Medication and breastfeeding: an explanatory list for mothers and professionals

This list, containing about 750 medicament’s, is specifically developed for mothers and professionals. If you are in need of a ‘usually safe’ or ‘not safe’ medicine, check with your doctor and show him the list for professionals.

Paediatrician Erica Post compiled this list [third version], based on the latest book of Thomas Hale [2008] and the latest recommendations of the American Academy of Paediatrics [2001]. This third update and translation was facilitated by the Kenniscentrum Borstvoeding with the help of Stefan Kleintjes, dietician, in September 2008 and June 2009.

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Look here for the pdf of this medication and breastfeeding – explanatory list. Useful if you want to make a print!

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Explanation for users

The medicaments in this list are ordered alphabetically and we have used the therapeutic moiety of the medication as it’s name. For example Valium is named Diazepam. Valium is a brand name for Diazepam.
Furthermore, the list contains, apart form the name of the medication and its function, the advice of Thomas Hale [L1 – L5] and the advice of the AAP. The information in the fifth column is used for attentions, not listed in the other columns, but things to remember. For example, antibiotics can cause Candida-infection.

The advices of Dr. Thomas Hale, pharmacologist

boek_hale2010.jpgThomas Hale’s advices are listed in the third column. Hale updates his advices every two years [last update 2008]. His advices are based on all known pharmokinetic aspects important for breastfeeding mothers and their baby’s. Hale’s information is also based on the most recent published scientific articles. Based on this information he determines the lactation risk category.

Thomas Hale lactation risk categories:

  • L1 Safest
  • Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bio-available in an infant.

  • L2 Safe
  • Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

  • L3 Moderately safe
  • There are no controlled studies in breastfeeding women, however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.

  • L4 Possibly hazardous
  • There is positive evidence of risk to a breastfed infant or to breast milk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant, e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective.

  • L5 Contraindicated
  • Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medicament that has a high risk of causing damage to an infant. The risk of using the drug in breastfeeding women clearly overweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

The advices of the American Association of Paediatrics [AAP]

The American Association of Paediatrics [AAP] also gives advice about medication and breastfeeding. Their information has a different categorizing and they have less information than Thomas Hale. When Hale and the AAP do not agree, Hale is usually stricter. For example, when medication has a bad influence on the quantity of milk, Hale lists this as negative while the AAP doesn’t. The advices of the AAP are listed in the fourth column.

Lactation risk categories by AAP

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  • Compatible: can be combined with breastfeeding.
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  • Caution: can be combined with breastfeeding under certain circumstances.
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  • Cessation: can not be combined with breastfeeding.

