels in nursing infants. Probably compatible.

Glycerin (C) No studies available. + No studies available. Probably compatible.

Glycopyrrolate (B)Questionable association between medication and

minor fetal malformations. + No studies available. Probably compatible.See Atropine

Gold Thiomalate (C)Few human studies, low risk in animals. Long term

follow up required. +Gold excreted and absorption into breast milk has been documented. Possible risk but not proven. One group does not recommend breast feeding. AAP considers it

compatible.

Granisetron (B) Low risk in animals, no human studies. + No human lactation studies.Drug likely excreted into breast milk.

Griseofulvin ©

Few human studies, and risk in animal studies. Medication is tumorigenic, embryotoxic, and teratogenic in some animal species. Possible

association with conjoined twins.-

No human lactation studies. Potential of tumorigenicity and potential for toxicity in nursing infant. Avoid use

during breast feeding.

Guaifenesin (C)Compatible, one study reported an increase in

inguinal hernias. Another study did not show an association between this and congenital defects.

+ No human lactation studies, probably compatible.

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Haemophilus b Conjugate Vaccine (C) No adverse effects reported. + Compatible with breastfeeding.

Haloperidol (C)Avoid in 1st trimester. Limb defects in 3 studies. Tardive dyskinesia can occur if exposure during

pregnancy.-

Excreted into breast milk. Use may be of concern. Effects on infant unknown. Infants showed a decrease

in psychomotor and mental development.

Halothane (B)Few human studies and animal studies imply low

risk. Anesthetic agents can cause depression in the newborn that may last for 24 hours or more.

+ Excreted into breast milk, amounts negligible. AAP considers it compatible with breast feeding.

Heparin (C)Possible association with cardiovascular defects and

other malformations. Heparin preferred over oral anticoagulants during pregnancy.

+ Not excreted into breast milk.

Hepatitis A Vaccine (C) Inactivated vaccine, compatible. + No studies during human lactation, probably compatible.

Hepatitis B Vaccine (C)No adverse effects reported. Recommended after 1st

trimester. + No studies during human lactation, probably compatible.

Heroin (B/D if prolonged therapy or high doses near term)

Risk in 3rd trimester. May cause significant increase in congenital malformations, jaundice, RDS, low APGAR scores, withdrawal, low birth weight, and increased perinatal mortality. Long term effects

include lower height, and weight, impaired organizational perceptual and behavioral abilities.

CI Crosses into breast milk and can cause addition in nursing infant. Breast feeding is contraindicated.

Homatropine (C)For anytime use there was an association with

congenital defects. Possible association with minor malformations.

+ Probably compatible with breast feeding.(See Atropine)

Human Papillomavirus Vaccine (B)Limited studies of use during human pregnancy, no

toxicity reported. ACOG states to avoid it during pregnancy.

+Compatible with breastfeeding. Ons study found the

infants to have more acute respiratory illnesses in the mothers who had the vaccine within 30 days.

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A B C D

Hydralazine (C)

Risk in 3rd trimester. No congenital abnormalities reported. Bleeding and thrombocyopenia in a neonate, fetal distress, fetal premature atrial

contractions,lupus like syndrome.+ Excreted into breast milk. No adverse effects noted.

AAP considers its compatible with breast feeding.

Hydrochlorothiazide (B)

Thiazide-related diuretics are not teratogenic. If taken by women with cardiovascular disorders, an

increased risk of defects was noted. May also cause hypoglycemia, thrombocytopenia, hyponatremia, hypokalemia, and death. May inhibit labor. Use in pregnancy only if required for patients with heart

disease. Monitor infant’s electrolytes, platelet count, and serum glucose carefully after birth.

+May suppress lactation. Thrombocytopenia may occur if

mother taking chlorothiazide. AAP considers it compatible.

Hydrocodone (C/D if prolonged or high doses near term)

Possible association with congenital malformations ( Cardiovascular defects) seen in first trimester.

Respiratory depression or withdrawal syndrome may occur.

+No human lactation studies. Drug likely excreted into breast milk. Observe nursing infant for GI problems,

sedation and changes in feeding patterns.

Hydrocortisone (C/D if 1st trimester.)

Risk to fetus low , animal studies showed risk: cataracts, IUGR, polycystic kidney disease, and cleft palate . In humans, decrease in BW and increase in

cleft lip with or withurt palate and cataracts are seen. Maternal benefit may ourweith fetal risk in certain

cases..

+ No human lactation studies . Risk is thought to be low. Compatible with breast feeding.

Hydromorphone (B/D if prolonged therapy or high doses near delivery)

No malformations reported; however, Withdrawal in infant could occur if mother was on prolonged

therapy.Respiratory depression can occur at delivery.+ Excreted into breast milk. Effects on nursing infant

unknown.

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A B C D

Hydroxychloroquine (C)

. Probably not a significant risk to fetus, especially at lower doses. CDC states that it may be used for malaria prophylaxis because not shown to be

harmful at prophylactic doses (400 mg/week).Higher doses may produce fetal risk but unknown.

+

Excreted into breast milk in small amounts. Breast feeding should be done with caution. Once weekly

doses, significantly reduced amount of drug exposure. ant. AAP considersas compatible with breast feeding.

Amount in breast milk is not adequate to provide malaria protection for infant.

Hydroxyurea (D)Animal studies revealed teratogenicity, in 13 human pregnancies there were no fetal anomalies. Studies too few to evaluate safety of use during pregnancy.

CI Excreted into breast milk. Contraindicated because of potential for adverse risks.

Hydroxyzine (C)

Animal studies show structural anomalies and death,human studies reveal low risk. One study saw

an increase in oral clefts. Can cause decrease in platelet aggregation and decrease in fetal heart rate

variability. If used near term, withdrawal and seizures can occur in infant.


Hyperalimentation, parenteral ( C)

compatible, Important to try to prevent maternal complications: report of cardiac tamponade with

resultant death in mother and infant, one stillborn at 22 weeks.

+ Compatible with breastfeeding.

Ibandronate (C)

No human pregnancy studies, animal studies imply moderate risk. Avoid use in women who may

become pregnant or during pregnancy.Skeletal problems and other abnormalities can occur.

Monitor infant for hypocalcemia.


breast milk amount absorbed prob insignificant. Probably compatible with breast feeding.

Ibritumomab (D)

No human or animal pregnancy studies. Avoid use during pregnancy.Immunosuppression can occur

and radioactive components can cause harm to the fetus.

CINo human lactation studies. Immunosuppression and

radiation effects are risks. Breast feeding contraindicated.

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Ibuprofen (B, D if used in 3rd trimester or near delivery)

No congenital anomalies reported. May cause closing of ductus arteriosus in utero, PPHN,

oligohydramnios, low normal to decreased amniotic fluid volume and inhibition of labor. NSAIDS have been associated with oral clefts, gastroschisis and

cardiac defects.

+ Excreted into breast milk in minial amounts. AAP considers it compatible with breast feeding.

Ibutilide (C)No human pregnancy studies, animal studies imply

risk. Benefit of treatment of maternal condition may outweigh fetal risk. Treatment course is short term.

+ No human lactation studies. Based on animal studies, a nursing infant would absorb the medication minimally..

Idarubicin (D)

Limited human studies, risk in animals.Can see: IUGR, hyperbilrubinemia, fetal death, diffuse cardiomyopathy of both ventricles and

interverntricular septum. Acute heart failure and cardiomyopathy reported in premature newborn.


breast milk. Because of potential risk of immunosuppression and carcinogenesis, breast feeding

is contraindicated.

Ifosfamide (D)

High risk of teratogenicity and fetal toxicity.Contraindicated in 1st trimester. IUGR, anhydramnios,acute fetal hypoxia, fetal growth

cessation and eventual neonatal death. Contraindicated in 1st trimester.


breast milk. Because of potential for adverse risks: bone marrow depression, urinary and CNS toxicity,

breast feeding is contraindicated.

Imatinib (D)

Limited human studies, toxicity in animals. Anomalies in human cases: congenital hear defect,

pyloric stenosis, meningocele, hypospadias, and hydrocephalus.. Avoid during pregnancy. Women of

childbearing age undergoing treatment should use effective contraception.

CI No human lactation studies. Drug likely excreted into breast milk. Contraindicated because of risk of toxicity.

Imipenem-Cilastatin (C)No studies in humans during 1st trimester. Considered safe during perinatal period. + Drug excreted into breast milk in small amounts.

Effects on infant are unknown.

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A B C D

Imipramine (C)May cause fetal malformations(possible association with cardiovascular defect), withdrawal syndrome,

and urinary retention.- Excreted into breast milk. Use may be of concern.

Effects on infant unknown.

Imiquimod (C)Few human studies, animal studies imply risk is low.

However, more studies needed befor it can be recommended for use during pregnancy.


breast milk inlow concentrations and probably not significant. Risk unknown, compatible with breast

feeding.

Immune globulin No adverse effects reported. + No studies available, probably compatible.

Immune globulin, hepatitis B (C) No adverse effects reported. + No studies available, probably compatible.

Immune globulin, tetanus (C) No adverse effects reported. + No studies available, probably compatible.

Immune globulin, varicella zoster (C)No adverse effects reported.Unknown if this will

protect the fetus from congenital varicella syndrome. + No studies available, probably compatible.

Indapamide (B,D if gestational hypertension)

Few human studies, low risk in animals(growth retardation in rats). Not recommended for

gestational diabetes because of risk of maternal hypovolemia.

+ No human lactation studies. May suppress lactation.

Indinavir (C)

Few human studies however, animal studies show birth defects and cause concern. US Dept. of Health and Human Services guidelines states HIV-1 infected

patients should continue use of antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential fetal risks.

CINo human lactation studies. Drug likely excreted into breast milk. Effect on nursing infant is unknown. CDC

recommends HIV infected mothers in developed countries do not breastfeed.

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A B C D

Indomethacin (B/D if used for greater than 48 hours or after 34 weeks gestation)

Risk in 1st and 3rd trimester. May cause delayed labor, premature closure of ductus arteriosus, PPHN,

decrease in fetal urine output, unilateral pleural effusion, periventricular leukomalacia, IVH, impaired

renal function, renal failure, intestinal perforation and death.Indomethacin with B blockers can cause maternal hypertension with fetal distress. NSAIDS

have been associated with congenital malformations.

+Excreted into breast milk. Questionable association of

one case report of seizures in nursing infant. AAP considers it ompatible with breast feeding.

Infliximab (B)Few human studies, no animal studies. Unable to

assess risk to embryo/fetus. +No human lactation studies. If excreted into breast milk it would be digested by GI tract. Manufacturer does not

recommend breast feeding.

Influenza vaccine ( C) Inactivated vaccine, compatible. + Maternal vaccination is compatible with breast feeding.

Insulin aspart (B)Limited human studies, other older forms of insulin

compatible. Primary concern is maternal hypoglycemia.

+ Nohuman lactation studies. Digested in infant's GI tract.

Insulin glargine (C)Few human studies, but show low risk; other older

forms of insulin compatible. Primary concern is maternal hypoglycemia.

+ No human lactation studies. Digested in infant's GI tract.

Insulin glulisine (C)

No human pregnancy studies, low risk in animals. Older forms of insulin are compatible so this form

should be considered compatible. Primary concern is maternal hypoglycemia.


Insulin lispro (B)

Human pregnancy and animal studies imply low ris.k . Two case of congenital defects using insulin lispro

were not definitely related to the insulin. Older forms of insulin are compatible so this form should

be considered compatible. Primary concern is maternal hypoglycemia.


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A B C D

Insulin, regular (B)

. Insulin rather than oral hypoglycemics should be used to control diabetes. Poorly controlled diabetes associated with increased risk of congenital defects.

Fetal macrosomia. + Digested in infant's GI tract.

Interferon-Alfa (all types) (C) Not a significant risk. Limited studies. Because of the

antiproliferative activity of these agents, use with caution during gestation.

+ Drug excreted into breast milk in small amounts. AAP considers it compatible with breast feeding.

Interferon-Beta (C)

No human pregnancy studies, risk in animal studies. Spontaneous abortion occurred in 4 women.

Relationship between drug and abortions can not be determined.

+ No studies available, probably compatible.

Interferon-Gamma©No human pregnancy studies. Animal studies imply

low fetal risk. + No studies available, probably compatible.

Iodamide (D)

Risk in 2nd and 3rd trimester. Contains high concentration of organically bound iodine. May

suppress fetal thyroid function. Monitor for hypothyroidism.

+ Excreted into breast milk. Nine hours after dose, no measurable drug identified.

Iodine (D)

Risk in 2nd and 3rd trimester. Topical use may result in significant absorption of iodine, resulting in

transient hypothyroidism in newborn. (See also Potassium iodide and Povidone iodine.) Transient

hypothroidism, goiter in the newborn, and cardiomegaly can be seen in the infant.

+ AAP considers it compatible, may affect the thyroid activity of the infant.

Iodipamide (D)Contains high concentration of organically bound

iodine. Risk in 2nd and 3rd trimester. May suppress fetal thyroid function. Monitor for hypothyroidism.

+Iodide is concentrated in breast milk. AAP considers it

compatible with breast feeding. May affect infant's thyroid activity. Monitor thyroid function.

Iodoquinol (C)Limited human pregnancy studies. No animal studies.

Use in 1st trimester has questionable association with congenital hip dislocation.


breast milk. Iodine levels may be increase in the seruma and urine of the infant. Effects unknown.

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A B C D

Ipratropium (B)Limited human pregnancy studies, no evidence of

harm to fetus. + No human lactation studies. AAP considers compatible with breast feeding.

Irbesartan (C 1st tri, D 2nd,3rd tri)

No reports of use during human pregnancy. Risk in 2nd and 3rd trimester: IUGR, prematurity, PDA,

anuria, hypocalvaria and oligohydramnios. Follow blood pressure and renal function in newborn.


breast milk. Effects unknown. AAP considers ACE inhibitors compatible with breast feeding.

Irinotecan (D)

No human pregnancy studies. Animal studies imply risk . Because of the potential risk, women of

childbearing age receiving drug should use adequate contraception.

CINo human lactation studies, Drug likely excreted into

breast milk. Effects unknown. Potential toxicities- nausea, vomiting, diarrhea, anorexia, bone marrow suppression, headache, abdominal pain, alopecia, hepatic toxicity. Breast feeding is contraindicated.

Isoetharine (C)Use Of sympathomimetics in first trimester

associated with possible increased risk of minor malformations, inguinal hernia and clubfoot.


Isoflurane (B)Few human studies, low risk in animals. Observe newborn for depression after delivery ( may last

greater than 24 hours).+ Low risk. AAP considers it compatible with breast

feeding.

Isoniazid (C)

Not teratogenic in humans. Use of INH for TB occurring during pregnancy is recommended

because untreated TB represents far greater hazard to mother and fetus than does INH.Hemorrhagic

disease of the newborn seen.

