Drug Use in Pregnancy & Lactation · Page 1 of 39 Department of Pharmaceutical Care Drug Use in...
Transcript of Drug Use in Pregnancy & Lactation · Page 1 of 39 Department of Pharmaceutical Care Drug Use in...
Page 1 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
The following tables summarize safety of drug use in pregnancy and lactation.
Medications of herbal origin are excluded from the list.
Under the column "Drug-Pregnancy Categories", letters A, B, C, D, and X signify the FDA Pregnancy categories.
These five categories indicate the potential of a systemically-absorbed drug to cause birth defects; the key differentiation among the categories rests upon the reliability of documentation and the risk: benefit ratio.
FDA Pregnancy Categories:
A : Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote.
B : Either animal-reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.
C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.
D : There is positive evidence of human fetal risk, but the benefit from use in pregnant women may be acceptable despite the risk (If the drug is needed for life threatening situations or for serious diseases for which safer drugs can not be used or are ineffective).
X : Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
For drugs not FDA approved; other classification systems were used to identify the pregnancy categories, whenever possible, the two other systems used are:
1. Micromedex Pregnancy Ratings:
Fetal risk cannot be ruled out
Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during pregnancy.
Fetal risk has been demonstrated
Evidence has demonstrated fetal abnormalities or risks when used during pregnancy or in women of childbearing potential. An alternative to this drug should be prescribed during pregnancy or in women of childbearing potential.
Fetal risk is minimal The weight of an adequate body of evidence suggests this drug poses minimal risk when used in pregnant women or women of childbearing potential.
2. Australian Drug Evaluation Committee (ADEC) Pregnancy Category Definitions
A : Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.
B1 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.
B2 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.
B3 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
significance of which is considered uncertain in humans.
C : Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.
D : Drugs which have caused, are suspected to have caused, or may be expected to cause an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.
X : Drugs that have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.
Note: For drugs in the B1, B2 and B3 categories, human data are lacking or inadequate and sub-categorization is therefore based on available animal data. The allocation of a B category does not imply greater safety than the C category. Drugs in category D are not absolutely contraindicated in pregnancy (e.g. anticonvulsants). Moreover, in some cases the 'D' category has been assigned on the basis of 'suspicion'.
If there was no data under the previous three categorizations, the drug-pregnancy category is assigned as "N/A"
Data for medication use during breast feeding, are complied from FDA data, WHO data and Micromedex Lactation Ratings:
1. WHO Lactation Ratings:
Avoid breastfeeding
Avoid breastfeeding if possible. May inhibit lactation
Avoid breastfeeding if possible. Monitor infant for side effects
Compatible with breastfeeding
Compatible with breastfeeding. Monitor infant for side effects
WHO documentation states insufficient data
2. Micromedex Lactation Ratings:
Infant risk cannot be ruled out
Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during breastfeeding
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Infant risk has been demonstrated
Evidence and/or expert consensus has demonstrated harmful infant effects when used during breastfeeding. An alternative to this drug should be prescribed or patients should be advised to discontinue breastfeeding.