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Cisplatinum

DRUGFUNCTIONHALEAAPCOMMENT
A
AcamprosateAnti alcoholismL3
AcarboseAnti diabetesL3?
AcebutololAnti hypertensiveL3 [hypotension]Compatible
Acetaminophen [paracetamol]AnalgesicL1Compatible
AcetazolamideDiureticL2Compatible
AcetohexamideAnti diabetesL3 [observe for hypoglycemia]?
AciclovirAnti viralL2Compatible
AcitretinAnti psoriaticL5Compatible Low in mothers milk but probably very toxic to a growing child
AdalimumabAnti reumaticL3?
AdefovirAnti hepatitisL4?
AlbendazoleAnti wormsL3?
AlbuterolBronchodilatationL1?
AlemtuzumabAnti leukemicL3-L4?
AlfentanilNarcotic AnalgesicL2?
Allergy injectionsDesensibilisationL1?
AllopurinolAnti goutL2Compatible
AlmotriptanAnti migraineL3 [none reported via milk]?
AlprazolamAnti anxietyL3Concern?
AlteplaseThrombolyticL3 [Short T 1/2=45minutes]?
AmantadineAnti viralL3 [reduces prolactin]?
AmikacineAntibioticL2?Candida?
AminosalicylacidAnti tubercularL3 [diarrhea?]Caution
AmiodaroneAnti arrhythmicL5 [M/P=5-13! hypothyroidy?]Concern?
AmitriptylineAnti depressantL2Concern?
Amlodipine BesylateAnti hypertensiveL3 [bradycardia? hypotension?]?
Amoxicilline (with Clavulanate)AntibioticL1CompatibleCandida?
AmphetaminAmfetamineL5 [agitation convulsions]Cessation
Amphotericine BAnti fungalL3 [none reported via milk; absorption unlikely]?
AmpicillineAntibioticL1?Candida?
Anthrax vaccineVaccinationL3?
AntipyrineAnalgesicL5?
Ascorbic acidVitaminL1?
AspartameSweetenerL1[L5 for child with PKU]?
AspirinAnalgesicL3 [Reye syndrome?]Caution
AtenololAnti hypertensiveL3 [bradycardia, hypotension?]Caution
AtomoxetineAnti ADHDL4 [none reported via milk, insomnia? Irritable?]?
Atorvastatine calciumReduces cholesterolL3 [cholesterol is important!]?Better not to use during breast feeding
AtropineAnti cholinergicL3?
AzapropazoneAnalgesicL2Compatible
AzathioprineImmuno-suppressantL3 [bone marrow suppressive!]?
AzelastineAnti histamineL3 [bitter taste, drinks less?]?
AzithromycineAntibioticL2CompatibleCandida?
AztreonamAntibioticL2CompatibleCandida?
B
BaclofenMuscle relaxantL2Compatible
BariumContrast substanceL1?
BeclomethasonSteroidL2?
BenazeprilAnti hypertensiveL3 [hypotension]?
Bendro flumethiazideDiureticL4 [reduces lactation!]Compatible
BenzonatateAnti coughL3 [little known]?
BepridilAnti hypertensiveL4 [long T 1/2 and high oral availability]?
BetamethasonSteroidL3 [none reported]?
BetaxololAnti hypertensiveL3 [hypotension?]?
Bethanechol chlorideCholinergicL4 [diarrhea, GI symptoms]?
BisacodylLaxativeL2?
BisoprololAntihypertensiveL3 [hypotension? hypoglycemic?]?
BMR vaccineVaccineL2 [light rash?]?
BromidesSedativeL5 [sedative]Compatible
BromocriptineProlactin suppression [no longer used because of side effects by the mother]L5 [reduces milk production]Caution
BrompheniramineAnti histamineL3 [insomnia, irritable]?
BudesonideSteroidL3 [none reported via milk]?
BumetanideDiureticL3 [none reported via milk]?
BupivacaineLocal anestheticL2?
BupropionAnti depressive, helps to stop smokingL3 [reduces milk production?] Concern?
BuspironeAntianxietyL3?
BusulfanCytostaticL5 [cytotolytic]?
ButabarbitalSedativeL3 [sedative]?
ButalbitalSedative, AnalgesicL3 [sedative]?
ButorphanolNarcoticL3 [Sedative]Compatible
C
CabergolineAnti prolactinL4 [reduces milk production!]?
CafeineStimulantL2 [sometimes irritable and insomnia]Compatible
CalcitoninCalcium metabolismL3 [reduces milk production?]?
CannabisHallucinogenL5 [sedation, long T 1/2]Cessation
CaptoprilAnti hypertensiveL2 [hypotension?]Compatible
CarbamazepineAnti convulsantL2Compatible
Carbamide peroxideAnti bacterial, Whitening agentL1?
CarbenicillineAntibioticL1?Candida?
CarbidopaDopamine antagonistL3?
CarbimazolThyroid inhibitorL3 [but PTU is preferred]Compatible
CarisoprodolMuscle relaxantL3 [Sedation?]?
CarteololAnti hypertensiveL3 [hypotension? hypoglycemia? lethargy?]?
CarvedilolAnti hypertensiveL3 [hypotension? hypoglycemia?]?
CefaclorAntibioticL1?Candida?
CefadroxilAntibioticL1CompatibleCandida?
CefazolinAntibioticL1CompatibleCandida?
CefdinirAntibioticL2?Candida?
CefditorenAntibioticL3 [none reported via milk ]?Candida?
CefepimeAntibioticL2?Candida?
CefiximeAntibioticL2 [diarrhea?]?Candida?
Cefoperazon SodiumAntibioticL2 [diarrhea?]?Candida?
CefotaximAntibioticL2 [diarrhea?]CompatibleCandida?
CefotetanAntibioticL2 [diarrhea?]?Candida?
CefoxitinAntibioticL1CompatibleCandida?
Cefpodoxim proxetilAntibioticL2 [diarrhea?]?Candida?
CefprozilAntibioticL1CompatibleCandida?
CeftazidimeAntibioticL1 [diarrhea?]CompatibleCandida?
CeftibutenAntibioticL2 [diarrhea?]?Candida?
CeftriaxonAntibioticL2 [diarrhea? oral – difficult to attain]CompatibleCandida?
CefuroximAntibioticL2 [diarrhea?]?Candida?
CelecoxibNSAIDL2?
CephalexinAntibioticL1 [diarrhea?]?Candida?
CephalothinAntibioticL2 [diarrhea?]?Candida?
CephapirinAntibioticL1 [diarrhea?]?Candida?
CephradinAntibioticL1 [diarrhea?]?Candida?
CerivastatinAnti cholinergic, lowers cholesterolL3 [cholesterol is important!]?Better not use during breast feeding
CetirizineAnti histamineL2 [sedative?]?
Chickenpox vaccineVaccine [living]L4 [only in emergency situations]?
ChloralhydrateSedativeL3 [sedative?]Compatible
ChlorambucilCytostaticL5 [cytotoxic]?