+Druf and its metabolite are excreted into breast milk.

Observe infant for peripheral neuritis or hepatitis. AAP considers it compatible with breast feeding.

Isoproterenol (C)Use of sympathomimetics in first trimester

associated with possible increased risk of minor fetal malformations.

+ No studies are available.

Isosorbide dinitrate/mononitrate (C) No human studies available. Risk in animal studies. + No studies available.

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A B C D

Isotretinoin (X)

With first-trimester use, causes severe birth defects, including external ear, CNS, craniofacial, cardiac, and

thymic anomalies. Prevent pregnancy during use. Use effective contraception 1 month before use,

during therapy, and for 1 month after discontinuation.

- Unknown if excreted into breast milk. Risk of toxicity.

Isradipine (C) Few human studies, low risk in animal studies. +No human lactation studies. Drug likely excreted into

breast milk. Effect on nursing infant is unknown.

Itraconazole (C)

Human studies do not show a significant risk of major anomalies. Safest course is to avoid use in 1st trimester because fluconazole has shown to cause

major malformations.-

Excreted into breast milk. Potential effects on nursing infants have not been studied. Can accumulate in

tissues( liver, skin, omentum and kidney). Should avoid breast feeding during treatment.

Ivermectin (C)Teratogenic in animal studies. No teratogenicity or

toxicity seen in the few human studies. Use after 1st trimester is probably acceptable.

+Excreted into breast milk. No human lactation studies. Low drug levels in milk probably not a risk to nursing

infant. AAP considers it compatible with breast feeding.

Kanamycin (D)May cause eighth cranial nerve damage.Ototoxicity

and hearing loss with deafness can occur. +Low concentrations in breast milk because of poor oral absorption. Observe for changes in bowel flora, allergic reactions, and use caution in interpreting culture results

with sepsis evaluation..

Kaolin/Pectin (C)

No human pregnancy studies. Agent not absorbed into systemic circulation. Iron deficincy and

hypokalemia may occur after ingesting substances containing kaolin. LBW infants and prematurity

increase in iron deficient mothers.

+ No effect on nursing infant. May produce anemia in mother if prolonged use.

Ketamine (B)

No reports of malformations in humans attributable to ketamine. May induce transient toxicities in

newborn( newborn depression and excessive muscle tone with intermittent apnea) that can be avoided by

using lower doses.

+The drug should be undetectable in maternal plasma ~ 11 hours after dose. Breast feeding after this time will

not expose the infant to this medication.

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A B C D

Ketoconazole ©Questionable risk of limb malformations with oral medication. Probably compatible with topical use. +

Excreted into breast milk, effects of exposure to nursing infants are unknown but not thought to be significant.

AAP considers it compatible with breast feeding.

Ketoprofen (B) ( D if used in 3rd trimester or near delivery)

Constriction of ductus arteriosus, PPHN, inhibition of labor and prolongation of pregnancy have occurred.

Small risk for SABs and congenital malformations.+

No human lactation studies. Drug likely excreted into breast milk, effects on nursing infants are unknown.

AAP considers another NSAID that is similar compatible with breast feeding.

Ketorolac ( C) ( D if used in 3rd trimester or near delivery)

Constriction of ductus arteriosus, fetal renal impairment, PPHN, inhibition of labor and

prolongation of pregnancy have occurred. Small risk for SABs and congenital malformations.

+Drug excreted into breast milk in clinically insignificant

amounts. AAP considers it compatible with breast feeding.

Labetalol

In 1st trimester, association with malformations increased. If used near delivery,may cause

hypotension and bradycardia. Monitor infant for 48 h after birth.May cause IUGR and decrease in

placental weight.

+ Monitor for hypotension and bradycardia.

Lactulose (B) No information available. + No studies available. Probably compatible.

Lamivudine (C)

Human and animal studies imply low risk to developing fetus. US Dept. of Health and Human Services guidelines states HIV-1 infected patients should continue use of antiviral therapy during

pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential fetal risks.Can

cause anemia, hypocalcemia, metabolic acidosis, lactic acidemia and neutropenia.

CILamivudine is excreted into breast milk. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in developed countries do not

breastfeed.

Lamotrigine ©Risk in humans. In 1st trimester: see increase risk of oral clefts. If taking with valproate, can see increase

in major defects. -

May be of concern. Consider monitoring infant’s serum lamotrigine concentration.Watch for adverse effects in

infant.

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A B C D

Lansoprazole (B)

Limited human studies, no teratogenicity in animals. Ouestionable risk of cardiac defects, potential

negligible risk of carcinogenicity, however, safest course is to avoid, especially in 1st trimester.

-No human lactation studies, Drug likely excreted into

breast milk. Potential risks on nursing infant- carcinogenicity(animal data) and suppression of gastric

acid secretion. Avoid breast feeding.

Lepirudin (B)Limited human studies, animal studies imply low risk, however, passage across placenta may occur. Risk of

embryo/fetal hemorrhage.+ Few human lactation studies. Drug not likely excreted

into breast milk.

Leucovorin (C) Compatible.(See Folic Acid) + Compatible with breast feeding. See Folic Acid.

Leuprolide (X)Contraindicated.No increase in IUGR, or major

congenital malformations. CI No human lactation studies. Breast feeding contraindicated.

Levetiracetam (C)

Limited human studies has not shown major congenital malformations, severe growth restriction has been observed. Recommend daily folic acid and

multivitamin supplementation.+

No human lactation studies, drug likely excreted into breast milk . The effects on nursing infant are unknown.

AAP considers other anticonvulsants compatible with breast feeding.

Levodopa (C)

Teratogenicity and dose-related toxicities observed in animal studies but not shown in the few human pregnancies. Conditions requiring levodopa therapy

are rare during childbearing age Chronic use warratns study of neurodevelopmental changes..

+ Excreted into breast milk. Inhibitory effect on prolactin release.

Levofloxacin (C)Avoid in pregnancy( esp 1st trimester) because of arthropathy and cartilage damage in immature

animals and humans. . Use safer alternative.+

Excreted into breast milk. Effects on nursing infants are unknown. AAP considers other fluoroquinolones as


Levorphanol (C, D if prolonged periods or high doses at term)

No reports of congenital anomalies. Risk in 3rd trimester. May cause respiratory depression and

withdrawal syndrome.+

No human lactation reports. Drug likely excreted into breast milk. Long-term effects on neurobehavior and

development need to be studied. Probably compatible.

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Levothyroxine (A)

First-trimester use possibly associated with cardiovascular anomalies, Down syndrome, and polydactyly, but confirmation needed. Maternal

hypothyroidism is associated with LBW and lower neuropsychological development of infants.

+ Compatible , does not interfere with neonatal thyroid screening.

L-Hyoscyamine (C)Unknown, poss association with polydactyly and limb

reduction defect. (See Atropine). + No data studies, probably compatible.(See Atropine)

Lidocaine (B)

Compatible, can cause tachycardia or bradycardia, low APGAR scores. Lower scores on tests of tone and muscle strength. In first trimester: increased risk of

respiratory tract anomalies, tumors and inguinal hernais, but confirmation needed..

+Drug excreted into breast milk in small amounts. very low risk of harm to nursing infant. AAP considers it as


Lincomycin (B)No reports of congenital malformations or

developmental defects reported. +Excreted into breast milk. No adverse effects reported.

Observe for changes in bowel flora, allergic reactions and use caution in interpreting results with sepsis

workup. Compatible with breast feeding.

Lindane (B)

Limited studies, low risk in animals. May cause neurotoxicity ,seizures and aplastic anemia. Possible association with hypospadius. Recommend to use no more than 2 times in pregnancy.Use pyrethrins with piperonyl butoxide rather than lindane to treat lice

during pregnancy.

+No human lactation studies..Drug likely excreted into

breast milk. Small amounts ingested by nursing infant are probably clinically insignificant. Breastfeed 4 days after discontinuing drug to prevent any drug in breast

milk.

Linezolid (C)No human pregnancy studies. Use other antibiotics

with known safely if possible. -No human lactation studies. Drug likely excreted into

breast milk. Effects on nursing infant unknown. Potential risks- myleosuppression has occurred in

animals and reversible thrombocytopenia in adults. Avoid breast feeding.

Liothyronine (AM)No adverse effects reported.Maternal hypothyroidism causes LBW and lower

neuropsychological development of newborns.+ Compatible with breast feeding. Does not affect thyroid

screening programs.

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A B C D

Lisinopril (C 1st tri, D 2nd,3rd tri)

Risk in 2nd or 3rd trimester. Discontinue as soon as pregnancy detected. ACE inhibitors have caused malformations and fetal death.Can cause chronic renal failure in the newborn, IUGR, fetal distress,

hypocalvaria and renal insufficiency.

+No human lactation studies. Drug likely excreted into breast milk. AAP considers it compatible with breast

feeding.

Lithium (D)

May cause cardiac congenital defects when used in first trimester and toxicity in newborn (cyanosis,

hypotonia, bradycardia, diabetes insipidus,,seizures, shockk, GI bleeding, jaundice, hepatomegaly and

other disorders) when used near term. Reduce risk by using lowest dose possible and monitoring serum

concentrations.

-Milk levels average 40% of maternal serum

concentration. AAP considers it as a drug that should be used with caution. Monitor infant for cyanosis,

hypotonia, bradycardia, and other lithium toxicities. Also recommended to monitor blood levels in infant.

Liotrix No adverse effects reported. + Compatible with breast feeding.

Lipids, parenteral ( C)

Limited studies, not a significant risk but cases of cardiac tamponade resulting in maternal and fetal

death another case of fetal demise has been reported.


Lomefloxacin (C)

No human pregancy studies, Other similar antibiotics have low risk for malformations.Use cautiously in 1st trimester. Arthropathies and fetal cartilage damage

seen in animal studies and some case reports of humans. Consider safer alternative.

+No human lactation studies, drug likely excreted into breast milk. Effects on nursing infants are unknown.

AAP considers ciprofloxacin and ofloxacin as compatible with breast feeding.

Loperamide (B)Limited studies, low risk in animals. Questionable

association with cardiovascular defects. Lower birth weights were seen in 21 infants.

+ No human lactation studies. AAP considers it as compatible with breast feeding.

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Lopinavir (C)

Human studies are limited, animal studies imply low risk to developing fetus. US Dept. of Health and Human Services guidelines states HIV-1 infected

patients should continue antiretroviral medications during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential fetal risks.

Possible risk of diabetes and hyperglycemia in pregnant women.

CINo human lactation studies.Drug likely excreted into

breast milk. however extensive plasma protein binding should limit this. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in developed


Loracarbef (B)No human pregnancy studies. . Other related

cephalosporins are considered safe.. +No human lactation studies, excretion into breast milk

likely.. Observe for changes in bowel flora, allergic reactions and use caution in interpreting culture results

with sepsis evaluation. AAP considers other cephalosporins as compatible with breast feeding.

Loratadine (B)

Data shows not a major teratogen. Consider chlorpheniramine or tripelennamine instead.

Loratidine ok if not if the 1st trimester and the others not tolerated.

+Loratadine and metabolite excreted into breast milk.

Risk to infant low. AAP considers it as compatible with breast feeding.

Lorazepam (D)

Risk in 1st and 3rd trimester. May cause neonatal respiratory depression and hypotonia.(Floppy infant

syndrome). Other drugs in this class have been suspected of causing malformations. Anal atresia

was seen in 5 cases.

- Unknown, but may be of concern if the infant's exposure is prolonged.

Losartan (C 1st tri, D 2nd,3rd tri)

Risk in 2nd and 3rd trimester. Drugs that act on the renin-angiotensin system can cause fetal and

neonatal morbidity and death when administered in pregnancy. In utero exposure can cause hypotension

and anuria in the newborn. Monitor newborn’s BP and renal function closely. Avoid use during

pregnancy.Can see IUGR, oligohydramnios, PDA, hypocalvaia, anuria of the newborn, limb

contractures and stillbirth.


breast milk -effects of exposure to nursing infant is unknown. AAP considers compatible with breast

feeding.

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A B C D

Lovastatin (X)Malformations seen with use of the drug.

Teratogenic in animal species. Avoid using in pregnancy.

CI Contraindicated because of risk of toxicity in infant.

Loxapine (C)No studies of use during human pregnancy- animal studies show risk- exencephaly and renal papillary

abnormalities.-

No human lactation studies. Drug likely excreted into breast milk- effects of exposure to nursing infant is

unknown. Avoid breast feeding.

Lubiprostone (C)Limited human pregnancy studies. No teratogenicity observed in two animal studies. Risk probably low. +

No human lactation studies. Not known if drug excreted, but if it is the amount will be small. Monitor nursing infants for: Diarrhea, headache and nausea.

Magnesium Sulfate (B)

Compatible. May cause neonatal respiratory depression,loss of reflexes and muscle weakness.If

infusion is prolonged, fetal hypocalcemia with congenital rickets can occur. Possible respiratory

arrest when gentamicin given to newborns with high magnesium levels.Can cause ileus, hypotonia and a decrease in GI motility. Observe infants during the

first 24-48 hours after birth.

+ AAP considers it compatible with breast feeding.

Mannitol (C) No adverse effects reported + No studies available- probably compatible.

Maprotiline (B)May cause oral cleft, but other factors may be

involved. Very limited studies. - Excreted into breast milk in low amounts. Clinical significance to nursing infant is unknown.

Measles Vaccine (XC)

Contraindicated because infection of the fetus with the virus may occur.Measles during pregnancy can cause impaired fetal growth, sillbirth, prematurity

and congenital malformations Should avoid becoming pregnant after vaccine(times differ-30

days to 3 months)


Mebendazole (C) Probably compatible, low risk. +Recent data support continuing breast feeding during treatment. Very little drug excreted into breast milk

and should be clinically insignificant.

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Mechlorethamine (D)Contraindicated in 1st trimester use.Possible fetal

malformations with first-trimester use and low birth weight with use any time during pregnancy.

CINo human lactation studies.Drug likely excreted into breast milk. Riks for severe toxicity in nursing infant-


Meclizine (B)

Possible fetal malformations reported; however, 3 studies involving large numbers of patients

concluded that meclizine is not a human teratogen. Questionable association with ocular

malformations.Increased risk of retrolental fibroplasia in premature infant exposed to

antihistamines during last 2 weeks in utero.


breast milk. Probably compatible. Caution- newborns and premature infants have increased sensitivity to

antihistamines.

Meclofenamate (B/D is used in 3rd trimester or near delivery.)

Risk in 1st and 3rd trimester. May cause delayed labor, premature closure of ductus arteriosus, and

PPHN.NSAIDs are associated with congenital malformations.

+No human lactation studies. Drug likely excreted into breast milk - effects of exposure to nursing infant is

unknown. AAP considers other NSAIDS as compatible with breast feeding.