Infant risk is minimal The weight of an adequate body of evidence and/or expert consensus suggests this drug poses minimal risk to the infant when used during breastfeeding
Milk effects are possible
Evidence suggests this drug may alter milk production or composition. If an alternative to this drug is not prescribed, monitor the infant for adverse effects and/or adequate milk intake
Abbreviations used in the tables:
AAP: American Academy of Pediatrics
APR: Australian Pregnancy Ratings
FDA: U.S. Food and Drug Administration
IU: International Unit
N/A: no data available
MLR: Micromedex Lactation Ratings
MPR: Micromedex Pregnancy Ratings
RDA: Recommended daily allowance
WHO: World Health Organization
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Abatacept C Excretion in breast milk unknown/not recommended (Possible toxicity)
Abiraterone X Not indicated for use in women
Acarbose B Excretion in breast milk unknown/not recommended
Acetaminophen [Paracetamol] C Excreted in breast milk/use caution
Acetaminophen [Paracetamol] and Codeine
Refer to Individual Agents
Refer to Individual Agents
Acetaminophen [Paracetamol] and Codeine and Caffeine
C Excreted in breast milk/not recommended
Acetaminophen [Paracetamol] and Tramadol
C Excreted in breast milk/not recommended
Acetazolamide C Excreted in breast milk/not recommended
Acetic Acid C Excretion in breast milk unknown/use caution
Acetylcysteine B Excretion in breast milk unknown/use caution
Aciclovir [Acyclovir] (Systemic, Topical)
B Excreted in breast milk/use caution
Activated Charcoal MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/use caution
Adalimumab B Excreted in breast milk/use caution
Adapalene C Excretion in breast milk unknown/use caution
Adefovir C Excretion in breast milk unknown/not recommended
Adenosine C Excretion in breast milk unknown/not recommended
Ado-Trastuzumab D Excretion in breast milk unknown/not recommended
Aescin No data available No data available
Aflibercept C Excretion in breast milk unknown/not recommended
Agomelatine (P) ADEC*: B1 MLR: Infant risk cannot be ruled out
Albendazole C Excreted in breast milk/use caution
Albumin C MLR: Infant risk cannot be ruled out
Alendronate C Excretion in breast milk unknown/use caution
Alfacalcidol No data available Excreted in breast milk/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Alfuzosin B Excretion in breast milk unknown
Alirocumab No data available Excreted in breast milk/not recommended
Allopurinol C Excreted in breast milk/use caution
Alpha-Lipoic Acid No data available Excretion in breast milk unknown
ALPRAZolam (C) D Excreted in breast milk/not recommended
Alprostadil C (Muse) Not intended for use by lactating women
Alteplase C Excretion in breast milk unknown/use caution
Aluminum Hydroxide B MLR: Infant risk cannot be ruled out
Amantadine C Excreted in breast milk/not recommended
Ambroxol No data available Excreted in breast milk/not recommended
Amethocaine (Tetracaine) C Excretion in breast milk unknown/use caution
Amidotrizoate [Diatrizoate] Meglumine [P]
C Briggs: No human data; probably compatible
Amikacin D Excreted in breast milk/not recommended
Amiloride B Excreted in breast milk/contraindicated
Amino Acids C Excretion in breast milk unknown/use caution
Aminophylline C Excreted in breast milk/not recommended
Amiodarone D Excreted in breast milk/not recommended
Amitriptyline C Excreted in breast milk/not recommended
Amlodipine C Excretion in breast milk unknown/not recommended
Amlodipine and Atorvastatin X Excretion in breast milk unknown/contraindicated
Amlodipine and Olmesartan D Excretion in breast milk unknown/not recommended
Amlodipine and Valsartan D Excretion in breast milk unknown/not recommended
Amlodipine, Valsartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Ammonium Chloride C Briggs: No human data; probably compatible
Amoxicillin B Excreted in breast milk/use caution
Amoxicillin and Clavulanic Acid B Excreted in breast milk/use caution
Amphotericin-B B Excretion in breast milk unknown/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Ampicillin B Excreted in breast milk/use caution
Ampicillin and Sulbactam B Excreted in breast milk/use caution
Anastrozole X Excretion in breast milk unknown/not recommended
Anidulafungin B Excretion in breast milk unknown/use caution
Antihemophilic Factor (Human, Recombinant)
C Excretion in breast milk unknown/use caution
Apixaban B Excretion in breast milk unknown/not recommended
Apomorphine C Excretion in breast milk unknown/not recommended
ARIPiprazole (P) C Excreted in breast milk/not recommended