ChloramphenicolAntibioticL4 [sensibilisation?]Concern?Candida?
ChlordiazepoxideBenzodiazepineL3 [sedative?]?
ChlorhexidineAnti microbalL4 [when sprayed on the nipple bradycardia]?
ChloroquineAnti malarialL3 [diarrhea? hypotension?]Compatible
ChlorothiazideDiureticL3 [reduces milk production?]Compatible
ChlorpheniramineAnti histaminieL3 [sedative?]?
ChlorpromazineTranquillizerL3 [sedative]Concern?
ChlorpropamideAnti diabeticL3 [hypoglycemia?]Concern?
ChlorprothixeenTranquillizerL3 [sedative?]Concern?
ChlorthalidonDiureticL3 [reduces milk production?]Compatible
CholestyramineCholesterol binderL1 [oral availability 0 %]?
Chorionic GonadotropinPlacental hormoneL3 [none reported via milk]?
CimetidineReduces gastric acidL2Compatible
CiprofloxacinAntibioticL3 [diarrhea, changes color of teeth!]CompatibleCandida?
CisaprideStimulates stomach and bowels[seldom used]L2?Rhythm deregulator?
CytostaticL4 [cytotoxic, M/P more as 1]Compatible
CitalopramAnti depressiveL3 [sedative]?
ClarithromycineAntibioticL1?Candida?
ClemastineAnti histamineL4 [sedative, irritable, convulsions]Concern?
ClindamycineAntibioticL2 [diarrhea?]CompatibleCandida?
ClobazamBenzodiazepineL3 [sedative?]?
ClomifeenOvulation stimulationL3 [reduces early milk production]?
ClomipramineAnti depressiveL2Concern?
ClonazepamBenzodiazepineL3 [sedative?]?
ClonidineAnti hypertensiveL3 [hypotension? reduces milk production?]?
ClorazepateBenzodiazepineL3 [sedative, constipation]?
ClotrimazolAnti fungusL1?
CloxacillineAntibioticL2 [diarrhea?]?Candida?
ClozapineSedativeL3Concern?
CocaineStimulantL5 [choking, vomiting, diarrhea, irritation, hypertension, tachycardia, dangerous]Cessation
CodeineAnalgesicL4 [sedative?]Concern
Coenzym Q10Co-factorL3?
ColchicineAnalgesic for goutL4 [somewhat unknown, bone marrow depression?]
ColesevelamReduces cholesterolL1 [oral availability 0%]?
CorticotropineStimulates cortisol releaseL3?
Coumarin derivatesAnti coagulantL2Compatible
Cromolyn SodiumAnti allergyL1?
CyclizineAnti histamineL3 [none reported via milk]?
CyclobensaprineMuscle relaxantL3 [none reported via milk, sedation?]?
CyclopentolateDilates pupilsL3
Cyclo-phosphamideCytostaticL5 [bone marrow suppressant]Caution
CycloserineAnti tuberculosisL3 [none reported via milk]Compatible
CyclosporineImmune SuppressionL3 [cytotoxic?]Caution
CyproheptadineAnti histamineL3 [none reported via milk, sedative?]?
CytarabineCytostaticL5 [cytotoxic]?
D
DactinomycineCytostaticL5 [cytotoxic]?
DalteparineAnticoagulantL2?
DanazolAndrogenL5 [reduces milk production? none reported via milk]?
DantroleneMuscle relaxantL4 [none reported via milk]?
DapsoneAntibioticL4 [hemolytic anemia?]CompatibleCandida?
DaptomycineAntibioticL3 [none reported via milk and adverse effects unlikely]?Candida?
DEETInsect repellantL3 Avoid use on large areas?
DeferoxamineIron binderL3 [none reported via milk and adverse effects unlikely]?
DesipramineAnti depressantL2Concern?
DesloratadineAnti histaminicL2?
DesmopressineAnti diuretic hormoneL2?
DexamethasoneSteroidL3 [avoid high doses]?
DexfenfluramineDiet pillL4 [none reported via milk]?
Dextro amphetamineCNS StimulantL3 [none reported via milk but caution]Caution, cessation
Dextro methorphanAnti cough syrupL1?
DiazepamSedativeL3[L4 chronic use] lethargic or sedationConcern?
DibucaineLocal anestheticL3 [none reported via milk]?
DiclofenacNSAIDL2?
DicloxacillineAntibioticL1?
DicyclomineAnti cholinergicL4 [apnea, constipation, tachycardia]?
DiethylpropionEffects hunger feeling [amphetamine]L5 [possibly less thirst, agitation effectssleeping pattern]?
Diethylstilbestrol (DES)EstrogenL5?
DiflunisalNSAIDL3 [none reported via milk]?
DigitoxineHeart stimulantL3 [none reported via milk]?
DigoxineCardiac stimulantL2Compatible
DimenhydrinateAnti motion sicknessL2?
DiphenhydramineAnti histamineL2 [none reported via milk possible sedation?]?
DiphenoxylateAnti diarrheaL3 [possible constipation? Sedative?]?
DipivefrineAnti glaucomaL2?
DipyridamolOpens veins, anti coagulantL3 [none reported via milk, seems no point]?
DirithromycineAntibioticL3 [none reported via milk]?Candida?
DisopyramideAnti arrhythmicL2Compatible
DisulfiramInhibitor of alcohol metabolismL5 [dangerous in combination with alcohol]?
Dolasetron MesylateAnti nauseaL3 [none reported via milk]?
DomperidonStimulates stomach activity [and milk production]L1Compatible
DopamineAdrenergic stimulantL2 [no absorption]?
DothiepinAnti depressiveL2Concern?
Doxazosin MesylateAnti hypertensionL4 [M/P=20!]?
DoxepinAnti depressiveL5[sedative, bad drinking, hypotonic, spitting, jaundice]Concern?
DoxercalciferolVitamin DL3 [hyper calcemie?]?
DoxorubicineCytostaticL5Cessation
DoxycyclineAntibioticL3 [L4 in chronic use, teeth color changes and lessens bone growth?]?Candida?
DoxylamineAnti histamineL4 [none reported via milk, sedative?]?
DroperidolAnti nauseaL3 [none reported via milk, sedative?]?
E
EchinaceaImmune stimulantL3 [none reported via milk]?
EculisumabMonoclonal antibodyL3 [none reported via milk]?
EfalisumabMonoclonal antibodyL3 [no data available]?
EletriptanAnti migraineL2?
EnalaprilAnti hypertensionL2Compatible
EncainideAnti arrhythmicL3 [extreme caution]?
EnoxacinAntibioticL3 [none reported via milk, caution, see Norfloxacin]?Candida?