Medroxyprogesterone (X)

Teratogenic and toxic in animal studies. Not recommended for use in pregnancy because of risk

of fetal malformations associated with use of female sex hormones( disorders of sex development) and

other defects. Growth retardation can occur if used within 4 weeks of conception.


Mefenamic Acid (C,D if 3rd trimester or near delivery)

Risk in 1st and 3rd trimester. Can cause premature closure of the ductuse arteriosus and suppression of fetal renal function. PPHN may occur if used in 3rd

trimester or near delivery. NSAIDs have been associated with congenital malformations.


breast milk- exposure unknown. Other NSAIDS may be considered less potentially toxic. However, the AAP

considers mefenamic acid as usually compatible with breast feeding.

Melatonin (C)No human pregnancy studies, animal studies imply

risk. -No human lactation studies. Low doses may be

compatible ,high doses toxicity risk, safest course of action is to avoid use during breast feeding.

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A B C D

Meloxicam (C, D if 3rd trimester or near term)

May close ductus arteriosus in utero, cause PPHN, inhibition of labor, and spontaneous abortion. NSAIDS have been asssociated with congenital

malformations.+

No human lactation studies. Drug likely excreted into breast milk. Effects unknown. AAP considers similar agent, piroxicam as compatible with breast feeding.

Melphalan (D)May cause IUGR. No reports of congenital defects but is similar to other alkylating agents that have

produced defects. Contraindicated in 1st trimester.CI

No human lactation studies..Drug likely excreted into breast milk. Risk of severe toxicity in nursing infant-


Menadione (C)May produce newborn toxicity( hyperbilirubinemia and kernicterus), phytonidione considered drug of

choice during pregnancy.+ Compatible with breast feeding.(See Phytonadione.)

Meningococcal Vaccine (C)Risk to fetus unknown, one review states use in pregnancy controversial another states it is ok if

outbreak.+ No studies available, probably compatible.

Meperidine (B/D if prolonged treatment or high doses near term)

May cause respiratory depression and withdrawal syndrome. First-trimester use possibly associated

with inguinal hernia, but confirmation needed. Can cause EEG changes in the neonate, transient

decrease in oxygenation.

+ Excreted into breast milk. No adverse effects seen. AAP considers it as compatible with breast feeding.

Mephobarbital (D)May cause withdrawal and hemorrhagic disease of newborn.With 1st trimester exposure: associated

with cardiac defects and cleft lip/palate.-

Monitor for sedation and withdrawal. AAP considers similar drug, phenobarbital, as an agent that has caused

major adverse effects in some nursing infants. Use caution if breast feeding. (See phenobarbital).

Mercaptopurine (D)

Risk in 3rd trimester. May cause fetal malformations, pancytopenia, and low birth weight.

IUGR,myelosuppression, and hemolytic anemia seen in infants.

-No human lactation studies.. Drug likely excreted into breast milk.. Risk for severe toxicity in nursing infant-

Avoid breast feeding.

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A B C D

Meropenem (B)Most likely safe to use in perinatal period, 28 weeks’

gestation or later. Use before 28 weeks unknown. + No human lactation studies.. Drug likely excreted into breast milk. Effects unknown.

Mesalamine (B)

Only one case of toxicity in the newborn: renal biopsy showing interstitial fibrosis, tubular atrophy,

and focal tubulointerstitial lesions. Maternal benefits appear to outweigh potential risks to fetus.

-Drug excreted into breast milk in small amount. Risk of

adverse effects-allergic reaction and diarrhea - in nursing infant. AAP considers it should be used with

caution during breast feeding.

Mesna (B)Few human and animal studies and pharmacokinetic

properties imply little risk to fetus. +No human lactation studies. Little if any drug expected

to be excreted into breast milk. However, if used in combination with antineoplastic agent- breast feeding

is contraindicated.

Mesoridazine (C)Unknown,Questionable association with congenital

malformations but not confirmed.. - Excreted into breast milk. AAP considers its effect on nursing infant is unknown but may be of concern.

Metaproterenol (C)No association with congenital defects except

possibly polydactly. Prevents premature labor. May cause fetal tachycardia and neonatal hypoglycemia.

+No human lactation studies. Prob.compatible.Monitor

nursing infant for tachycardia, hypoglycemia and tremor.

Metaxalone (B)No human pregnancy studies, very limited animal

studies. Avoid during 1st trimester. -No human lactation studies, drug likely excreted into breast milk.. Effects on nursing infant are unknown.

Observe closely for sedation.

Metformin (B)Human and animal pregnancy studies imply low risk.

However insulin consider drug of choice to treat maternal hyperglycemia- better glucose control.

+ Excreted into breast milk. Nursing infants had normal blood glucose levels.

Methadone (B/D if prolonged treatment or high doses at term)

Risk in 3rd trimester. May cause withdrawal syndrome, low birth weight, and death.

Thombocytosis and hyperbilirubinemia seen in newborn.

+Drug likely excreted into breast milk in low

concentrations. AAP considers it as compatible with breast feeding. One infant death secondary to

methadone in breast milk.

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A B C D

Methamphetamine (C)

With medical use, risk is low for congenital anomalies,, one can see withdrawal symptoms. With amphetamine abuse, increased incidence of preterm labor, placental abruption, fetal distress, postpartum

hemorrhage, IUGR, feeding difficulty, drowsiness, and lassitude that may last several months. Can see

cerebral injuries.

CI The AAP considers amphetamines as contraindicated during breastfeeding.

Methaqualone (D) Not recommended during pregnancy. - No studies available.

Methenamine (C)One study was associated with fetal malformations,

but confirmation needed. Probably compatible. + Excreted into breast milk. No adverse effects reported.

Methimazole (D)

May cause aplasia cutis (scalp defects) and other malformations(hypoplastic or absent nipples, facial anomaliies, choanal atresia, esophageal atresia with

TE fistula, radioulnar syostosis and psychomotor delay) . Use propylthiouracil rather than carbimazole

or methimazole to treat hyperthyroidism during pregnancy. May cause hypothyroidism during

pregnancy.

+ Potential for interfering with thyroid function.

Methocarbamol (C)One case of arthrogryposis. Questionable association with congenital contractures. + Amounts of drug excreted into breast milk probably not

significant.

Methotrexate (X)

Associated with methotrexate embryopathy in 1st trimester:IUGR.low set ears,limb abnormalites,

possible mental retardation, decrease in calvarium ossification. In 2nd or 3rd trimester associated with

fetal toxicity and mortality. Few cases reported sever myelosuppression in newborn.

CI Contraindicated. May accumulate in tissues, cytotoxic,interferes with cellular metabolism.

Methoxsalen (C)No association between this drug and congenital

malformations. Long-term effects ,eg cancer, need to be studied.

-No human lactation studies, drug acts as

photosensitizer. Stop breast feeding and discard milk for at least 24 hours if drug is given.

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Methyldopa (B)

no association between this medication and congenital maformations. A decrease in systolic

blood pressure was seen in infants in the first two days of life. Monitor neonate for hypotension for 48

h after delivery. Transient nasal obstruction in a newborn.

+ limited studies,prob compatible

Methylene blue (C, D if intra-amniotically)

Risk in 2nd and 3rd trimester.Possibly associated with fetal malformations. Can also cause intestional

obstruction and jejunal atresaia. May cause hemolytic anemia, hyperbilirubinemia, and

methemoglobinemia with intra-amniotic injection of large doses.

No studies available.

Methylphenidate (C)Few human studies, animal studies imply moderate

risk. -Excreted into breast milk. Potential toxicity will

probably occur in 1st month of life. Observe infant for CNS stimulation- decreased appetitie, insomnia and

irritability.

Methyltestosterone (X)Testosterone derivatives are contraindicated at any

time during pregnancy.(See testosterone) CINo human lactation studies. However, breast feeding should be stopped if methyltestosterone therapy must

be initiated.(See testosterone)

Metoclopramide (B) No adverse effects reported. -Increases milk production. Effects on nursing infant

unknown but may be of concern because it is a dopaminergic blocking agent.

Metolazone (B D if used in gestational hypertension)

Thiazide-related diuretics may cause increased risk of congenital defects if taken during first trimester. May

also cause hypoglycemia, thrombocytopenia, hyponatremia, hypokalemia, and death and may

inhibit labor. Use during pregnancy only if required for patients with heart disease. Carefully monitor

infant’s electrolytes, platelet count, and serum glucose after birth.

+May suppress lactation. Adverse effects have not been reported, but infant's electrolytes and platelets should

be monitored.

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A B C D

Metoprolol (C ,D if 2nd or 3rd trimester)

Hypotension and bradycardia may occur. Monitor infant for 48 h after birth.IUGR if treated early in 2nd

trimester, decrease in placenta weight if treated in 3rd trimester.

- Monitor for bradycardia and hypotension.

Metronidazole (B)

Possible fetal malformations with first-trimester use. Questionable risk of carcinogenic

potential.Contraindicated in first trimester in patients with trichomoniasis and bacterial vaginosis.

Use in second and third trimesters for these indications is acceptable.

-If single dose hold breast feeding for 12-24 hours, if

multiple dose best to not breast feed, the medication is carcinogenic and mutagenic.

Mexiletine (C)Based on human and animal studies- not significant risk. Caution too few studies to determine safety. +

Excreted into breast milk. AAP considers it compatible with breast feeding. Observe for changes in feeding

and weight gain.

Miconazole (C) No adverse effects reported. + No studies available.

Midazolam (D)Limited human studies, animal studies imply low risk. Observe newborn for depression if used just prior to

delivery.- Excreted into breast milk. AAP considers its effect on

nursing infant unknown but may be of concern.

Mifepristone (X)Teratogenic in one animal species. Risk of

embryotoxicity. Used to terminate pregnancy. CI Contraindicated. Potent antihormonal effects.

Miglitol (B)No reports of use during human pregnancy, Insulin is treatment of choice for diabetes during pregnancy-

provides better glucose control. -

Effects of exposure on nursing infants unknown. Conflicting reports, manufacturer and review state do

not breastfeed, others state prob compatible.

Milrinone (C)

No human prenancy studies, animal studies imply potential risk. Maternal tachycardia observed in

pregnant baboons without increase in mean arterial BP or fetal heart rate, ABG or pH.


Mineral Oil (C)No adverse effects reported but may inhibit maternal

absorption of fatsoluble vitamins (A, D, E, and K) if taken long term.


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A B C D

Minocycline (D)



+Excreted into breast milk in low concentrations.

Theoretical dental staining and inhibition of bone growth is unlikely. Observe infant for changes in bowel flora, allergic reaction and use caution ininterpreting

culture results with sepsis evaluation. Compatible.

Minoxidil (C)

May cause hypertrichosis that gradually disappears over 2–3 months. Can cause decreases in blood pressure that could affect placental perfusion.

Questionable cause of malformations-best to avoid in 1st trimester.

Drug likely excreted into breast milk , no adverse effects seen.Compatible.

Mirtazapine (C)Limited human pregnancy studies imply risk is low.

More studies needed to assess the risk of developmental toxicity.

-Excreted into breast milk. Long-term effects on

neurobehavior and development unknown. AAP considers other antidepressants as drugs for which

effect is unknown but may be of concern.

Misoprostol (X) Teratogenic and can cause congenital malformations. - Could cause significant diarrhea in infant.

Mithramycin (Plicamycin) (X) May cause fetal harm. Avoid during pregnancy. CI No data available.

Mitoxantrone (D)Antineoplastic agent. Reports of fetal death in 2nd trimester. Avoid in 1st trimester. Contraindicated. CI Contraindicated. Eliminated slowly with potential risk.

Modafinil (C)Animal studies imply risk, Nine cases in humans(7

normal births, one early delivery, one spontaneous abortion). Avoid in 1st trimester.


breast milk; effects on nursing infant unknown. Observe for adverse effects- anxiety, insomnia, infection ,headache, nausea, and nervousness.

Moexipril (C 1st tri, D 2nd,3rd tri)

Appear to be teratogenic in 2nd and 3rd trimester. Renal defects, hypocalvaria,hypotension, IUGR are some of reported effects.Blood pressure and renal

function in the newborn should be monitored. Follow pregnancty for oligohydramnios.

+No human lactation studies. Effects on nursing infant is unknown. Other ACE inhibitors are excreted into breast

milk in low amounts and considered compatible with breast feeding by AAP.

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A B C D

Montelukast (B)Not a teratogen in animals, but human studies are lacking.Use suggested in recalcitrant asthma who responded to the medication prior to pregnancy.

+ No human lactation studies. Prob. compatible.

Morphine (C, D if long term or high dose near delivery)

No teratogenic effects reported. Possible risk of inguinal hernia. Can cause respiratory depression

when used during labor. Monitor for neonatal withdrawal following prolonged maternal use.

+Excreted into breast milk. AAP classifies as compatible

with breast feeding. Long-term effects on neurobehavior and development are unknown.

Moxalactam (C)Cephalosporin antibiotic- considered compatible, no

adverse effects. +Excreted into breast milk, Theoretical risk of

enterocolitis secondary to gram positive organism colonization of bowel, therefore not recommneded by

some.. AAP considers it compatible with breast feeding.

Moxifloxacin (C)

No human pregnancy studies. Animal studies show toxicity. Some researchers feel all fluoroquinolones

should not be used gduring pregnancy. Use safer alternatives.

+No human lactation studies available, probably excreted

into breast milk. Effects on nursing infants are unknown. AAP considers it compatible with breast

feeding.

Mumps vaccine (C)Not for use in pregnancy because of risk of malformations. Live, attenuated vaccine. + No studies available, probably compatible.

Muromonab-CD3 (C)No human or animal pregnancy studies, unable to

access risk. Preterm delivery is of concern. Questionable risk of immunosuppresion in the fetus.

CINo human lactation studies, Drug likely excreted into

breast milk. Effects are unknown. Effects seen on adults were severe and involved most organ systems.

Manufacturer states breast feeding contraindicated .

Mycophenolate (D)

Studies reveal risk of death and structural defects in human and animals. Malformations seen include:

defects of the kidney, heart, esophagus, distal limbs, cleft lip and palate, facial anomalies, and external

ear. Manufacturer states women of childbearing age use contraception during and for 6 weeks after

therapy is discontinued.

CINo human lactation studies. Drug likely excreted into breast milk. Contraindicated, see increased infections

and risk of lymphoma.

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A B C D

Nabumetone (C)May close ductus arteriosus in utero, cause PPHN,

inhibition of labor, and spontaneous abortion. NSAIDS associated with congenital malformations.

-No human lactation studies. Drug likely excreted into breast milk. Other NSAIDS( diclofenac, fenoprofen, flurbiprofen, ibuprofen, ketoprofen, ketorolac and

tolmetin) considered safer.

Nadolol (C, D if 2nd or 3rd trimester)

May cause bradycardia and hypotension in infants exposed near term. Carefully monitor blood pressure

and heart rate. Also can see in the infant: IUGR, tachypnea, hypothermia, hypoglycemia and

cardiorespiratiory depression.