Ascorbic Acid (Vitamin C) C Excreted in breast milk/use caution
Aspirin (Acetylsalicylic Acid) D Excreted in breast milk/use caution
Atenolol D Excreted in breast milk/use caution
Atenolol and Chlortalidone [Chlorthalidone]
D Excretion in breast milk unknown/use caution
Atomoxetine C Excretion in breast milk unknown/use caution
AtorvaSTATin X Excretion in breast milk unknown/contraindicated
Atosiban No data available Excreted in breast milk/contraindicated
Atropine B/C (Product Specific) Excreted in breast milk/use caution
Axitinib D Excretion in breast milk unknown/not recommended
AzaCITIDine (P) D Excretion in breast milk unknown/contraindicated
AzaTHIOprine D Excreted in breast milk/not recommended
Azelaic Acid B Excretion in breast milk unknown/use caution
Azelastine C Excretion in breast milk unknown/use caution
Azithromycin (Ophthalmic) B Excretion in breast milk unknown/use caution
Azithromycin (Systemic) B Excreted in breast milk/use caution
Bacitracin and Neomycin Refer to Individual Agents Refer to Individual Agents
Baclofen C
Excreted in breast milk/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Barium Sulfate (P) MPR: Fetal risk is minimal MLR: Infant risk is minimal (Not absorbed systemically)
BCG C Excretion in breast milk unknown/not recommended
Beclomethasone C Excretion in breast milk unknown/use caution
Bemiparin No data available Excretion in breast milk unknown/not recommended
Bendamustine D Excretion in breast milk unknown/not recommended
Benoxinate (Oxybuprocaine) C Excreted in breast milk/use caution
Benzocaine and Phenazone C Excretion in breast milk unknown/use caution
Benzoyl Peroxide C Excretion in breast milk unknown/use caution
Benzylpenicillin [Penicillin G] (Parenteral/Aqueous)
B Excreted in breast milk/use caution
Benzylpenicillin [Penicillin G] Benzathine
B Excreted in breast milk/use caution
Betahistine ADEC*: B2 Excretion in breast milk unknown/use caution
Betamethasone (Systemic) C Excretion in breast milk unknown/use caution
Betamethasone (Topical) C Excretion in breast milk unknown/use caution
Betamethasone and Clotrimazole (Topical)
Refer to Individual Agents
Refer to Individual Agents
Bevacizumab C Excretion in breast milk unknown/not recommended
Bicalutamide X Excretion in breast milk unknown/contraindicated
Bimatoprost C Excretion in breast milk unknown/use caution
Bisacodyl ADEC*: A MLR: Infant risk cannot be ruled out
Bisoprolol C Excretion in breast milk unknown/use caution
Bisoprolol and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Bivalirudin B Excretion in breast milk unknown/use caution
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Bleomycin D Excretion in breast milk unknown/not recommended
Bosentan Contraindicated Not recommended
Brimonidine B Excretion in breast milk unknown/not recommended
Brimonidine and Timolol Refer to Individual
Agents Refer to Individual Agents
Bromazepam (C) ADEC*: C Excretion in breast milk unknown/not recommended
Bromhexine ADEC*: A Excreted in breast milk/not recommended
Budesonide C (Capsule, Tablet)/B
(Nasal, Oral Inhalation)
Excreted in breast milk/use caution (capsule, oral inhalation, tablet)
Budesonide (Topical) C Excreted in breast milk/use caution
Budesonide and Formoterol Refer to Individual
Agents Refer to Individual Agents
Bumetanide C Excretion in breast milk unknown/not recommended
Bupivacaine C Excreted in breast milk/not recommended
Bupreborphine
BuPROPion C Excreted in breast milk/use caution
Cabergoline B Excretion in breast milk unknown/not recommended
Cabozantinib D Excretion in breast milk unknown/not recommended
Calcipotriol [Calcipotriene] and Betamethasone
C Do not apply to the breast if breast-feeding
Calcitonin C Excretion in breast milk unknown/use caution
Calcium Acetate, Carbonate, Chloride, Citrate, Gluconate
MPR: Fetal risk cannot be ruled out
MLR: Infant risk cannot be ruled out
Calcium Dobesilate No data available No data available
Calcium Hydroxylapatite No data available No data available
Calcium Polystyrene Sulphonate C Excretion in breast milk unknown/use caution
Canagliflozin C Excreted in breast milk/use caution
Candesartan
D Excretion in breast milk unknown/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Candesartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Capecitabine D Excretion in breast milk unknown/not recommended
Captopril D Excreted in breast milk/not recommended
Carbachol C Excretion in breast milk unknown/use caution
CarBAMazepine D Excreted in breast milk/not recommended
Carbetocin
Use in pregnancy prior to delivery is contraindicated.