EnoxaparinAnti coagulantL3 [none reported via milk, adverse effects unlikely]?
EphedrineStimulantL4 [none reported via milk but observe for agitation etc]?
EpinephrineStimulantL1?
EpoprostenolVasodilatorL3 [none reported via milk, unlikely to be absorbed]?
Ergonovine MaleateAnti postpartum bleedingL3 [reduces prolactin?]?
ErgotamineAnti migraineL4 [reduces milk production by chronic use, nausea?]Caution
ErythromycineAntibioticL2
L3 early postnatal [pylorus-stenosis!]
Compatible
EscitalopramAnti depressantL2?
EsmololBeta BlockerL3 [none reported via milk]?
EsomeprasolAntacidL2?
EstazolamBenzodiazepineL3 [none reported via milk, sedation?]?
EszopicloneHypnoticL3 [none reported via milk, sedation?]
EthambutolAnti tubercularL2Compatible
EthanolAlcoholL3 [sedative, irritable, bad drinking, reduces milk production, taste]Compatible
EthosuximideAnti convulsantL4 [sedative, bad drinking, irritable]Compatible
EthotoinAnti convulsantL3 [none reported via milk but see Phenytoin?
EtretinateAnti psoriaticL5 [early closing of the fontanel and epiphyses]?
EzetimibeReduces cholesterolL3 [no data available, cholesterol is important!]?Better not to use during breast feeding
F
FamciclovirAnti viralL2?
FamotidineAntacidL1?
FelbamateAnti convulsiveL4 [none reported via milk, serious side effects?]?
FelodipineAnti-hypertensiveL3 [none reported via milk]?
Fennel [in high concentrations or etheric oil]Estrogenic?L4 [reduces milk production]
FenoprofenNSAIDL2?
FentanylOpiumL2Compatible
FexofenadineAnti histamineL2Compatible
FilgastimIncreases blood amountL2?
FlavoxateUrine spasmolyticL3 [none reported via milk]?
Flecainide AcetateAnti arrhythmicL3 [nausea?, dizziness, constipation?]Compatible
FloxacillineAntibioticL1?Candida?
FluconazolAnti fungalL2Compatible
FludrocortisonSteroidL3 [none reported via milk]?
FlunarizineAnti hypertensionL4 [none reported via milk accumulation?]?
FlunitrazepamBenzodiazepineL3[L4 by chronic use, sedative?]?
FluoresceinDiagnostic dyeL3 [do not use with light therapy because of possible light toxic]Compatible
FluorideEnamel hardenerL2Compatible
FluorouracilCyto staticL5?
FluoxetineAnti depressiveL2 older child
L3 neonate [crying, cramps, reported once]
Concern?
FluphenazinePsychotherapyL3 [none reported via milk, sedative?]?
FlurazepamSedativeL3 [none reported via milk, sedative?]?
FlurbiprofenAnalgesicL2?
FluticasonSteroidL3 [none reported via milk, adverse effects unlikely]?
FluvastatinReduces cholesterolL3 [none reported via milk but cholesterol is necessary]?
FluvoxamineAnti depressiveL2Concern?
Folic acidVitaminL1Compatible
Formoterol FumarateBronchodilatationL3 [none reported via milk, adverse effects unlikely]?
FoscarnetAnti viralL4 [kidney toxic? deposits in teeth and bones?]?
FosinoprilAnti hypertensionL3 older child
L4 neonate
?
FosphenytoineAnti convulsiveL2Compatible
FurazolidonAntibioticL2 older child
L4 neonate [hemolytic anemia]
?Candida?
FurosemideDiureticL3 [reduces milk production?]?
FytomenadionVitamin K1L1Compatible
G
GabapentinAnti convulsiveL3 [none reported via milk]?
GadodiamideContrast bij MRI’sL3 [none reported via milk, adverse effects unlikely]?
GadopentetateContrast for MRI’sL2Compatible
GadoteridolContrast for MRI’sL3 [none reported via milk, adverse effects unlikely]?
Gallium-67 CitrateRadioactive isotopeL4 [radio active! no breast feeding for 14 days!]Temporary stop breast feeding
GentamicineAntibioticL2?Candida?
Gentian violetAnti fungalL3 [avoid high doses and long usage]?
GlimepirideReduces sugar levelL4 [none reported via milk, hypoglycemia]?
GlipizideReduces sugar levelL3 [milk levels undetectable]?
GlucosamineAnti arthritisL3 [none reported via milk, adverse effects unlikely]
GlyburideReduces sugar levelL2?
GoldAnti rheumaticL5 [remains in the body very long, months!]Compatible
GrepafloxacinAntibioticL4 [diarrhea? arthropathy?]?
GriseofulvineAnti fungalL2?
H
Halazepamanti anxietyL3?
HaloperidolAnti psychoticL2Concern?
HalothaanAnestheticL2Compatible
HeparineAnti coagulantL1?
Hepatitis vaccineVaccineL2?
HeroineNarcoticL5 [sedative, tremor, restless, bad drinking]Cessation
Hexa chloropheneAnti septicL4 [toxic?]?
HistamineDiagnostic agentL3
HydralazineAnti hypertensiveL2 [hypotension?]Compatible
Hydrochloor-thiazideDiureticL2 [reduces milk production?]Compatible
Hydrocortison [local]SteroidL2?
HydromorphoneAnalgesicL3 [sedative?]?
HydroxychloroquineAnti rheumatic and -malariaL2Compatible
HydroxizineAnti histamineL1 [sedative?]?
HyoscyamineAnti cholinergicL3 [none reported via milk]?
I
I-radioactiveL4Temporary stop [sometimes complete]
IbuprofenAnalgesicL1Compatible
ImipenemAntibioticL2?Candida?
ImipramineAnti depressantL2 [sedation? dry mouth?]Concern?
IndapamideDiureticL3 [none reported via milk]?
IndomethacineNSAIDL3Compatible
InfliximabAnti rheumaticL2?
InsulineAnti diabetesL1?
Ipratropium BromideBronchodilatorL2?
IronMetal supplementL1?
IsoniazideAnti tuberculoseL3 [hepatitis? weakness? spitting?]Compatible
IsoproterenolBronchodilatorL2?
IsosorbideOpens veinsL3?
IsotretinionVitamin A derivateL5 [teratogen]?
IsradipineAnti hypertensionL3 [low blood pressure? sleepiness? low heartbeat?]?
ItrakonazolAnti fungalL2?
IvermectinAnti parasiticL3Compatible