- Few studies, Risk for toxicity,Monitor for bradycardia and hypotension.

Nafcillin (B) No adverse effects reported. + Nostudies available- refer to Penicillin.

Nalbuphine (B D if prolonged or hig doses near term)

May cause respiratory depression and fetal distress and withdrawal syndrome. + No human lactation studies.. Drug likely excreted into

breast milk. Amounts are insignificant.

Nalidixic Acid (C)Limited studies on human, animal studies imply

moderate risk, pyloric stenosis seen as possible risk. +Drug excreted into breast milk in small amounts that

are considered clinically insignificant. One case of hemolytic anemia in infant with G6PD deficiency. AAP

considers it compatible.

Nalorphine (D)May cause respiratory depression. Naloxone

preferred. + No studies available.

Naloxone (B)No adverse effects reported.Caused fatal respiratory

failure in one infant. + No studies available.

Naltrexone (C)Few human studies. Risk of changing opoid receptors

in the brain and altering behavior is of concern. -No human lactation studies. Drug likely excreted into

breast milk. Effects unknown. Potential adverse effects of drug- alteration of opioid receptors in the brain, altered levels of some hormones of hypothalamic,

pituitary, adrenal and gonadal origin.

Naproxen (C,D if used in 3rd trimester or near delivery)

Risk in 1st trimester of structural anomalies. In 3rd trimester may cause closure of ductus arteriosus,

with resulting pulmonary hypertension of newborn. Avoid use near term.

+Drug excreted into breast milk in very small quanities. The effects on nursing infant unknown. AAP considers

it compatible with breast feeding.

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A B C D

Naratriptan (C)Embryo and fetal developmental toxicity. Human

pregnancy studies too few to assess risk. Avoid use during pregnancy.

+ No human lactation studies. Drug likely excreted into breast milk. Effects on nursing infant are unknown.

Nedocromil sodium (B)Not a major teratogen. Cromolyn sodium may be preferred because of greater experience during

pregnancy.+ With this inhaled drug, very little reaches systemic

circulation implying no risk to nursing infant.

Nefazodone (C)Few human pregnancy studies, animal studies imply

moderate risk. Two major malformations- neural tube defect and Hirschsprung's disease.

-

Excreted into breast milk Observe for drowsiness, lethargy, failure to maintain body temperature and

poor feeding. Long-term effects on neurobehavior and development during CNS development have not been studied. AAP considers effects of other antidepressants on nursing infants as unknown but may be of concern.

Nelarabine (D)No human pregnancy studies, animal studies imply significant risks. Avoid during pregnancy, especially

1st trimester.CI

No human lactation studies. Drug likely excreted into breast milk. Severe neurologic toxicity: seen in adults:

severe somnolence, convulsions, peripheral neuropathy and ascending peripheral neuropathies. Avoid breast

feeding.

Nelfinavir (B)

Not a major teratogen. US Dept. of Health and Human Services guidelines states HIV-1 infected patients should continue antiviral agents during


CINo studies during human lactation. Drug likely excreted

into breast milk. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in developed


Neomycin (C)No fetal malformations reported. May cause

ototoxicity(risk of deafness low), which has been reported with use of other aminoglycosides.

+No human lactation studies. Drug excreted in small amounts and absorbed by nursing infants. Amount

probably insignificant.

Neostigmine (C)No fetal malformations reported.Transient muscular

weakness seen in 20% of infants whose mothers have myasthenia gravis.

+No human lactation studies.. Non ionionized fraction of

drug likely excreted into breast milk. The effects on nursing infants are unknown.

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A B C D

Nevirapine (C)

Human studies are limited, however animal studiesimply low risk. US Dept. of Health and Human

Services guidelines states HIV-1 infected patients continue use of antiviral therapy , with the exception of efavirenz. Maternal benefits outweigh potential

fetal risks.

CIExcreted into breast milk. CDC recommends HIV infected mothers in developed countries do not

breastfeed.

Niacin (A/C if doses above RDA)Questionable association of pregnancy induced

hypertension. + Compatible with breast feeding.

Niacinamide(A/C if doses above RDA)Questionable association of pregnancy induced

hypertension. + Compatible with breast feeding.

Nicardipine (C)Limited human studies, animal studies show risk. Hypotension and bradycardia may occur. Monitor

infant for 48 hours after birth.+

Probably compatible with breast feeding. No human lactation studies. Manufacturer states drug appears in

milk of lactating rats.

Nicotine (transdermal, others) (D)

Cigarette smoking may cause prematurity, placenta previa, PROM, placental abruption, growth

retardation, low birth weight, SIDS, abnormal neurobehavioral development, and increase in

certain childhood diseases,retinal abnormalities, increase in major birth defects(heart, limbs, feet,

muscles, small bowel, abdominal wall, GU system. Studies are needed on nicotine replacement therapy.

-Unknown, smoking is not recommended during

breastfeeding. Nicotine replacement therapy use has not been studied.

Nifedipine (C)

In animal studies not a major teratogen. Causes fetal hypoxemia and acidosis in pregnant rhesus monkeys.

Severe adverse effects when combined with magnesium sulfate. Try standard therapy first for

severe hypertension.

+Drug excreted into breast milk. Best to breastfeed four

hours after dose. AAP considers it compatible with breastfeeding.

Nimodipine (C)Teratogenic and toxic in animals. Human pregnancy

studies too few to assess risk. Potential maternal hypotension could adversely affect fetus.

+ Excreted into breast milk. Exposure to nursing infant thought to be clinically insignificant.

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A B C D

Nisoldipine (C)

Lack of human pregnancy studies- unable to assess fetal risk. Other calcium channel blockers have been

used without any major congenital defects or fetal toxicity.

+No human lactation studies, drug likely excreted into breast milk. Effects on nursing infants are unknown,

however, other calcium channel blockers excreted into breast milk are considered compatible with breast

feeding by AAP- diltiazem, nifedipine and verapamil.

Nitazoxanide (B)No human pregnancy studies, animal studies imply

low risk. Avoid in 1st trimester. +No human lactation studies.. Uknown if active

metabolites are excreted ,if present they would be in limited amount. Effects on nursing infants unknown but thought not to be clinically significant. Monitor

nursing infant for GI symptoms.

Nitrofurantoin (B)No adverse effects reported. May cause hemolysis if

given near term in patient withand without G6PD deficiency. Best to avoid near delivery.

+ Excreted in milk in small amounts. Monitor infants with G6PD deficiency for hemolytic anemia.

Nitroglycerin (B/C per manufacturer)

No adverse effects reported. Few studies, especially with first trimester use. Can cause fetal heart changes ( loss to beat to beat variability,late

decelarations,and bradycardia)+ No studies available.

Nitroprusside (C)May cause fetal bradycardia. Avoid prolonged use.

Risk of cyanide accumulation in fetus. - No studies available.

Nitrous oxide (C)

Animal studies show- abortions, growth retardation, structural anomalies, neuroteratogenicity. Human pregnancy studeis- SAB, infertility and decreased

birth weight with chronic exposure; not a major risk for congenital anomalies. Long-term

neurodevelopmental deficits need to be studied further.

+No human lactation studies. Because of low solubility in blood and tissue, nursing infant would probably not be

exposed.

Nizatidine (B)Human and animal pregnancy studies- drug does not

have antiandrogenic effects. +Drug excreted into breast milk in small amounts., prob insignificant. AAP considers cimetidine as compatible


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Nonoxynol-9/Octoxynol-9 (Vaginal Spermicide) (C)

Vaginal spermicides are not a risk for congenital malformations. FDA states that spermicides do not

cause birth defects.-

No human lactation studies. Drug likely excreted into breast milk, if this occurs, effects on nursing infants are

unknown.

Norepinephrine (D)

Use of alph and beta-adrenergic stimulant, norepinephrine could cause contriction of uterine

vessels and reduce blood blow, producing fetal hypoxia and bradycardia. Ephedrine is preferred.

- No human lactation studies. Breast feeding would not probably take place while receiving this drug.

Norethindrone (X)Question of cardiac malformations and hypospadius.

May cause masculinization of female infants. +

Causes dose-dependent suppression of lactation. Decreased weight gain, milk production and nitrogen

and protein content of human milk have been associated with this drug. Changes probably only

significant in malnourished mothers. Use lowest dose possible. AAP classifies drug as compatible with breast

feeding.

Norethynodrel (X)Question of cardiac malformations and hypospadius.

May cause masculinization of female infants. +

Causes suppression of lactation. Decreased weight gain, milk production and nitrogen and protein content

of human milk have been associated with this drug. Changes probably only significant in malnourished

mothers. Use lowest dose possible. AAP considers drug as compatible with breast feeding.

Norfloxacin (C)Not a risk of major malformations. Use caution in

pregnancy, especially during first trimester. Best to avoid use in pregnancy and use a safer alternative.


breast milk. Other quinolones, ciprofloxicin and ofloxacin are considered compatible with breast feeding

by AAP.

Norgestrel (X) Used as an oral contraceptive. Contraindicated. + No alteration of breast milk composition, volume or duration of lactation.

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Nortriptyline (C)May cause fetal malformations, but confirmation needed. May cause urinary retention in newborn. -

Excreted into breast milk in low concentrations- no adverse effects noted . Long-term effects of chronic

exposure in nursing infants to antidepressants in unknown but concern for effects on neurobehavior. AAP considers the drug for which effect on nursing

infant is unknown but of concern.

Novobiocin (C)No adverse effects reported, but may cause

hyperbilirubinemia if used near term. +Excreted into breast milk. No adverse effects reported.

Observe for changes in bowel flora, allergic reactions and use caution when interpreting culture results with

sepsis. Compatible with breast feeding.

Nystatin (C) No adverse effects reported + Nystatin poorly absorbed . Excretion into breast milk would not occur.

Octreotide (B)Not a teratogen in animals. Normal outcome in 5

human pregnancies. Does cross the placenta. Data too limited to assess safety.

+Expect excretion into breast milk. No human lactation studies. Risk to infant nonexistent because medication

is digested.

Ofloxacin (C)

Available evidence for other agents in this class indicates a causal relationship with birth defects can

not be excluded(Ciprofloxacin, Norfloxacin). Question of arthropathies and fetal cartilege

damage. Ofloxacin should be used with caution in pregnancy, especially the 1st trimester. Consider

using safer agent as alternative.

+ Excreted into breast milk. AAP considers it compatible with breast feeding.

Olanzapine (C)

Not teratogenic in animals- produces embryo and fetal developmental toxicity. No structural

congenital malformations reported in humans, however studies too few to assess risk. Avoid use

during pregnancy. If maternal disease requires continuing treatment during pregnancy- folic acid 4

mg/day is recommended.

-Sedation can occur in nursing infants. Decreasing dose may eliminate this problem but may affect control of

mother's disease. Risk of long term neurodevelopmental toxicity .Avoid use during breast

feeding.

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A B C D

Olmesartan (C 1st tri, D 2nd,3rd tri)

No human pregnancy studies. Risk in 2nd or 3rd trimester:anuria, hypocalvaria, IUGR, prematurity, PDA, hypotension and oligohydramnios. Monitor

newborn renal funtion and blood pressure.+

No human lactation studies. Drug likely excreted into breast milk, effects are unknown. AAP considers ACE inhibitors, a similar class of agents, compatible with

breast feeding.

Olsalazine ©No reports of adverse effects following use during

human pregnancy.Toxicity in one case with mesalamine (relationship is controversial ).

-Active metabolite, 5-aminosalicylic acid(mesalamine), is

excreted into human milk. Diarrhea reported , therefore observe infant for diarrhea and changes in

stool.

Omalizumab (B)Few animal studies imply risk of harm to human

embryo/fetus is low. Other immunoglobulins have been used in pregnancy without causing harm.

- No human lactation studies. Excreted into breast milk. Effects on nursing infants are unknown but risk low.

Omeprazole (C)

Teratogenic risk probably low. Dose related gastric tumors occured in rats given omeprazole.

Questionable risk of cardiac defects. Avoid if possible, especially in first trimester.

-Few human lactation studies. Drug likely excreted into

breast milk. Effects are unknown. Avoid use during breast feeding. Risk of suppression of gastric acid secretion and carcinogenicity observed in animals.

Ondansetron (B) No adverse effects reported. + No human lactation studies. Drug likely excreted into breast milk, effects unknown.

Oral Contraceptives (all classes) (X)

Risk of congenital anomolies(VACTERL) is low.May affect development of sexual organs (masculinization

of females) and may cause hyperbilirubinemia in newborn.

+

Causes dose-dependent suppression of lactation. Decreased weight gain, milk production and nitrogen

and protein content of human milk have been associated with this drug. Changes probably only

significant in malnourished mothers. Use lowest dose possible. AAP considers drug as compatible with breast

feeding.

Orlistat (B)

No human pregnancy studies. Probably low risk. May cause deficiency of fat-soluble vitamins. May need supplemental to avoid deficiency which may

cause fetal adverse effects.+

No human lactation studies. Drug would probably not be found in breast milk. May cause deficiency of

vitamins(A,D, and E) in mom.

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A B C D

Orphenadrine (C)Few human studies, no animal studies. No

association was found between drug and congenital defects.


Oseltamivir (C)No studies of use during human pregnancy. Despite lack of embryo and fetal toxicity in animals, risk to

human embryo/fetus cannot be assessed..+ No studies during human lactation. Drug likely excreted

into breast milk. Effect unknown.

Oxacillin (B) No adverse effects reported +Excreted into breast milk in low concentrations.

Adverse effects rare, Observe for changes in bowel flora, allergies and use caution when interpreting

culture results with sepsis.

Oxaprozin (C,D if used in 3rd trimester or near delivery)

May close ductus arteriosus in utero, cause PPHN, inhibition of labor, and spontaneous abortion. Also

associated with congenital anomalies, however small risk.

0No human lactation studies. Drug likely excreted into

breast milk. Other NSAIDS( diclofenac, fenoprofen, flurbiprofen, ibuprofen, ketoprofen, ketorolac and

tolmetin) preferred.g

Oxazepam (D)Teratogenic syndrome seen: CNS defect, growth

retardation, dysmorphic features. - Monitor for lethargy. EEG showed sedation type pattern.

Oxcarbazepine (C)

Embryo/fetal toxic and teratogenic in some animal species. No major congenital malformations- one

case of mild facial defects. Provide folic acid supplementation.

+One report of use during human lactation. No adverse

effects reported. AAP considers carbamazepine as compatible with breast feeding, oxcarbazepine can be

also considered compatible.

Oxprenolol (C/D if used in 2nd or 3rd trimester.


and heart rate. May cause IUGR.- Monitor for hypotension and bradycardia.