Carbetocin induced contractions are of a longer duration than those observed with oxytocin and are not
stopped by discontinuation of therapy. Improper
use during pregnancy may produce
symptoms similar to those observed with oxytocin overdosage (eg, hyperstimulation
of uterus, uterine rupture).
Excreted in breast milk/use caution
Carbidopa and Levodopa C WHO: Avoid breastfeeding
Carbimazole ADEC*: C AAP: Compatible with breastfeeding
Carbocisteine [Carbocysteine] No data available Excretion in breast milk unknown/not recommended
CARBOplatin D Excretion in breast milk unknown/not recommended
Carboprost Trometamol [Tromethamine]
C Excretion in breast milk unknown
Carvedilol C Excretion in breast milk unknown/not recommended
Caspofungin C Excretion in breast milk unknown/use caution
Cefalexin [Cephalexin] B Excreted in breast milk/use caution
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
CeFAZolin B Excreted in breast milk/use caution
Cefdinir B Excretion in breast milk unknown
Cefepime B Excreted in breast milk/use caution
Cefixime B Excretion in breast milk unknown
Cefprozil B Excreted in breast milk/use caution
Ceftazidime B Excreted in breast milk/use caution
Ceftriaxone B Excreted in breast milk/use caution
Cefuroxime B Excreted in breast milk/use caution
Celecoxib C (Prior to 30 weeks
gestation)/D (≥30 weeks gestation)
Excreted in breast milk/use caution
Cephalexin B Excreted in breast milk/use caution
Certolizumab Use with caution Not excreted in breast milk/use caution
Cetirizine B MLR: Infant risk cannot be ruled out
Cetrorelix X Excretion in breast milk unknown/contraindicated
Cetuximab C Excretion in breast milk unknown/not recommended
Chloral Hydrate No data available Excreted in breast milk/not recommended
Chlorambucil D Excretion in breast milk unknown/not recommended
Chlorhexidine Gluconate B/C (Product Specific) Excretion in breast milk unknown/use caution
Chloroquine C Excreted in breast milk/not recommended
Chlorphenamine [Chlorpheniramine]
C WHO: Avoid breastfeeding
Chlorpromazine ADEC*: C Excreted in breast milk/not recommended
Chlorzoxazone and Paracetamol MPR: Fetal risk
cannot be ruled out MLR: Infant risk cannot be ruled out
Chorionic Gonadotropin (Human, Recombinant)
X Excretion in breast milk unknown/use caution
Ciclesonide C Excretion in breast milk unknown/use caution
CicloSPORINE [CycloSPORINE] (Systemic)
C Excreted in breast milk/not recommended
Cinacalcet C Excretion in breast milk unknown/not recommended
Cinnarizine No data available Excretion in breast milk unknown/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Ciprofloxacin (Ophthalmic) C Excretion in breast milk unknown/use caution
Ciprofloxacin (Systemic) C Excreted in breast milk/not recommended
Cisatracurium B Excretion in breast milk unknown/use caution
Cisplatin D Excreted in breast milk/not recommended
Citalopram C Excreted in breast milk/consider risk:benefit
Clarithromycin C Excretion in breast milk unknown/use caution
Clindamycin (Systemic, topical) B Excreted in breast milk/not recommended
Clobazam Contraindicated in
the first trimester of pregnancy
Present in breast milk
Clomifene [ClomiPHENE] X Excretion in breast milk unknown/use caution
ClomiPRAMINE C Excreted in breast milk/not recommended
ClonazePAM D Excreted in breast milk/not recommended
CloNIDine C Excreted in breast milk/use caution
Clopidogrel B Excretion in breast milk unknown/not recommended