K
Kalium IodideAnti thyroid glandL4?
KanamicineAntibioticL2CompatibleCandida?
Kava-kavaSleeping pillL5?
KetoconazolAnti fungalL2Compatible
Ketoprofen[none reported via milk, adverse effects unlikely] Pain killerL3?
KetorolacAnalgesicL2Compatible
Kombucha teaHerbal teaL5?
L
LabetalolAnti hypertensionL2Compatible
LamivudineAnti viralL2?
LamotrigineAnti epilepticL3 [plasma levels 30% of maternal, no adverse effects noted]Concern?
LansoprasoleReduces gastric acid productionL3 [none reported via milk, adverse effects unlikely]?
LatanoprostAgainst glaucomaL3 [none reported via milk]?
LeadL5?
LeflunomideReduces infectionsL4 [malignancy-risk?]?
LepirudinAnti coagulantL2?
LetrozoleReduces oestrogen synthesisL4?
Leuprolide acetateGRH analogL5 [reduces milk production]?
LevalbuterolBronchodilatationL2?
LevetiracetamAnti-epilepticL3 [none reported via milk]?
LevobunololAnti glaucomaL3 [none reported via milk, observe for lethargy and apneu?]?
LevocabastineUsed for itchL2?
LevocarnitineDiet supplementL3 [no data]
LevodopaAnti ParkinsonL4 [reduces milk production]?
LevofloxacinAntibioticL3?Candida?
LevonorgestrelAnti conceptiveL2Compatible
LevothyroxineThyroid gland hormoneL1Compatible
LidocaineAnestheticL2Compatible
LincomicineAntibioticL2?Candida?
LindaneAnti schurftL4 [damages nervous system]?
LinezolidAntibioticL3 [diarrhea?]?Candida?
LiothyronineThyroid gland hormoneL2?
LisinoprilAnti hypertensiveL3 [none reported via milk, weakness? hypo tension?]?
LithiumAnti manic depressionL4 [effects heart rhythm, weakness?, control lithium levels]Caution
L-MethylfolateFolic acid metaboliteL3 [none reported via milk]?
LomefloxacinAntibioticL3 [none reported via milk]?Candida?
LoperamideAnti diarrheaL2Compatible
LoracarbefAntibioticL2?Candida?
LoratidineAnti histamineL1Compatible
LorazepamAnti fearL3 [none reported via milk, observe for sleepiness]Concern?
LormetazepamSedativeL3 [none reported via milk, milk levels extremely low]
LosartanAnti hypertensiveL3?
LovastatinReduces cholesterolL3 [cholesterol is important!]?Better discontinue during breast feeding
LoxapineTranquillizerL4?
LSDHallucinatorL5?
Lyme disease vaccineVaccineL2?
M
Magnesium hydroxide Laxative L1 ?
Magnesiumsulfate Anti epileptic and laxative L1 Compatible
Mannitol Diuretic L3
[temporary less milk production?]
?
Maprotiline Anti depressive L3 ?
MarcoumarAnti coagulantL2Compatiblesee Coumarin derivates
Mebendazole Anti parasitic L3 [reduces milk production?] ?
Meclizine Anti travel sickness L3 [none reported via milk] ?
Medroxy
progesteron
Hormone L1
[L4 during the first three days after birth]
Compatible
Mefloquine Anti malaria L2 ?
Melatonine Hormone L3 ?
Meloxicam Reduces infections L3 ?
Meningococcen vaccin Vaccine L1 ?
Menotropine Hormone L3 [reduces milk production?] ?
Meperidine [=Pethidine] Analgesic L2
[L3 when used shortly after birth, sedative]
Compatible Adverse effects increases with anti depressive medication
Mepindolol sulfate Bèta blocker L2 ?
Mepivacaine Local pain killer L3 [none reported via milk] ?
Meprobamate Anti fear L3 [none reported via milk, sedative?] ?
Mercaptopurine Anti cancer L3 ?
Mercury Mercury L5 ? Caution with removing amalgams
Meropenem Antibiotic L3 [none reported via milk] ? Candida?
Mesalamine Slows thyroid gland L3 [diarrhea?] Caution
Mesoridazine Anti psychoticum L4 [sedative!] Concern?
Metaxalon Muscle relaxant L3 ?
Metformin Anti diabetic L1 ?
Methacholine Broncho constriction L3 ?
Methadon Narcotic analgesic L3 Compatible
Methicilline Antibiotic L3 ? Candida?
Methimazol Slows thyroid gland L3 [none reported via milk] Compatible
Methocarbamol Muscle relaxant L3 ?
Methohexital Anesthetic L3 [none reported via milk adverse effects unlikely] Compatible
Methotrexate Anti cancer L3 for acute use
[L5 chronic use]
Cessation
Methscopolamine Against cramps L3 [none reported via milk, adverse effects unlikely] ?
Methyldopa Anti hypertension L2 Compatible
Methylergonovine Vasoconstrictor L2
[L4 chronic use]
?
Methylphenidate Anti ADHD L3 [none reported via milk, observe for insomnia and weight?] ?
Methylprednisolon Corticosteroid L2 [except for long term high dosage] Compatible
Metoclopramide Prolactin stimulation L2 Concern?
Metoprolol Beta blocker L3 [none reported via milk, observe for hypo tension? low heart activity?] Compatible
Metronidazole Antibiotic L2 [possible less drinking] Concern? Metallic flavor
Mexiletine Anti arrhythmic L2 Compatible
Miconazol Anti fungal L2 ?
Midazolam Sleeping pill L3 [none reported via milk] Concern?
Midodrine Anti hypotensive L3 [none reported via milk, hypertension? insomnia?] ?
Mifepristone Anti progesteron L3 [increases milk production] ?
Miglitol Anti diabetic L2 ?
Minocycline Antibiotic L3
[L4 by chronic use, changes teeth color and reduces bone grow]
? Candida?
Minoxidil Anti hypertension L2 Compatible
Mirtazapine Anti depressive L3 [none reported via milk, sedative?] ?
Misoprostol Prostaglandine L3 [none reported via milk, diarrhea? cramps?] ?
Mitoxantrone Anti MS L5 ?
Mivacurium Blocks muscle activity L2 ?
Moclobemide Anti depressive L3 [none reported via milk] ?
Modafinil Keeps awake L4 [reduces milk production?] ?
Mometason Corticosteroid L3 [none reported via milk] ?