Oxybutynin (B)No human pregnancy studies. Animal studies imply

low risk. + No human lactation studies. Drug likely excreted into breast milk- effects unknown.

Oxycodone (B/D if long term or at high doses near delivery)

May cause withdrawal syndrome and respiratory depression. No congenital malformations reported. + Observe for sedation, feeding difficulties and GI side

effects.

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A B C D

Oxymetazoline (C)No risk if given at recommended frequency to

healthy patient. Higher dose and frequency may cause persistent late fetal heart rate decelerations.


Oxymorphone (B/D if long term or at high doses near delivery)

May cause withdrawal syndrome and respiratory depression. No congenital malformations reported. + No studies available.

Paclitaxel

Teratogenic and embryo and fetal toxic in animal studies. Few human studies to define risk. Risk of congenital malformations during organogenesis in

animals. Avoid use during this time.CI No human lactation studies. Contraindicated because

of risk of toxicity.

Palonosetron (B)No human pregnancy studies. Animal studies imply

minimal risk. +No human lactation studies. Drug likely excreted into breast milk- effects unknown. Drug usually used short term so should be minimal risk. Caution if used long

term.

Pamidronate (D)

Limited cases:hypocalcemia and bilateral talipes equinovarus(questionable association). Drug resides in bone and goes back into systemic circulation. Use

during pregnancy or in women who may become pregnancy is not recommended. Monitor infant for

hypocalcemia

+No human lactation studies.. Drug likely excreted into

breast milk, but amount insignificant. Probably compatible with breast feeding.

Pancuronium Bromide (C)

No data on use in early pregnancy. Has been administered to mother at C-section and to fetus

during last half of pregnancy without harm to fetus. Can cause decreased accelerations and beat to beat

variability. Observe for newborn depression.

+No human lactation studies. Non-ionized drug fraction

may be excreted into breast milk in trace amounts, effects are unknown. Poorly absorbed from GI tract.

Panitumumab (C)No human pregnancy studies, animal studies imply risk. Best to avoid use of this antineoplastic agent

during pregnancy.-

No human lactation studies. Drug likely excreted into breast milk. Effects unknown, risk of

immunosuppression and other severe adverse effects.

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A B C D

Pantoprazole (B)

Animal and few human pregnancy studies imply low risk.Two other proton pump inhibitors do not show

an association with congenital malformations. Avoid during 1st trimester is safest course.

+Excreted into breast milk in small amounts. Risk of

suppression of gastric acid secretion in nursing infant, but overall risk of toxicities is low.

Paregoric (B/D if prolonged or high dose near delivery)

May cause withdrawal syndrome and respiratory depression. No congenital malformations reported. + Probably excreted into breast milk, limited studies.

Probably compatible.

Paromomycin (C)No congenital malformations seen, Drug poorly

absorbed, almost 100% excreted in feces. Little if any drug reaches fetus.

+ Excretion into breast milk not likely because drug not absorbed after oral administration.

Paroxetine (D)

Increased risk of congenital malformations, increase in cardiac defects(VSD and ASD). May cause

withdrawal. Can see jaundice, hypoglycemia and respiratory distress. Can also see LBW, prematurity, neonatoal serotonin syndrom, neonatal behavioral syndrom ,PPH, and abnormal neurobehavior with

SSRI Also, see Fluoxetine.

- Effect on nursing infant is unknown but may be of concern.

Pegfilgrastim (C)No human pregnancy studies, animal studies do not imply risk. No fetal harm seen in pregnancy use. Use

preferred over pegfilgrastim.+

No human lactation studies. Excretion into breast milk not expected, if so, it would be digested by GI tract.

Risk to nursing infant would be very low.

Penicillamine (D)May cause connective tissue abnormalities (cutis

laxa). - No human lactation studies. Some recommend avoiding use during breast feeding.

Penicillin G (all forms) (B) Association with adverse effects very unlikely. +All antibiotics are excreted in breast milk in limited

amounts. Observe for changes in bowel flora, allergies and use caution in interpreting culture results with

sepsis workup.

Pentamidine (C)Aerosolized pentamidine 300 mg/month in 15 women in second and third trimesters had no

adverse effects on fetus or newborn.CI No human lactation studies. Levels in breast milk would

be insignificant because systemic levels are very low.

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A B C D

Pentobarbital (D)May cause withdrawal syndrome and hemorrhagic

disease in newborn. - Excreted into breast milk- effects unknown.

Pergolide (B)Limited human studies, animal studies imply low risk.

Use during pregnancy will be rare and not recommended.


breast milk - effects unknown. Monitor infant for nausea and constipation. Inhibits prolactin secretion

and may inhibit lactation. Avoid breast feeding.

Perindopril (C 1st tri, D 2nd,3rd tri)

Appear to be teratogenic in 2nd and 3rd trimester. Renal defects, hypotension, hypocalvaria, and IUGR

are some of reported effects. Monitor newborn blood pressure and renal function.

+No human lactation studies. Effects unknown. Other

ACE inhibitors considered compatible with breast feeding by AAP.

Permethrin (B)No adverse effects reported. Recommended by CDC

as DOC for pubic lice in pregnant women. +No human lactation studies. Little if any drug expected to be excreted into breast milk. CDC feels permethrin

or pyrethrins with piperonyl butoxide treatment of choice for pubic lice during lactation.

Perphenazine (C) No adverse effects reported.Possible association in

one case. -Excreted into breast milk. No adverse effects reported

in one case. AAP considers it as a drug for which effect is unknown but may be of concern.

Phenazopyridine (B) No adverse effects reported. + No data available.

Phenobarbital (D)

. May cause withdrawal syndrome, hemorrhagic disease in newborn, major and minor fetal

malformations, and neurodevelopmental problems. Use at lowest possible level to control seizures.

-Monitor for sedation and withdrawal. AAP considers

the medication to have caused major adverse effects in some nursing infants. Use caution if breast feeding.

Phenolphthalein (C)Small amounts of laxative absorbed systemically. No

major or minor malformations reported. +Some conjugated drug excreted into breast milk in low

concentrations. Concern for diarrhea but none reported in nursing infants. Monitor for change in

bowel habits.

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Phentermine (C)Contraindicated, especially during 1st trimester.

Used for weight control. In a human study, increased incidence of stillbirths.

CINo human lactation studies. Drug likely excreted into breast milk -effects unknown. CNS stimulation and

other reactions may occur. Breast feeding is contraindicated.

Phentolamine (C)

Used for management of hypertension caused by pheochromocytoma. No adverse effects on fetus or

newborn attributed to drug. Observe for fetal hypoxia.


Phenylephrine (C) Fetal malformations reported, but confirmation

needed. May cause constriction of uterine vessels. +No human lactation studies. Drug likely excreted into

breast milk. Expect excretion into breast milk- effects on nursing infants unknown.

Phenyltoloxamine (C) No studies available. + No studies available.

Phenytoin (D)

. May cause fetal hydantoin syndrome (craniofacial [broad nasal bridge, low-set hairline, short neck, and microcephaly]; limbs [hypoplasia of nails and distal

phalanges]; impaired growth; and many other abnormalities). May also cause tumors and

hemorrhagic disease in newborn at delivery.

+Monitor for methemoglobinuria (rare). Keep maternal

phenytoin in therapeutic range. One infant had drowsiness and decreased sucking.

Physostigmine (C)Infrequently used in pregnancy. No congenital

defects reported. + No studies available.

Phytonadione (C) No adverse effects reported +Breast-fed infants should receive prophylactic vitamin K

at birth because content in breast milk is low and hemorrhagic disease may occur.

Pilocarpine (C) Few human studies. Probably compatible. + No human lactation studies. Drug likely excreted into breast milk.

Pimozide (C)

No human pregnancy studies. Animal studies do not imply risk of teratogenicity. If used near delivery

may cause extrapyramidal effects in newborn. Safest to avoid during pregnancy.


breast milk- effects unknown. Monitor closely for extrapyramidal effects,sedation and constipation.

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A B C D

Pindolol (B)D if used in 2nd or 3rd trimester.


and heart rate. May cause IUGR.- Monitor for hypotension and bradycardia.

Pioglitazone (C)No studies available. Insulin is treatment of choice

for diabetes during pregnancy- provides better glucose control.

+ No human lactation studies. Drug likely excreted into breast milk- effects unknown.

Piperacillin (B) No adverse effects reported. +Excreted into breast milk in low concentration. Observe

for changes in bowel flora, allergic reactions and use caution ininterpreting culture results with sepsis

evaluation. Compatible with breast feeding.

Piperazine (B) Adverse effects unlikely. - Excreted into breast milk. Breast feed right before dose and hold for 8 hours following dose.

Piroxicam ©D if 3rd trimester.May close ductus arteriosus in utero, cause PPHN,

inhibition of labor, and spontaneous abortion. NSAIDs associated with congenital malformations.

+ Drug excreted into breast milk in insignificant amounts. AAP considers it compatible with breast feeding.

Pneumococcal vaccine (C)No adverse effects reported; however, use during

pregnancy for high risk patients only. + No human studies, probably compatible.

Podofilox (C) Contraindicated.(See podophyllum) - No studies available.

Podophyllum (C)Questionable human teratogen. Contraindicated during pregnancy- can cause severe myelotoxicity

and neurotoxicity in mother.- No studies available.

Poliovirus Inactivated vaccine (C) Compatible.Use only if increased risk of exposure. + No human studies, probably compatible.

Poliovirus Live vaccine (C) Compatible.Use only if increased risk of exposure. +Compatible with breastfeeding. Breastfeeding should be withheld 6 hours before and after administration of

vaccine to prevent inhibition.

Polymyxin B (B) no reports of congenital defects. + No studies available.

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A B C D

Potassium chloride (A)Only one infant reported with limb reduction and hypospadius. Follow potassium levels in mother. + Compatible with breast feeding. No adverse effects

reported.

Potassium citrate (A, C by manufacturer)

No adverse effects reported.Follow potassium levels in mother. + No human lactation studies. Probably compatible.

Observe for gastrointestinal problems in infant.

Potassium gluconate (A) No adverse effects reported.See potassium chloride. + Compatible with breast feeding. No adverse effects reported.

Pravastatin (X)Contraindicated, cholesterol and cholesterol products are important in fetal development CI

No human lactation studies. Excreted into breast milk. Because of the risk of toxicity- avoid use during

lactation.

Prazosin (C) Few human studies, low risk in animal studies. - No human lactation studies. Drug excreted into breast milk, effects are unknown.

Prednisolone (C/D if 1st trimester.)May cause immunosuppression and cataracts;

carries small risk of fetal malformations such as orofacial clefts.

+Small amounts found in breast milk. Not clinically

significant. AAP considers it compatible with breast feeding.

Prednisone (C/D if 1st trimester)May cause immunosuppression and cataracts;

carries small risk of fetal malformations such as orofacial clefts.

+Small amounts found in breast milk. Not clinically

significant. AAP considers it compatible with breast feeding.

Pregabalin (C)No human pregnancy studies. Caused growth

retardation, behavioral deficits and death. Avoid use during pregnancy.

-No human lactation studies.. Drug likely excreted into breast milk- effects unknown. Monitor for dizziness,

somnolence, blurred vision, peripheral edema, myopathy, and decreased platelet count. Avoid use

during breast feeding.

Primaquine (C)No congenital defects reported. May cause

hemolysis if given near term in patients with G6PD deficiency.


Primidone (D)

Possible risk of fetal malformations similar to those associated with phenytoin and of tumors and

hemorrhagic disease of newborn at birth.Can also cause tremors, jitterness and overactivity in

newborns.Vit K1 should be given right after birth.

Drug excreted into breast milk. AAP considers use with caution .Monitor for ssedation.

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A B C D

Probenecid (C) No congenital defects reported or associations seen. -Excreted into breast milk. Toxicity observed probably

related to concurrent antibiotic administered. Observe for diarrhea.

Procainamide (C)Not associated with congenital anomalies or adverse

fetal effects. + Excreted in and accumulates in milk. AAP considers it compatible. Long-term effects are unknown.

Procarbazine (D)May cause fetal malformations and low birth

weight.Contraindicated in 1st trimester. CINo human lactation studies. Drug likely excreted into

breast milk. Contraindicated because of risk of tumorigenicity.

Prochlorperazine (C) Fetal malformations reported rarely. -Other phenothiazines excreted into breast milk so

prochlorperazine excretion likely. Sedation in nursing infant a possible side effect.

Promazine (C)Fetal malformations reported rarely.May cause

hyperbilirubinemia in infant. - No human lactation studies.. Drug likely excreted into breast milk . Monitor for possible sedation.

Promethazine (C)

May cause respiratory depression when given at term (controversial ).Transient behavioral and EEG changes in infant. Impaired platelet aggregation in

newborn.+ Drug likely excreted into breast milk- effects are

unknown.

Propafenone (C)Unknown in 1st trimester, limited studies in 2nd and

3rd, embryotoxic in animals. + Excreted into breast milk. Probably compatible but few studies.

Propantheline (C) Question of minor malformations. + No studies available.

Propofol (B)

When used during C-section, most studies show no difference in Apgar scores of infants exposed to

propofol.Can see hypotonia, irritability, somnolence and low APGAR scores.

+ Drug excreted into breast milk in low concentrations.- amounts considered insignificant.

Propoxyphene (C/D if long term)May cause fetal malformations and has caused

neonatal withdrawal syndrome. + Excreted into breast milk. AAP considers it compatible.

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A B C D

Propranolol ( C,D if 2nd ,3rd trimester)

May cause low birth weight, IUGR,resp depression at birth, prolonged labor, neonatal hypoglycemia,

polycythemia, hyperbilirubinemia, thrombocytopenia,hypocalcemia with

convulsions,fetal bradycardia,hypotension, and bradycardia. Carefully monitor blood pressure,

respirations, and heart rate for 24–48 h in infants exposed near term.

AAP considers it compatible.Monitor for hypotension and bradycardia.

Propylthiouracil (D)

Fetal malformations reported, but association with this drug unclear. May cause reversible

hypothyroidism and goiter in infant. Drug of choice for treatment of hypothyroidism during

pregnancy.Neonatal hepatitis that resolved.

+ AAP considers it compatible.Monitor thyroid function of infant periodically.

Protamine (C) No adverse effects reported. + No studies available.

Protirelin (C)Few human studies- animal studies imply moderate

risk. + Low levels of T3 and T4 are seen in breast milk of mothers on this medication.

Pseudoephedrine (C)May cause minor fetal malformations(question of

intestinal atresia and gastroschisis) with first-trimester use. Avoid in 1st trimester.

+ AAP considers it compatible. Monitor for agitation.

Pyrazinamide (C)Limited human pregnancy studies- no animal studies.

Only one case- no drug-related fetal toxicity. Use caution.

+ Excreted into human milk in small amounts. Probably compatible.

Pyridostigmine ( C)

May cause premature labor when given near term.May cause microceophay and CNS problems.

