Obstetrics Book

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Medications in LactationAka: Lactation Safe Medications, Contraindicated Drugs in Lactation

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  1. See Also
    1. Medications in Pregnancy
  2. General
    1. Assess benefit versus risk for medication
    2. Choose medications safe for Lactation
    3. Use medications with short half lives
    4. Patient Education
      1. Ask physician or pharmacist before new medication
  3. Antibiotics considered safe in Lactation
    1. Penicillin Antibiotics
    2. Cephalosporin Antibiotics
    3. Erythromycin (concentrated in human milk)
    4. Clindamycin
  4. Analgesics considered safe in Lactation
    1. Acetaminophen (Tylenol)
    2. Aspirin (AAP recommends use with caution)
    3. Codeine
    4. Ibuprofen
  5. Anticonvulsants in Lactation
    1. Very low breast milk concentrations (highly bound)
      1. Phenytoin (Dilantin)
      2. Tiagabine (Gabitril)
      3. Valproate
    2. Low to moderate breast milk concentrations
      1. Carbamazepine
      2. Phenobarbital
      3. Lamotrigine
      4. Topiramate (Topamax)
      5. Zonegran
      6. Primidone (metabolized in part to phenobarbital)
        1. Risk of infant Sedation
        2. AAP recommends using with caution
    3. High breast milk concentration (minimally bound)
      1. Gabapentin
      2. Levetiracetam (Keppra)
      3. Ethosuximide (AAP: Compatible with Lactation)
  6. Antidepressants considered potentially safe in Lactation
    1. AAP recommends use with caution
      1. Unknown longterm effect
      2. Use if benefits outweigh risk
    2. Preferred agents
      1. Fluoxetine
      2. Sertraline
  7. Cardiovascular medications in Lactation
    1. Antihypertensives safe in Lactation
      1. Captopril
      2. Enalapril (no data on Lisinopril)
      3. Hydrochlorothiazide (may decrease milk production)
      4. Methyldopa
    2. Miscellaneous drugs considered safe in Lactation
      1. Digoxin
      2. Coumadin
      3. Heparin (not excreted into breast milk)
    3. Cardiovascular medications to avoid in Lactation
      1. Avoid Acebutolol
      2. Avoid Amiodarone
  8. Assorted medications considered safe in Lactation
    1. Magnesium Sulfate
    2. RhoGAM
    3. Rubella vaccine
  9. Herbs and Teas considered safe in Lactation
    1. Avoid Caffeine more than 2 beverages per day
    2. Herbs
      1. Chamomile
      2. Garlic
      3. Ginger
      4. Ginseng
      5. Valerian
    3. Teas
      1. Chicory
      2. Orange Spice
      3. Peppermint
      4. Raspberry
      5. Red bush tea
      6. Rose hips
  10. Contraindicated Drugs in Lactation
    1. Medications that decrease milk production
      1. Bromocriptine
      2. Diuretics
    2. Chemotherapeutic Medications
      1. Cyclophosphamide
      2. Cyclosporine
      3. Doxorubicin
      4. Methotrexate
      5. Gold salts
      6. Propylthiouracil
      7. Methimazole
    3. Radioactive Chemicals used in Nuclear Medicine
      1. Gallium-67 (in breast milk up to 14 days)
      2. Indium-111 (in breast milk up to 20 hours)
      3. Iodine 131 (in breast milk up to 14 days)
      4. Radioactive Sodium (in breast milk up to 96 hours)
      5. Technetium-99m (in breast milk up to 3 days)
    4. Miscellaneous Medications
      1. Dextroamphetamine
      2. Ergotamine
      3. Lithium
      4. Metronidazole
      5. Chloramphenicol
      6. Potassium iodide
      7. Phenindione (anticoagulant)
    5. Drugs of Abuse
      1. Amphetamine
      2. Cocaine
      3. Heroin
      4. Marijuana
      5. Nicotine
      6. Phencyclidine
  11. References
    1. (2000) Harriet Lane Handbook, Mosby, p. 913
    2. Briggs (1998) Drugs in Pregnancy and Lactation, 5th ed
    3. Middleton (1998) Allergy, Mosby, p. 941
    4. (1994) Pediatrics 93:137
    5. Howard (2001) Pediatr Clin North Am 48(2):485

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