Montelukast Anti astma L3 [none reported via milk] ?
Morfine Painkiller L3 [none reported via milk, maybe sedative by high dosages?] Compatible
Moxifloxacin Antibiotic L2 ? Candida?
Mupirocin Anti bacterial crème L1 ?
Mycophenolate Reduces immunity L4 ?
N
Nabumeton Anti-inflammatory L3 [none reported via milk] ?
Nadolol Anti hypertensive L4 [lots goes in mothers milk] Compatible
Nafcilline Antibiotic L1 ? Candida?
Nalbuphine Analgesic L2 ?
Nalidixine zuur Anti septic L3 [anemia?] Compatible
Naloxon Antagonist for morphine L3 ?
Naltrexone Narcotic antagonist L1
Naproxen Analgesic L3
[L4 by chronic use]
Compatible
Naratriptan Anti migraine L3 [none reported via milk] ?
Natalizumab Anti MS L3 [no data available] ?
Nebivolol Beta blocker L3 [neonatal hypo glycemia reported]
Nedocromil Anti asthmatic L2 ?
Nefazodone Anti depressive L4 [drowsiness, weakness, reduces growth] ?
Netilmicine Antibiotic L3 [none reported via milk, diarrhea?] ? Candida?
Nevirapine Anti HIV L3 [none reported via milk] ?
Nicardipine Anti hypertension L2 ?
Nicotine [chewing gum etc.] Against smoking L2 ?
Nicotinezuur Vitamin B3 L3 [none reported via milk] ?
Nifedipine Anti hypertensive L2 Compatible
Nimodipine Anti hypertensive L2 ?
Nisoldipine Anti hypertensive L3 [none reported via milk, hypotension? sedative?] ?
Nitazoxanide Anti parasites L3 [no data available] ?
Nitrazepam Sleeping pill L2 [short term] [sedation?] ?
Nitrendipine Anti hypertensive L2 ?
Nitrofurantoine Antibiotic L2 [don’t use in babies with G6PD deficiency or younger than one month] Compatible Candida?
Nitroglycerine Opens veins L4 [none reported via milk, methemo-
globinemia?]
?
Nitroprusside Hypotensive L4 ?
Nitrous oxide Anesthetic gas L3 [none reported via milk]
Nizatidine Reduces gastric acid L2 ?
Norethindrone Anti conceptive L1 ?
Norethynodrel Anti conceptive L2 [none reported via milk, may reduce milk production?] ?
Norfloxacin Antibiotic L3 [none reported via milk] ? Candida?
Nortriptyline Anti depressive L2 Concern?
Nystatine Antifungal L1 ?
O
Ofloxacine Antibiotic L2 Compatible Candida?
Olanzapine Anti psychotic L2 ?
Olmesartan Anti hypertension L3 [older babies] ?
Olopatadine Local antihistamine L2 ?
Olsalazine Anti inflammatory L3 [none reported via milk, in long term use diarrhea and cramps?] ?
Omeprazol Reduces gastric acid L2 ?
Ondansetron Anti nausea L2 ?
Orlistat Anti obesity L3 [none reported via milk, adverse effects unlikely] ?
Orphenadrine citrate Muscle relaxant L3 ?
Oseltamivir Anti-influenza L2 ?
Oxaprozine Analgesic L3 ?
Oxazepam Anti fear L3 [none reported via milk] ?
Oxcarbazepine Anti epileptic L3 [none reported via milk] ?
Oxybutynine Anti cramps L3 [less milk production?] ?
Oxycodone Analgesic L3 [none reported via milk, sedative?] ?
Oxytocine Stimulates delivery and TSR L2 ?
P
Paclitaxel Anti cancer L5 ?
Palonosetron Anti emetic L3 [no data available] ?
Pamidronate Bone resorption inhibitor L2 ?
Pantoprazol Reduces gastric acid L1 ?
Paracetamol Analgesic L1 Compatible
Paromomycin amoebicide L3 [no data available]
Paroxetine Anti depressive L2 [none reported via milk in numerous studies] Concern?
Penciclovir Antiviral L3 [none reported via milk] ?
Penicillamine For arthritis L4 ?
Penicilline G Antibiotic L1 [diarrhea?] ? Candida?
Pentazocine Analgesic L3 ?
Pentobarbital Hypnotic L3 [none reported via milk, sedation?] ?
Pentosal Polysulfate Analgesic L2 ?
Pentoxifylline Reduces blood viscosity L2 ?
Permethrin Insecticide L2 ?
Perphenasine Anti psychotic L3 [none reported via milk, sedation?] Concern?
Phenazopyridine Pain killer L3 [none reported via milk] ?
Phencyclidine Hallucinogen L5 Cessation
Phenobarbital Anti-epileptic L3 [sedation? withdrawal?] Caution
Phentermine Reduces appetite L4 [reduces drinking?] ?
Phenylephrine Constricts blood vessels L3 [None reported via milk] ?
Phenyl-propanolamine Anorexiant L2 [insomnia?]
Phenytoine Anti epileptic L2 Compatible
Pilocarpine Hypotensive L3 [none reported via milk, cramp, diarrhea?] ?
Pimecrolimus For dermatitis L2 (L4 on the nipple) ?
Pimozide Tranquillizer L4 ?
Pioglitazon Anti diabetic L3 [no data available] ?
Piperacillin Antibiotic L2 ? Candida?
Pirbuterol acetate Broncho-
dilatation
L2 [irritation? tremors?] ?
Piroxicam Analgesic L2 Compatible
PodofilotoxineAnti genital warts L3 [caution; after use, wait 4 hours before feeding] ?
Polio vaccine Vaccine L2 ?
Polyethyleen
glycol
Laxans L3 [none reported via milk] ?
Polymixine B sulfate Antibiotic L2 ? Candida?
Potassium Iodide Anti thyroid L4 ?
Povidon iodine Anti septic L4 [reduces thryoid-
gland function when used in large amounts?]
Compatible
Pramipexol Anti Parkinson L4 [reduces milk production] ?
Pramlintide acetate Anti diabetic L3 [first week] [none reported via milk]
L2 [following weeks, unlikely to enter milk]
?
Pravastatin Reduces cholesterol L3 [cholesterol is important!] ? Better not to use during breast feeding
Prazepam Anti fear L3 [none reported via milk, sedative?] Concern?
Praziquantel Anti worms L2 ?
Prazosin Anti hypertension L4 ?
Prednicarbate Corticosteroid crème L3 [not on nipple] [none reported via milk] ?
Prednison Corticosteroid L2 Compatible
Primaquine fosfate Anti malaria L3 [none reported via milk] ?