20% of infants whose mothers have myasthenia gravis have muscular weakness.

+Excreted into breast milk, drug undetectable in nursing

infants. AAP considers it compatible with breast feeding.

Pyridoxine (A)Probably does not cause fetal

malformations.Convulsions seen(Intrauterine and infant).


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A B C D

Pyrimethamine (C)

Probably does not cause birth defects. Administer with folinic acid or folic acid supplementation, especially during first trimester to avoid birth

defects.+ Excreted into breast milk. AAP considers it compatible

with breastfeeding.

Quazepam (X)

No human pregnancy studies. Effects are probably the same as with other benzodiazepines. Risk for

Withdrawal and neonatal motor depression if used near delivery.

-Excreted into breast milk in small amounts. The effects

if any on nursing infant's CNS function is unknown. AAP considers drug, whose effect is unknown but of concern

when used for prolonged periods.

Quetiapine (C)

Human preganancy studies too limited to access risk. Animal studies- not teratogenic, caused embryo/fetal toxicity. If therapy continued during pregnancy, folic

acid supplemental 4mg/day is suggested.-

Excreted into breast milk- no reports of adverse effects in nursing infants. Long-term effects unknown.

Manufacturer states it is best to avoid breastfeeding.

Quinapril (C 1st tri, D 2nd,3rd tri)

Appear to be teratogenic in 2nd and 3rd trimester. Renal defects, hypotension, IUGR are some of

reported effects. Monitor newborn blood pressure and renal function.

+Drug excreted into breast milk in insignificant amounts. AAP considers captopril and enalapril- similar agents, as

compatible with breast feeding. Compatible.

Quinidine (C)Considered relatively safe for fetus. High doses have

oxytocic properties and may cause abortion.Thrombocytopenia in infants in few cases.

+ Few human studies. AAP considers it compatible.

Quinine (D, X per manufactucturer.)

Has caused malformations of limbs, CNS, heart, and GI tract as well as deafness and other

abnormalities.Hemolysis in G6PD infants.Auditory and optic nerve damage also seen. Avoid during

pregnancy.

+Excreted into breast milk, no adverse effects seen . G6PD should be ruled out in infants at risk for the disease. AAP considers it compatible with breast

feeding.

Quinupristin/Dalfopristin (B)No human pregnancy studies, Drug does not cause teratogenicity or embryo/fetal toxicity in animals. -

No human lactation studies. Probably not excreted into breast milk. Caution, if present, may change nursing

infants bowel flora and cause resistant strains. Breastfeeding is not recommended.

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A B C D

Rabeprazole (B)No human pregnancy studies. Animal studies imply

low fetal risk. Safest course is to avoid during 1st trimester.

-No human lactation studies. Drug likely excreted into breast milk. Effects on nursing infants are unknown.

Because drug has mutagenic and carcinogenic potential in animals, and risk for gastric acid suppression, avoid

breastfeeding.

Ramelteon (C)No human pregnancy studies, animal studies imply

fetal risk. Infrequent exposure does not seem to pose embryo/fetal risk.

-No human lactation studies. Carcinogenic in animal

studies.Drug likely excreted into breast milk. Effects on nursing infant are unknown, observe for sedation.

Caution with breastfeeding.

Ramipril (C 1st tri, D 2nd,3rd tri)

Appear to be teratogenic in 2nd and 3rd trimester. Renal defects, hypocalvaria,hypotension, IUGR are some of reported effects. Monitor newborn blood

pressure and renal function.+

Drug likely excreted into breast milk. AAP considers captopril and enalapril- similar agents, as compatible

with breast feeding. Compatible.

Ranitidine (B) Not a major teratogen +Excreted into breast milk- effects on nursing infant are

unknown. Decreases gastric acidity but effect on nursing infant unknown. AAP considers similar agent-

cimetidine, as compatible with breastfeeding.

Remifentanil (C, D if long term or high amounts at term)

Not teratogenic or toxic in animals. Narcotic analgesics not considered to be human teratogens- Observe for sedation and respiratory depression at

birth if given during labor.+

No human lactation studies. Drug likely excreted into breast milk. Has very short half-life. Other narcotic

agents are considered as compatible with breastfeeding by AAP.

Reteplase (C)No human pregnancy studies. Bleeding is major risk

and pregnancy may increase it. +No human lactation studies. Drug not likely to be

excreted into breast milk in clinically significant amounts. Probably compatible.

Ribavirin (X)Teratogenic in animals. No abnormalities seen,

however, only 1 human exposure reported. Avoid in pregnancy.

-No human lactation studies. Drug likely excreted in to breast milk- effects on nursing infants are unknown.

Drug causes toxicity in lactating animals and their offspring.

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A B C D

Rifabutin (B)No human pregnancy studies, animal studies imply

low risk. Maternal benefits outweigh potential embryo/fetal risk.

CI

No human lactation studies. Drug likely excreted into breast milk. Milk may be brown-orange color. Effects

on nursing infants unknown but risk of toxicity- leukopenia, neutropenia, rash are potential adverse

effects. CDC does not recommend breast feeding in HIV + patients in developed countries.

Rifampin (C) Probably not a teratogen. May cause hemorrhagic

disease of newborn; prevent with vitamin K administration.

+Excreted into breast milk in amounts that pose very

little risk to nursing infants. No adverse effects reported, AAP considers it compatible with

breastfeeding.

Rifapentine (C)

Toxic and teratogenic in animals. Human pregnancy studies limited- SABs. Best avoided during 1st

trimester. Untreated TB poses greater risk to fetus than drug. CDC does not recommend use of this

drug during pregnancy.

+No human lactation studies. Drug likely excreted Expect

excretion into breast milk, may cause red-orange discoloration. Effects on nursing infants are unknown.

AAP considers rifampin, similar agent as compatible with breastfeeding.

Rifaximin (C)No human pregnancy studies, animal studies imply

risk. Very small amounts absorbed systemically- embryo/fetal risk is low .. Avoid during 1st trimester.


breast milk. in very small amounts due to limited systemic absorption. Effects on nursing infants unknown but probably not clinically significant.

Rimantadine (C)No human pregnancy studies. Embryotoxic but no significant teratogenicity in animals. Probably safer

than amantadine. -

No human lactation studies. Drug likely excreted into breast milk. Manufacturer recommends avoid use

during breastfeeding.

Risedronate (C)

No human pregnancy studies. Developmental toxicity seen in animals. Long half-life from bone

suggest drug will remain for prolonged periods. Fetal skeleton abnormalities a concern.Monitor fetal

skeleton.

+No human lactation studies. Drug likely excreted in

breast milk in low amounts. Effects on nursing infants are unknown but probably not significant.

Risperidone (C)

Not teratogenic in animals, but stillbirths have occurred. Limited human studies. If therapy necessary for maternal condition, folic acid supplemention- 4mg/day is recommended.

-Excreted into breast milk. AAP considers other

antipsychotic drugs to have an unknown effect on nursing infants but may be of concern, especially with long-term use. Could possibly alter CNS function(long

and short term).

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A B C D

Ritodrine (B)

Manufacturer considers use contraindicated before 20th week of gestation. Severe fetal and neonatal toxicities infrequent- fetal tachycardia, neonatal

hypoglycemia reported.+ No studies available.

Ritonavir (B)

Few human studies, however animal studies imply low risk . US Dept. of Health and Human Services

guidelines state HIV-1 infected patients should continue use of antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits

outweigh potential fetal risks.

CINo studies during human lactation. Drug likely

excreted into breast milk. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in

developed countries do not breastfeed.

Rituximab (C)Limited human pregnancy studies. Potential for

reversible immunosuppression, infection. -May be excreted into breastmilk. Potential exists for immunosuppression and other severe adverse risks in

nursing infant.

Rizatriptan (C)Limited human studies, animal studies imply

moderate risk. + No human lactation studies. Drug likely excreted into breast milk- effects on nursing infants are unknown.

Rocuronium (C)Human pregnancy studies are limited, animal studies

imply low risk. Neuromuscular blockade in infant rare risk..

+No human lactation studies. Drug likely excreted into breast milk in low levels. Effect on nursing infants are

unknown.

Ropinirole (C)No human pregnancy studies, animal studies imply

risk. Avoid use during 1st trimester. -

No human lactation studies.. Drug likely excreted into breast milk- effects on nursing infants unknown.

Observe for fatigue, syncope, somnolence, dizziness, dyspepsia, and nausea and vomiting. Inhibits prolactin

secretion and may inhibit lactation. Avoid use during breastfeeding.

Ropivacaine (B)Human and animal pregnancy studies imply very low

risk to human fetus. +No human lactation studies. Very small amounts

appear in maternal circulation and clear within 24 hours . Appears no risk to breastfeeding infant.

Rosiglitazone (C)

Limited use during human pregnancy, Insulin is treatment of choice for diabetes during pregnancy-

provides better glucose control. Animal studies imply risk.

+ No human lactation studies. Drug likely excreted into breast milk. Effects on nursing infants are unknown.

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Rosuvastatin (X)Contraindicated, cholesterol and cholesterol products are important in fetal development CI

No human lactation studies. Drug likely excreted into breast milk. Avoid use during breastfeeding because of

risk of toxicity.

Rubella vaccine (C)

This live virus vaccine should not be used during pregnancy because of risk of congenital rubella

syndrome.CDC also states that a women should not become pregnant 3 months after the vaccine.

+Compatible with breastfeeding. ACOG and CDC

recommend vaccination of susceptible women in immediate postpartum period.

Saccharin (C)Few human pregnancy studies. Conflicting views on whether it is safe or best to avoid or use cautiously

during pregnancy.+ Excreted into breast milk, amounts low. Compatible


Salmeterol (C)Human pregnancy studies imply risk to fetus minimal

to nonexistent. +No human lactation studies. Drug likely excreted into

breast milk. Drug levels in mom after dose are very low, insignificant levels would probably be in breast milk.

Saquinavir (B)

Human studies are limited, however animal studies imply low risk to developing fetus. US Dept. of

Health and Human Services guidelines state HIV-1 infected patients should continue antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential fetal risks.

CINo studies during human lactation. Drug likely excreted

into breast milk. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in developed


Sargramostim (C)

No human or animal pregnancy studies. Not likely that it would cause embryo/fetal toxicity. Best to

avoid during pregnancy until more studies become available.

+No human lactation studies. Drug likely excreted into breast milk- effects on nursing infants unknown. Low

risk to infant because drug is not absorbed.

Scopolamine (C)

May cause tachycardia, decreased heart rate variability and deceleration in the fetus when given to mother during labor.Scopolamine toxicity in one

infant( fever, lethargy and tachycardia).+ No human lactation studies. Excreted into breast milk.

AAP considers it compatible with breast feeding.

Secobarbital (D)May cause hemorrhagic disease of newborn; prevent

with vitamin K administration. May cause withdrawal.

+ Excreted into breast milk. Effect on infant unknown. AAP considers it compatible with breastfeeding.

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A B C D

Senna (C) No adverse effects reported. + Observe for diarrhea. AAP considers it compatible with breastfeeding.

Sertaconazole (C)

No human pregnancy studies, animal studies do not show developmental toxicity. The drug also can not be detected after many topical doses.Risk of toxicity

is unlikely.+

No human lactation studies. After multiple applications to the skin, there is no detectable

concentration in the plasma. Risk to nursing infants- nonexistent. Probably compatible.

Sertraline ( C, D if 2nd and 3rd trimester)

Few human and animal studies do not imply it is a major teratogen. May cause SABs low birth weight,

preterm delivery, neonatal serotonin syndrome, neonatal behavioral syndrome(withdrawal), possible sustained abnormal neurobehavior beyond neonatal

period, respiratory distress and PPHN.

- Effect on nursing infant is unknown but may be of concern. Concentrated in human milk.

Sevelamer (C)No human pregnancy studies, few animal studies

imply low risk. Mother may require extra vitamins ,especially fat-soluble vitamins.

+ No human lactation studies. May cause vitamin deficiency because it is not absorbed.

Sevoflurane (C)Few human studies during pregnancy, animal studies

imply low risk. May cause depression in the newborn that can last for more than 24 hours.

+Risk to nursing infant probably very low. AAP considers

Halothane,another similar agent, as compatible with breast feeding.

Silicone implants (C)Compatible. No reports of connective tissue or

autoimmune disorders. + AAP concludes that based on studies done, women with silicone implants should be able to breastfeed.

Simethicone (C) No adverse effects reported. + No human lactation studies. Low risk because drug is not absorbed.

Simvastatin (X)Contraindicated, cholesterol and cholesterol products are important in fetal development CI

No human lactation studies. Drug likely excreted into breast milk. Avoid use during breastfeeding, it has risk

of toxicity.

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A B C D

Sirolimus (C)

Limited human pregnancy studies, animal studies imply toxicity but not teratogenicity. Safest course is

to avoid during pregnancy. Manufacturer recommends women of childbearing age to use

contraception before, during and for 12 weeks after therapy is stopped.


breast milk- effects on nursing infants unknown. Carcinogencity potential with long-term exposure.

Avoid breastfeeding.

Smallpox vaccine (X)

CDC states smallpox vaccine is contraindicated during pregnancy, with 28 days of conception and in persons who might have close contact with pregnant

women within 28 days of their vaccination.CI

CDC states that breastfeeding women should not be vaccinated, however, if nursing woman is exposed she

should be vaccinated and stop breastfeeding.

Solifenacin (C)No human pregnancy studies. Animal studies imply

moderate risk. Best course is to avoid use during pregnancy.

+No human lactation studies. Drug likely excreted into breast milk. AAP considers other anticholinergics as

compatible. Risk to nursing infants unknown, but probably low.

Somatostatin (B) No human pregnancy studies.. ( see octreotide.) + No human lactation studies. ( see octreotide.)

Sorafenib (D)

No human pregnancy studies, animal studies imply risk. Drug inhibit angiogenesis. Manufacturer

recommends use of contraception during and for at least 2 weeks after completion of therapy.


breast milk- effects on nursing infants unknown. Contraindicated because of toxicity seen in adults:

diarrhea, rash, hemorrhage and hypertension.

Sotalol (B)D if 2nd or 3rd trimester.

Low risk, but few studies during 1st trimester. Potential for fetal growth retardation and reduced placental weight. If used near delivery, observe for

evidence of beta blockade.- Milk levels 3–5 times maternal serum levels. Could

cause bradycardia and hypotension.

Spectinomycin (C) No adverse effects reported. + No studies available.

Spironolactone ( C, D for gestational hypertension)

No adverse effects reported; however, potential risk of antiandrogenic effects. Diuretics not

recommended for gestational hypertension.+

Unknown if spironolactone is excreted into breast milk, minimal amount of metabolite found in breast milk,

probably insignificant . Effects on nursing infants unknown. AAP considers it compatible with

breastfeeding.