Primidone Anti epileptic L3 [sedative in neonatal period?] Caution
Procainamide Anti arythmicum L3 [hypo tension? liver function?] Compatible
Procaine Anesthetic L3 ?
Pro
chlorperazine
Reduces nausea L3 [none reported via milk, apnea?] ?
Progesteron Hormone L3 [none reported via milk, adverse effects unlikely, maybe less milk production in the first weeks] Compatible
Promethazine Anti histaminic L2 [none reported via milk, sedative? apnea?] ?
Propafenon Anti arythmicum L2 ?
Propofol Sedative L2 ?
Propoxyphene Analgesic L2 Compatible
Propranolol Beta blocker L2 [do not use in asthmatic children] Compatible
Propylthiouracil Anti thyroid L2 Compatible
Pseudo ephidrine Decongestant L3 [by acute usage]
L4 [by chronicle use, reduces milk production]
Compatible
Pyrantel Anti worms L3 [none reported via milk] ?
Pyrazinamide Anti tubercular L3 [none reported via milk] ?
Pyridostigmine Muscle stimulant L2 Compatible
Pyridoxine Vitamin B 6 L2
L4 in high dosage
Compatible
Pyrimethamine Anti malaria, folium acid antagonist L3 [carcinogen?] Compatible
Q
Quazepam Sedative L2 Concern?
Quetiapine fumarate Anti psychoticum L2 ?
Quinacrine Anti malaria L4 [by long term use] ?
Quinapril Anti
Hypertension
L2
L4 [in first days post partum]
?
Quinidine Anti arythmicum L2 [none reported via milk, liver function?] Compatible
Quinine Anti malaria L2 Compatible
Quinupristin Antibiotic L3 [none reported via milk] ? Candida?
R
Rabeprazol Reduces gastric acid L3 [none reported via milk] ?
Rabies vaccine Vaccine L3 [none reported via milk] ?
Ramelteon Hypnotic L3 [no data available] ?
Ramipril Anti hypertensive L3 [none reported via milk] ?
Ranitidine Reduces heartburn L2 ?
Remifentanil Analgesic L3 [none reported via milk, not absorbed] ?
Repaglinide Anti diabeticum L4 [hypo glycemic] ?
Reserpine Anti hypertensive L4 ?
Retapamulin Anti bacterial L3 [no data available, adverse effects unlikely] ?
Ribavirin Antiviral L4 ?
Riboflavin Vitamin B2 L1 Compatible
Rifampicine Antibiotic L2 Compatible Candida?
Rifaximin Antibiotic L3 [adverse effects unlikely] ? Candida?
Rimantadine Anti viral L3 [none reported via milk] ?
Risedronate For bone resorption L3 [none reported via milk] ?
Risperidon Anti psychotic L3 [none reported via milk] ?
Ritodrine L3 [none reported via milk] ?
Rizatriptan Anti migraine L3 [none reported via milk, sedative?] ?
Rofecoxib Analgesic L2 [cramps?] ?
Ropinirole Stimulates dopamine, against restless legs L4 [reduces milk production!] ?
Ropivacaine Local anesthetic L2 ?
Rosiglitazon Anti diabetic L3 [no data available] ?
Rosuvastin Calcium Reduces cholesterol L3 [no data available, cholesterol is important] ? Better not use during breast feeding
Rotigotine Dopamine agonist L4 [reduces milk production?] ?
Rubella vaccine Vaccine L2 [light signs of rubella?] ?
S
Saccharine Sweetener L3 [none reported via milk] ?
Sage Herb L4 [dry mouth, infected gums?] ?
Salicylic acid, topical Anti-acne L3 [no data available] ?
Saline laxatives Laxative L2 Compatible
Salmeterol Bronchodilatation L2 ?
Salsalate NSAID L4 [Reye syndrome?]
Scopolamine Anti cholinergicum L3 [none reported via milk, sedative? dry mouth?] ?
Secobarbital Sedativum L3 [none reported via milk, sedative?] Compatible
Selegiline MAO-inhibitor L4 ?
Selenium sulfide Local antibiotic L3 [none reported via milk, do not apply direct on nipple] ?
Senna laxatives Laxative L3 [thin bowel movements? no drug detected in milk] Compatible
Sertraline Anti depressive L2 Concern?
Sevoflurane Anesthetic L3 [none reported via milk] ?
Sibutramine Reduces appetite L4 ?
Silicone implants Mammoplasty L3 ?
Silver Sulfadiazine Local antibiotic L3 ?
Simvastatine Reduces cholesterol L3 [cholesterol is important!] ? Better not to use during breast feeding
Sincalide For cholecystography L3 [do not feed first two hours after use] ?
SintromAnti coagulantL2Compatiblesee Coumarin derivates
Sirolimus Immune suppressant L4 [reduces milk production?] ?
Sitagliptin Phosphate Anti diabetic L3 [no data available]
Smallpox Vaccine Vaccine L4 ?
Sodium Oxybate CNS depressant L3 [no data available, sedative?] ?
Solifenacin succinate For bladder overactivity L4 [sedation? dry mouth?] ?
Somatropine Growth hormone L3 [none reported via milk, adverse effects unlikely] ?
Sotalol Anti hypertensive L3 [none reported via milk, sedative? hypo tension?] Compatible
Spironolacton Diuretic L2 Compatible
St John’s Wort [Sint Jans kruid] Anti depressive L2 ?
Streptomycine Antibiotic L3 [none reported via milk] Compatible Candida?
Strontium89 chloride Radioactive L5 ?
Succimer Against lead poisoning L3 [none reported via milk] ?
Sucralfate Reduces stomach ulcers L2 ?
Sulconazol Nitrate Anti fungal L3 [none reported via milk] ?
Sulfamethoxazol Antibiotic L3 [none reported via milk, caution in jaundices babies and low G6PD] ? Candida?
Sulfasalazine Anti inflammatory L3 [diarrhea?] Caution
Sulfisoxazol Antibiotic L2 [caution by jaundices babies and low G6PD] Compatible Candida?
Sulpiride Anti depressive L2 ?
Sumatriptan succinate Anti migraine L3 [none reported via milk] Compatible
T
Tacrolimus Immune-suppressant L3 [none reported via milk] ?
Tamoxifen Anti cancer L5 ?