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A B C D

SSKI (Potassium Iodide) (D) Contraindicated. +Long term ingestion of high doses of iodine carry an

unknown risk to the infant. AAP considers potassium iodide as compatible with breast feeding, but states that the infants thyroid may be affected. Consider

monitoring infant's thyroid function.

St. John's Wort (C)

Limited studies available. Herbal product with lack of standardization of components and presence of

contaminants. May expose fetus to unintended chemicals.

-Unknown if any of the components are excreted into

breast milk or if they pose a risk to nursing infant. One infant with jaundice reported.

Stavudine (C)

Human studies are limited, however animal studies imply low risk to developing fetus. US Dept. of

Health and Human Services guidelines states HIV infected patinets should continue use of antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh potential

fetal risks.


breast milk .. Effect on nursing infant is unknown. CDC recommends HIV infected mothers in developed


Streptokinase (C) No adverse effects reported. + No human lactation studies. Risk of exposure is low.

Streptomycin (D)May cause eighth cranial nerve damage and

ototoxicity Risk of deafness small. +Excreted into breast milk. No adverse effects reported

and because of poor absorption, oxotoxicity is not a risk. Observe for changes in bowel flora, allergic

reactions and use caution in interpreting culture results with sepsis evaluation. Compatible with breast feeding.

Streptozocin (D)Teratogenic in several animal species, also has mutagenic and carcinogenic effects. Should be

considered a teratogen.CI

No human lactation studies. Drug likely excreted into breast milk. Risk for severe toxicity- avoid

breastfeeding.

Succimer (C)

No human pregnancy studies. Produces fetotoxicity and teratogenicity in animals. If used during

pregnancy- monitor effects on maternal and fetal zinc and copper metabolism.


breast milk- effects on nursing infant unknown. Because drug used for treatment of lead or other heavy

metal poisoning, breastfeeding is contraindicated.

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A B C D

Succinylcholine (C) Not teratogenic.May cause respiratory depression in infant with genetic trait for atypical cholinesterase. +

Drug is rapidly metabolized to inactive metabolite, therefore significant amounts would not appear in

breast milk. Compatible.

Sucralfate (B) No adverse effects reported. + Drug minimally excreted into breast milk.

Sufentanil (C,D if long term or high amounts near term)

Not a major risk. Dose-related respiratory depression and negative effects on neurobehavior may occur in

the infant.+

Use during lactation is not expected. No human lactation studies. Drug likely excreted into breast milk.

Effects are unknown.

Sulbactam (B)Given with ampicillin. No adverse effects reported.

Compatible.Observe for bacteria resistence or superinfection in the newborn.

+Drug likely excreted in breast milk. Effects on nursing infants unknown. Observe for changes in bowel flora,

allergic reactions and use caution in interpreting culture results with sepsis evaluation. AAP considers it


Sulfasalazine (B/D near term)No increase in congenital anomalies. May increase risk of jaundice and kernicterus when given near

term.- May cause bloody diarrhea in nursing infants. AAP

recommends to give with caution.

Sulindac (B/Dif 3rd trimester or near delivery)

No congenital anomalies reported. May cause closing of ductus arteriosus in utero, PPHN,

suppresion of renal function, small risk of congenital malformations and inhibition of labor.

-No human lactation studies. Risk of toxicity. Because of prolonged half-life, use safer alternatives- diclofenac,

fenoprofen, flurbiprofen, ibuprofen, ketoprofen, ketorolac and tolmetin during breast feeding.

Sumatriptan (C)

Not an animal teratogen- produces embryo and fetal developmental toxicity. Human pregnancy data too limited to assess risk. Avoid use during pregnancy.

Four cases of VSD reported.+

Excreted into breast milk, absorption from GI tract is inhibited so amount reaching nursing infant is probably

nonexistent.. AAP considers it compatible with breastfeeding.

Sunitinib (D)

No human pregnancy studies, animal studies imply risk. Inhibits angiogenesis, essential for development of the fetus. Women of childbearing age should use

contraception.-

No human lactation studies. Drug and active metabolite likely excreted in breast milk. Unknown effects for infant, but likely risk of toxicity affecting

multiple organ systems.

Tacrolimus (C)May cause reversible hyperkalemia, renal toxicity,

IUGR, and premature delivery.Questionable association with cardiomyopathy.

+Excreted into breast milk. Based on available data,

breast feeding does not appear to be a risk to nursing infant. Infant plasma levels may be monitored.


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A B C D

Tamoxifen (D)

Avoid during pregnancy because of toxicities reported in animals, increased incidence of

abortions, and possible human teratogenicity. Disorder of sexual differentaition reported in 1

female infant.

CI Inhibits lactation. Because of the potential toxicities of the drug, breast feeding is contraindicated.

Tazobactam (B) No reports of use during pregnancy. Probably safe. +Few studies available, Drug likely excreted into the

breat milk in low concentrations. Adverse effects rare, monitor infant for allergic reaction, changes in bowel

flora and use caution in interpreting culture results with sepsis work up.

Telithromycin (C)

No studies of use during human pregnancy, animal studies imply low risk. Drug may cause severe

hepatocellular hepatitis. Best course is to avoid use during pregnancy.

+

No human lactation studies. Drug likely excreted into breast milk. Effects on nursing infant unknown.

Monitor infant for changes in bowel flora, allergic reactions, use caution in interpreting culture results

with sepsis work up.Watch for diarrhea, nausea, vomiting, headache and dizziness. Probably

compatible.

Telmisartan (C 1st tri, D 2nd,3rd tri)

Potential to cause teratogenicity and severe fetal and neonatal toxicity identical to that seen with ACE

inhibitors. Observe blood pressure and renal function in the infant. Reports of anuria, IUGR, PDA,

prematurity, oligohydramnios, and hypocalveria.

+No human lactation studies. Drug likely excreted into breast milk. Effects on nursing infant are unknown.

AAP states ACE inhibitors compatible with breast feeding.

Temazepam (X)

Few human studies, animal studies imply risk. Potential drug interaction between temazepam and

diphenhydramine resulted in stillbirth. Avoid this combination.

-Excreted into breast milk. AAP considers its effect

unknown but may be of concern. Observe for sedation and changes in feeding.

Temozolomide (D)No studies during human pregnancy, animal studies imply risk. Women of childbearing age should use

contraception.CI

No human lactation studies. Drug and active agent likely excreted into breast milk. Breast feeding

contraindicated. If breast feeding, observe nursing infant for alopecia, nausea, vomiting, anorexia,

headache, constipation, fatigue, thrombocytopenia and convulsions.

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A B C D

Tenecteplase (C)

No studies during human pregnancy, animal studies does not suggest direct risk. Maternal hemorrhage is

a major risk. Therapy should not be withheld if maternal condition warrants therapy.

-No human lactation studies available. Not known if excretion into breast milk occurs. Pharmacokinetic

properties of drug suggest exposure in nursing infant would be minimal.

Teniposide (D)Contraindicated during 1st trimester. Risk during

2nd and 3rd trimester unknown. Occupational exposure may be a risk to fetus.

- No human lactation studies available.

Tenofovir (B)

Few human studies, however animal studies imply low risk . US Dept. of Health and Human Services

state HIV infected patients should continue antiviral therapy during pregnancy(except for efavirenz). Maternal benefits outweigh potential fetal risks.

CINo human studies. Drug likely excreted in breast milk. Effect on nursing infant is unknown. CDC recommends

HIV infected mothers in developed countries do not breastfeed.

Terbinafine (B)No human pregnancy studies, animal data imply low risk, however until human data available, avoid use

during pregnancy.-

Excreted into breast milk- effects on nursing infant are unknown. Prolonged length of therapy increases risk of

toxicity. Avoid use during breastfeeding.

Terbutaline (B)May cause transient fetal tachycardia and neonatal

hypoglycemia. One case report of myocardial necrosis reported.

+ AAP considers it compatible with breastfeeding.

Terconazole (C)No animal teratogenicity, embryotoxicity at high

doses. No association between drug and congenital defects have been reported.

+ No human lactation studies.

Terfenadine (C) No adverse effects reported. +Excreted into breast milk in clinically insignificant

amounts. No human lactation studies. AAP considers it compatible with breastfeeding.

Testosterone (X)

Contraindicated. First trimester use causes masculinization of the female fetus, clitoral

hypertrophy in female fetuses, fused or partially fused labia and possibly absent vagina- (nonadrenal

female pseudohermaphroditism.) Clitoral hypertrophy occurs with exposure at any gestational age. Animal studies show changes in CNS of females.

CI Suppresses lactation. Long-term effects in nursing infants unknown. Breastfeeding is contraindicated.

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A B C DTetanus/Diphtheria Toxoids & Acellular Pertussis Vaccine (C)

No adverse effects. + Compatible.

Tetracaine (C)Few human pregnancy studies. Topical

administration does not appear to represent risk of embryo and/or fetal harm.

+No human lactation studies. Low amounts in systemic

circulation. Risk to nursing infant appears to be non existent. .

Tetracycline (D)

Tetracyclines should be avoided during pregnancy because they may cause adverse effects, including

permanent yellow-brown staining of teeth, inhibition of bone growth, maternal liver toxicity, and

congenital defects.

+Drug likely excreted in low concentrations. Theoretical

dental staining and inhibition of bone growth is unlikely. Observe infant for changes in bowel flora,

allergic reaction and use caution in interpreting culture results with sepsis evaluation. Compatible.

THC (Marijuana) (X)

Contraindicated. Reports of low birth weight, leukemia, increased risk of ventricular septal defects,

increase the effects of alcohol,adverse effects on neurobehavior, mild neonatal withdrawal. All

reported effects require further study.

CI AAP states the drug should not be used during breastfeeding.

Theophylline (C)

May cause transient tachycardia, irritability, and vomiting at birth, especially if mother’s serum concentrations above therapeutic range. No

congenital defects reported. Theophylline withdrawal with apneic spells responsive to

theophylline therapy reported.

+ AAP considers compatible with breastfeeding. Monitor for irritability.

Thiabendazole (C) No adverse effects reported, but data limited. + No human lactation studies. Drug likely excreted into breast milk- effects on nursing infants unknown.

Thiamine (A/C if above RDA)Compatible. Risk factor C if used in doses above

RDA. + AAP considers it compatible with breastfeeding.

Thioguanine (D)May cause fetal malformations and chromosomal abnormalities.IUGR and intrauterine fetal death in

two cases.CI

No human lactation studies. Risk of toxicity, including tumors in nursing infants- breastfeeding is

contraindicated.

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A B C D

Thioridazine (C) Probably safe for use in pregnancy. - No studies available.

Thiotepa (D)Avoid in 1st trimester. Medication is teratogenic in animals. Studies limited in 2nd and 3rd trimester. CI

No human lactation studies. Drug likely excreted in breast milk. Risk for toxicity, esp. tumors in nursing

infants- breastfeeding is contraindicated.

Thiothixene (C) Limited information, low risk in animal studies. - No human lactation studies. Drug likely excreted into breast milk- effects on nursing infants unknown.

Thyroglobulin (A) Compatible. + Compatible with breastfeeding.

Thyroid (A) . Probably safe for use in pregnancy. + Compatible with breastfeeding.

Thyrotropin (C) Does not cross the placenta. Compatible. + Compatible with breastfeeding.

Tiagabine (C)

Not teratogenic or embryo/fetal toxic in animals. Human pregnancy studies too few to document risk. Safest course is to avoid in 1st trimester. If necessary

to continue therapy, folic acid 4mg/day supplementation is recommended.


Ticarcillin (B) No adverse effects reported. +Drug excreted into breast milk in small amounts. No

adverse effects reported. Observe for changes in bowel flora, allergic reactions and use caution in interpreting culture results with sepsis evaluation. Compatible with

breast feeding.

Ticlopidine (B)

Not teratogenic in animals. Human pregnancy studies too few to document risk. May cause life-threatening blood dyscrasias. Other antiplatelet agents available and should be used if possible.


breast milk, effects on nursing infants unknown. Potential life-threatening blood dyscrasias imply

breastfeeding should be avoided.

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A B C D

Tiludronate (C)

No human pregnancy studies. Risk of developmental toxicity in animals. Long half-life from bone suggest

drug will remain for prolonged periods following discontinuation of therapy. Monitor fetal skeleton

and infants for hypocalcemia.

+No human lactation studies.. Drug likely excreted

intobreast milk in low amounts. Effects on nursing infants are unknown but probably not clinically

significant.

Timolol ( CD if 2nd or 3rd trimester or used systemic)

May cause IUGR, bradycardia and hypotension in infants exposed near term. Carefully monitor blood

pressure and heart rate.-

Monitor for hypotension ,bradycardia and other signs of B blockade. AAP states it is compatible with

breastfeeding.

Tinidazole (C)Few human pregnancy studies. Chemically related to

metronidazole, which is the preferred drug. Avoid during 1st trimester.

-Excreted into breast milk- effects on nursing infants

unknown. AAP classifies as drug whose effect is unknown but may of concern. If single dose given, hold

breastfeeding for 12 to 24 hours.

Tinzaparin (B)Probably does not cross placenta and thus presents a

minimal risk to the fetus. +No human lactation studies. Drug would be inactivated

in GI tract and risk to nursing infant would be insignificant. Compatible with breast feeding.

Tipranavir (C)

Few heman studies, however animal studies imply low risk to developing fetus. US Dept. of Health and Human Services states HIV infected patinets should

continue antiviral therapy during pregnancy, with the exception of efavirenz. Maternal benefits outweigh

potential fetal risks.

CI Inhibits lactation. Because of the potential toxicities of the drug, breast feeding is contraindicated.

Tizanidine ( C)

No human pregnancy studies. Animal studies imply toxicity . No congenital defects seen in animal

studies. Risk of maternal hypotension. Avoid during 1st trimester.

-No human lactation studies. Drug likely excreted into breast milk-effects on nursing infants unknown, but Breastfeeding not recommended because of risks to adults: sedation, hypotension, liver injury, psychotic

symptoms.

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A B C D

Tobramycin (C/D from manufacturuer)

No congenital defects reported. Potentiation of magnesium sulfate induced neuromuscular

weakness. Monitor infant for ototoxicity because this has occurred with other aminoglycosides (eg,

kanamycin and streptomycin).

+

Excreted into breast milk. No adverse effects reported and because of poor absorption, oxotoxicity is not a

risk. Observe for changes in bowel flora, allergic reactions and use caution when interpreting culture

results with sepsis evaluation. Compatible with breast feeding.

Tocainide (C)No human pregnancy studies, no teratogenticity in

animal studies. + No human lactation studies. Drug likely excreted into breast milk- effects on nursing infants unknown.

Tolazamide (C)May cause prolonged neonatal hypoglycemia when

given near term. -No human lactation studies. Drug likely excreted into

breast milk- effects on nursing infants unknown but hypoglycemia is possibleg.

Tolbutamide (C)May cause prolonged neonatal hypoglycemia when given near term.Insulin preferred drug . Has caused

neonatal thrombocytopenia. -

Excreted into breast milk. Effects on nursing infants unknown but hypoglycemia is potential toxicity. AAP

classifies as compatible with breastfeeding. Monitor for jaundice.

Tolmetin (C, D if 3rd trimester or near delivery)

Associated with congenital anomalies reported. May cause closing of ductus arteriosus in utero, PPHN,

and inhibition of labor.+

Excreted into breast milk- clinical significance of levels unknown. AAP considers it compatible with

breastfeeding.

Tolterodine (C)No human pregnancy studies, few animal studies

imply low risk. Avoid during 1st trimester. - No human lactation studies. Drug likely excreted in breast milk. Effects on nursing infants unknown.

Topiramate (C)

Teratogenic in animals, hypospadias has been observed but definite relationship not established. Safest to start folic acid supplementation prior to

conception. Should avoid during 1st trimester, use lowest effective dose.

-

Excreted into breast milk. No adverse effects noted in limited number of exposed nursing infants. However,

risk of: fatigue, somnolence, difficulty with concentration, aggressive reaction, confusion, difficulty

with memory, ataxia, purpura, epistaxis, infections, anorexia and weight loss. Observe nursing infants for

signs of toxicity.

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A B C D

Topotecan (D)No human pregnancy studies. Animal studies imply

risk. Women of childbearing age should use contraception.

CI

No human lactation studies. Drug likely excreted into breast milk- effects on nursing infant unknown. Risk for

serious toxicity- bone marrow suppression, nausea, vomiting, headache, diarrhea, constipation, abdominal

pain, alopecia and hepatic toxicity. Breastfeeding is contraindicated.

Tramadol (C)Few human pregnancy studies, case of neonatal

withdrawal reported. + Drug and its active metabolite excreted into breast milk. Effects on nursing infants unknown.

Trandolapril (C 1st tri, D 2nd,3rd tri)

Unconfirmed risk in 1st trimester. Appear to be teratogenic in 2nd and 3rd trimester. Renal defects,

hypocalvaria,hypotension, IUGR are some of reported effects. Monitor newborn blood pressure

and renal function.

+No human lactation studies. Drug likely excreted in

breast milk. Effects on nursing infants unknown. AAP classifies captopril and enalapril( similar medications),

as compatible with breast feeding.

Tranexamic Acid (B)No adverse effects reported in use during pregnancy

in animals and humans. + Excreted into breast milk. Amount absorbed by nursing infant is unknown and effects on infant are unknown.

Trastuzumab (B)

Few human pregnancy studies- no congenital malformations reported. Fetal renal toxicities-

oligohydraminos or anhydramnios observed in 3 cases. Remains in maternal system 5 months after

last dose. Avoid use during pregnancy.

-

No human lactation studies.. Drug likely excreted into breast milk. Unknown effects but potential risks- left

ventricular dysfunction, CHF, anemia, leukopenia, diarrhea and increased risk of infection. Manufacturer recommends avoid breastfeeding during treatment and

for 6 months after last dose.

Trazodone (C)Low risk for major malformations. No studies

evaluating developmental toxicities. - Excreted in milk. Effects unknown but of concern.

Treprostinil (B)

No human pregnancy studies, animal studies imply low risk. Maternal hypotension which could cause a decrease in placental perfusion and fetal hypoxia can

occur.-

No human lactation studies. Drug likely excreted in to breast milk- effects on nursing infants unknown but

potential for adverse effects exist- headache, nausea, vomiting, restlessness and anxiety. Avoid

breastfeeding.

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A B C D

Tretinoin (Systemic) (D)Teratogenic. Retinoic acid embryology- CNS,

craniofacial, cardiovascular and thymic anomalies. Contraindicated in pregnancy.

+Vitamin A and probably tretinoin are natural substances

of breast milk. No studies available on amounts excreted into breast milk or risk to nursing infant.


Tretinoin (Topical) (C)When used topically, teratogenic risk thought to be

minimal. +Probably minimal absorption , therefore amounts in

breast milk should not be significant. Probably compatible.

Triamcinolone ( C) (D if in 1st trimester)

Human and animal studies imply risk. Growth retardation, orofacial clefts possible with systemic

administration.+

No human lactation studies. Drug likely excreted into breast milk. The effects on nursing infant are unknown.


Triamterene ( C, D for gestational hypertension)

Risk during pregnancy, may decrease placental perfusion, maternal hypovolemia. + No human lactation studies. Drug likely excreted into

breast milk. Effects unknown. Probably compatible.

Trimethoprim (C)

Folate antagonist, so there is risk of fetal malformations. Teratogenic, defects include

cardiovascular, neural tube defects, and possibly oral clefts.

+ Excreted into breast milk in low concentrations, Compatible.

Trimethoprim/ sulfamethoxazole (C)

Contains trimethoprim a folate antagonist, so there is risk of fetal malformations. Teratogenic, defects

include cardiovascular, neural tube defects, and possibly oral clefts.

+ Excreted into breast milk in low concentrations, AAP classifies as compatible.

Tripelennamine (B) No adverse effects reported. +No human lactation studies. Probably compatible,

however, manufacturer states breast feeding is contraindicated because of increased sensitivity of

infants to antihistamines.

Triprolidine (C) No adverse effects reported. + Excreted into breast milk in low amounts. AAP considers compatible with breastfeeding.

Trospium (C)No studies during human pregnancy, animal studies imply low risk. Best to avoid use during pregnancy +

No human lactation studies. Drug likely excreted but in limited amounts. Exposure in nursing infants should be

low and risk of toxicity minimal.

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A B C D

Urokinase (B)Low risk. One case of separation of the placenta with

hemorrhage. + No human lactation studies. Probably compatible.

Valacyclovir (B) No adverse effects reported. +Lack of adverse effects seen with acyclovir, the primary metabolite of valacyclovir, it is considered compatible

with breastfeeding.

Valerian(B)

Herbal product. Very few human and animal studies. Conflicting opinions regarding use during pregnancy. Safest approach is to avoid use, however inadvertent

exposure probably presents low risk.- No human lactation studies, Avoid during

breastfeeding.

Valganciclovir (C)No human pregnancy studies. Animal studies for

ganciclovir imply high risk to embyro/fetus. CIActive metabolite, ganciclovir has risk of causing severe toxicity; HIV-1 infected mothers in developed countries should not breastfeed. Breastfeeding contraindicated.

Valproic Acid (D)

Increased risks of neural tube defects and defects of head, face, digits, GU tract, and mental and physical

growth.IUGR, distress at birth, transient hyperglycemia, fetal distress, hepatoxicity and

hyperbilirubinemia may also be a risk.

- Compatible with breast-feeding per AAP.One report of anemia and thrombocytopenia purpura in an infant.

Valsartan (C 1st tri, D 2nd,3rd tri)

Few human studies. Not a risk for anomalies in 1st trimester. During 2nd and 3rd

trimester:oligohydramnios, anuria,IUGR, prematurity, PDA, anuria, hypocalvaria, fetal limb

contractures, pulmonary hypoplasia and craniofacial deformation. Follow renal function and blood

pressure in the infant.

+No human lactation studies.. Drug likely excreted in

breast milk. The effects unknown. AAP considers compatible with breastfeeding.

Vancomycin (B)No reports of congenital defects.Transient fetal

bradycardia has occurred. +Excreted into breast milk. Effects on nursing infant

unknown. Observe for changes in bowel flora, allergic reaction and use caution in interpreting culture results

in sepsis workup. Compatible with breastfeeding.

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Varenicline (C)

No human pregnancy studies available. Animal data imply low risk, and smoking causes developmental toxicity. Benefit appears to outweigh unknown risk

to embryo/fetus.-

No studies available. Drug likely excreted in breast milk.Effects on infant unknown. Observe infant for

sleep disturbance, constipation, flatulence, nausea and vomiting.

Varicella vaccine (C)Potential infection of the placenta and developing

fetus + Compatible with breastfeeding.

Vasopressin (B)No fetal malformations reported. May cause uterine

contractions (infrequent). + Compatible with breastfeeding.

Vecuronium (C)Few human studies, fetal risk unknown early in

pregnancy but no toxicities reported during 2nd and 3rd trimester.

+ No human lactation studies available. Low if any excretion into breast milk. Probably compatible.

Venlafaxine (C,D if 2nd and 3rd trimester)

Not a major risk for major congenital malformations. Associated with SABs, low birth weight, prematurity, neonatal serotonin syndrome, neonatal behavioral syndrome, risk of abnormal neurobehavior beyond

the neonatal period and respiratory distress.

- Excreted into breast milk. The long-term effects have not been adequately studied. Unknown but may be a

risk.

Verapamil (C)May cause decreased uterine blood flow,

hypotension, and fetal bradycardia. + Excreted into breast milk. Limited human lactation studies but probably compatible.

Vidarabine (C) Few human pregnancy studies. Teratogenic in

animal studies. + No human lactation studies. Unknown if excreted into breast milk.

Vinblastine (D)Risk for congenital defects and embryo/fetal toxicity.IUGR and LBW have been reported. CI

No human lactation studies available. Because of risk of toxicity to nursing infant, women should not

breastfeed.

Vincristine (D)

Congenital defects may occur. Pancytopenia,transient bone marrow

hypoplasia,chromosomal aberrations and IUGR can occur.

CINo human lactation studies available. Because of risk of

toxicity to nursing infant, women should not breastfeed.

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Vinorelbine (D)Few human studies, risk of anemia, leukopenia,

thrombocytopenia. Avoid in 1st trimester and near delivery.

CI No human lactation studies available. Contraindicated because of bone marrow depression seen in adults.

Vitamin A (A/X if over RDA)Severe maternal Vitamin A deficiency is teratogenic.

Doses above the RDA are also teratogenic. + Compatible with breastfeeding. Unknown risk if mother on high doses.

Vitamin B12 (Aif RDA dose, C if above) No adverse effects reported. + Compatible with breastfeeding.

Vitamin C (A if RDA dose, C if above)No reports directly link this vitamin to congenital

defects in humans. May cause scurvy in infant if used at high doses during pregnancy.


Vitamin D (A if RDA dose/D if therapeutic doses)

. High doses of vitamin D teratogenic in animals but not in humans. Because vitamin D raises calcium

levels, may be associated with supravalvular aortic stenosis syndrome, which is often associated with


+ Compatible with breastfeeding. Monitor for increased calcium levels if mother is taking pharmacologic doses.

Vitamin E (A if RDA dose, /C if above) No adverse effects reported. + Compatible with breastfeeding.

Vitamins, Multi (A) No adverse effects reported. + Compatible with breastfeeding.

Voriconazole (D)No human pregnancy studies, animal data imply risk

for toxicity and teratogenicity. -No studies during human lactation. Drug likely excreted

into breast milk. Risk of toxicity in neonatal period. Avoid breastfeeding while taking medication.

Vorinostat (D)No human pregnancy studies. Drug probably crosses

placenta and exposure of embryo/fetus expected. CINo human lactation studies. Drug likely excreted into

breast milk. Effects on nursing infant unknown but risk of toxicity. Breastfeeding contraindicated.

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Warfarin (X)

Major risk of congenital defects. May cause fetal warfarin syndrome (hypoplastic, flattened nasal

bridge; stippled epiphyses; and other features, such as low birth weight, eye defects, development

retardation, congenital heart disease, and death). May also cause hemorrhage. If anticoagulation is

required during pregnancy, heparin given at lowest effective dose is probably safer choice.

+Maternal warfarin therapy is compatible with breastfeeding. Other oral anticoagulants are

contraindicated in lactating women.

Zafirlukast (B)Few studies during human pregnancy. ACOG and

ACAAI feel use in pregnant patients with asthma who have had response to treatment prior to pregnancy.

-Excreted into breast milk, however the effects are unknown. The manufacturer recommends against

breastfeeding.

Zalcitabine (C)

Few human studies; animal reproductive toxicity is of concern. U.S. Department of Health and Human Services state that HIV1 infected patients should

continue antiviral therapy during pregnancy( efavirenz not recommended).

CINo studies on use during human lactation. Drug likely excreted in breast milk. It is recommended that HIV-1


Zaleplon (C)No human pregnancy studies . Not a teratogen in

animals, however long term treatment could result in toxicity. Restrict use to short-term.

+ Excreted into breastmilk in small amounts, effects on nursing infant are unknown.

Zanamivir (C)No human pregnancy studies. Animal data imply low

risk . No human data. +No studies on use during human lactation. Drug likely

excreted in breast milk. Effects are unknown, but risk is low.

Zidovudine (C)

Neonatal anemia and IUGR may occur. No pattern of birth defects found. If indicated, benefits of maternal AZT treatment to the infant outweigh the risks of AZT-

induced toxicity.CI It is recommended that HIV-1 infected mothers in

developed countries do not breastfeed.

Zileuton ( C)No human pregnancy studies. Animal data imply

that drug be avoided during pregnancy. +No data on use during human lactation. Drug likely

excreted in breast milk however the effects are unknown.

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Ziprasidone (C)No human pregnancy studies. Animal studies imply

risk. Until human studies available, pregnancy should be avoided while taking this drug.

-No studies on use during human lactation. Drug likely excreted in breast milk. Effects are unknown. Concern

for changes in neurobehavior of infant.

Zoledronic Acid (D)Only one patient with use in pregnancy, animal

studies imply risk. Manufacturer recommends drug should not be used in pregnancy.

-No studies on use during human lactation. Drug likely excreted in breast milk. Until more data is available,

avoid use of drug during breastfeeding.

Zolmitriptan (C)No human pregnancy studies, animal studies imply

low risk. + No studies on use during human lactation. Drug likely excreted in the breast milk. Effects are unknown.

Zolpidem (B)

Few human pregnancy studies , no congenital malformations seen; however not enough data available to access risk. If chronic use consider

withdrawal in infant but not reported.+

Excreted into breast milk in small amounts that would indicate few adverse effects if any would occur in

nursing infant. May cause sedation and changes in feeding.

Zonisamide ( C)

Few human pregnancy studies . Congenital anomalies seen in two infants, but other

anticonvulsants (known teratogens) were used. Until more data is known, use of drug during pregnancy

should be avoided.

-Excreted into breast milk with high concentration. No

adverse effects noted. If breastfeeding, monitor infant. Long-term effects on infants unknown.

Based on data from:

Drugs in Pregnancy and Lactation, Briggs, Freeman and Yaffe, Eds. 8th Ed, Lippincott Williams & Wilkins, Philadelphia 2008

Medication Safety in Pregnancy and Breastfeeding, Koren Ed. 1st Ed McGraw Hill, New York, 2007Clinician's Pocket Reference 2009, Gomella, Haist and Adams, Eds. McGraw Hill, New York, 2009

Manufacturers package inserts as of October, 2008.

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