Tazaroteen Anti psoriatic L3 [none reported via milk, caution if more than 20 % of skin requires usage] ?
Tea tree oil Anti fungal L3 [none reported via milk] ?
Technetium 99m Radioactive L4 Stop breast feeding temporarily!
Tegaserod maleate Anti IBS L3 [none reported via milk] ?
Telbivudine Anti hepatitis B L4 ?
Telithromycine Antibiotic L3 [no data available] ? Candida?
Telmisartan Anti hypertension L3 [none reported via milk]
L4 [in neonatal period]
?
Temazepam Sleeping pill L3 [none reported via milk, sedative?] Concern?
Tenofovir disoproxil fumarate Anti retroviral L3 [no data available] ?
Terazosin HCL Anti hypertensive L4 ?
Terbinafine Anti fungal L2 ?
Terbutaline Broncho dilatation L2 Compatible
Terconazol Anti fungus L3 [none reported via milk] ?
Tetracycline Antibiotic L2 Compatible Candida?
Thallium 201 Radioactive L3 Stop breast feeding for 24-48 hours ?
Theofylline Broncho dilatation L3 [none reported via milk, irritation? insomnia?] Compatible
Thiabendazol Anti parasitic L3 [none reported via milk] ?
Thiopental sodium Anesthetic L3 [none reported via milk] Compatible
Thioridazine Anti psychotic L4 [neonatal apnea common] ?
Thiotixeen Anti psychotic L4 [sedative? seizures?] ?
Thyroid scan Radiographic scan L4 [possible thyroid suppression] ?
Thyrotropine Stimulates thyroid gland L1 ?
Tiagabine Anti convulsant L3 [none reported via milk, sleepiness?] ?
Ticarcilline Antibiotic L1 Compatible Candida?
Ticlopidine Anti coagulant L4 ?
Tigecycline Antibiotic L3 [tooth dicoloration?] ?
Timolol Anti-hypertensive L2 Compatible
Tinidazole Antibiotic L2 ? Candida?
Tinzaparin sodium Anti coagulant L3 [none reported via milk] ?
Tizanidine Muscle relaxant L4 ?
Tobramycin Antibiotic L3 [diarrhea?] ? Candida?
Tocainide Anti arythmicum L4 ?
Tolbutamide Anti diabeticum L3 [none reported via milk] Compatible
Tolmetin sodium Analgesic L3 [none reported via milk] Compatible
Tolterodine Reduces urine incontinence L3 [none reported via milk] ?
Topiramate Anti epileptic L3 [none reported via milk, sedative?] ?
Torsemide Diuretic L3 [none reported via milk] ?
Tramadol HCL Analgesic L3 [none reported via milk, sedative?] ?
Trastuzumab Anti cancer L4 ?
Trazodone Anti depressant L2 Concern?
Tretinoine Reduces acne L3 [when used locally]
L4 [when used orally]
?
Triamcinolon Corticosteroid L3 [none reported via milk] ?
Triamterene Diuretic L3 [none reported via milk] ?
Triazolam Sleeping pill L3 [none reported via milk, sedative?] ?
Trimeprazine Reduces itch L3 [none reported via milk, sedative?] ?
Tri metho-
benzamide
Reduces vomiting L4 ?
Trimethoprim Antibiotic L2 Compatible Candida?
Tripelennamine Anti histamine L4 [sedative? sleep apnea?] ?
Triprolidine Anti histamine L1 [sedative?] Compatible
Triptorelin pamoate LHRH analog L3 [none reported via milk, adverse effects unlikely]
Tropicamide Ophthalmic agent L3 [wait 3-4 hours before feeding] ?
Tropisetron Reduces vomiting L3 [none reported via milk] ?
Trovafloxacin Antibiotic L4 ? Candida?
Tuberculose skin test L2 ?
Typhoid vaccine Vaccine L3 [none reported via milk, killed species suggested] ?
U
Ursodiol Gal acid L3 [none reported via milk] ?
V
Valacyclovir Anti viral L1 ?
Valerian Herb L3 [none reported via milk] ?
Valganciclovir Anti viral L3 [no data available] ?
Valproic acid Anti epileptic L2 ?
Valsartan Anti hypertension L3 ?
Vancomicine Antibiotic L1 ? Candida?
Varencline Smoking cessation L4 ?
Varicella vaccine Vaccine L2
L5 In immuno compromised children
?
Varicella zoster infection Chickenpox L4 [no breast feeding unless guarded with VZIG] ?
Vasopressin Anti diuretic L3 [none reported via milk] ?
Venlafaxine Anti depressive L3 [no data available] ?
Verapamil Anti hypertension L2 Compatible
Verteporfin For macula degeneration L3 [interrupt breast feeding for 24 hours]
Vigabatrin Anti convulsant L3 [none reported via milk] ?
Vitamin A Vitamin A L3 [when not higher than 5000 IU/day] ?
Vitamin B 12 Vitamin B 12 L1 Compatible
Vitamin D Vitamin D L2 Compatible
Vitamin E Vitamin E L2 [when not applied on nipple] ?
W
WarfarineAnti coagulantL2Compatible
X
Y
Yellow fever vaccine Vaccine L3 [if older than 6 months]
L4 [if younger than 6 months]
[none reported via milk]
?
Z
Zafirlukast Anti astma L3 [none reported via milk] ?
Zaleplon Sleeping pill L2 ?
Zanamivir Anti viral L3 [no data available] ?
Zidovudine Anti viral L3 [high blood levels in babies?] ?
Zink salts Crèmes etc. L2 ?
Ziprasidone Anti psychotic L4 ?
Zolmitriptan Anti migraine L3 [none reported via milk] ?
Zolpidem tartrate Sleeping pill L3 [poor feeding? sleepiness?] Compatible
Zonisamide Anti convulsive L5 [very high blood levels!] ?
Zopiclone Sleeping pill L2 ?
Zuclopenthixol Anti psychotic L3 [none reported via milk]

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boek-hale2008.jpg

Literature and further reading

Footnote

  • This list may be copied and distributed without further permission as long as the sources [URL] are mentioned, and only when it is under no circumstances used violating the WHO-code of substitutes for breast milk.

Copyrights

© Erica Post, peadiatrician
© Kleintjesconsult | Kenniscentrum Borstvoeding – Stefan Kleintjes, nutritionist

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