Clotrimazole C Excretion in breast milk unknown
Cloxacillin B WHO: Compatible with breastfeeding
Colchicine C Excreted in breast milk/use caution
Colecalciferol [Cholecalciferol] MPR: Fetal risk
cannot be ruled out Excreted in breast milk/use caution
Colestyramine [Cholestyramine] Resin
C Not excreted in breast milk/use caution
Colistimethate C Excreted in breast milk/use caution
Cosyntropin C Excretion in breast milk unknown/use caution
Co-Trimoxazole [Sulfamethoxazole and Trimethoprim]
D Excreted in breast milk/use caution
Crotamiton C Excretion in breast milk unknown
Cyanocobalamin (Vitamin B12) C Excreted in breast milk/compatible
Cyclobenzaprine B Excretion in breast milk unknown/use caution
Cyclopentolate C Excretion in breast milk unknown/use caution
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
CycloPHOSPHAMIDE D Excreted in breast milk/not recommended
Cyproterone ADEC*: B3 Not intended for use by lactating women
Cyproterone and Ethinylestradiol [Ethinyl Estradiol]
X Excreted in breast milk/not recommended
Cytarabin D Excretion in breast milk unknown/not recommended
Dapagliflozon C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Dabigatran C Excretion in breast milk unknown/not recommended
Dapoxetine
not indicated for use in women
not indicated for use in women
Dacarbazine C Excretion in breast milk unknown/not recommended
DACTINomycin D Excretion in breast milk unknown/not recommended
Dalfampridine C Excretion in breast milk unknown/not recommended
Dantrolene C Excreted in breast milk/not recommended
Darbepoetin Alfa C Excretion in breast milk unknown/use caution
Deferasirox C Excretion in breast milk unknown/not recommended
Degarelix X Excretion in breast milk unknown/not recommended
Denosumab D (Xgeva®), X (Prolia®) Excretion in breast milk unknown/not recommended
Desferrioxamine [Deferoxamine] C Excretion in breast milk unknown/use caution
Desflurane B Excretion in breast milk unknown/use caution
Desloratadine C Excreted in breast milk/not recommended
Desmopressin B Excretion in breast milk unknown/use caution
Desogestrel No data available Excreted in breast milk/use caution
Desvenlafaxine C Excreted in breast milk/not recommended
Dexamethasone (Ophthalmic) C Excretion in breast milk unknown/use caution
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Dexamethasone (Systemic) C Excretion in breast milk unknown/not recommended
Dexlanzoprazole No data available Excretion in breast milk unknown/not recommended
Dexmedetomidine C Excretion in breast milk unknown/use caution
Dexpanthenol C Excretion in breast milk unknown/use caution
Dextromethorphan ADEC*: A MLR: Infant risk is minimal
Dextrose C (Injection, Infusion) MLR: Infant risk cannot be ruled out
Dextrose and Sodium Chloride C Refer to Individual Agents
Diazepam (C) D Excreted in breast milk/not recommended
Diclofenac (Ophthalmic) C No data available
Diclofenac (Systemic) C/D ≥30 weeks gestation (Oral)
Excreted in breast milk/not recommended
Diclofenac (Topical)
B (Topical Gel 3%) / C (Topical Gel 1%, Topical Solution, Topical patch) / D (Topical Patch and
Solution ≥30 weeks' gestation)
Excretion in breast milk unknown/not recommended
Dienogest No data available Excretion in breast milk unknown/contraindicated
Digoxin C Excreted in breast milk/use caution
Digoxin Immune Fab C Excretion in breast milk unknown/use caution
Dihydroergotamine X Excreted in breast milk/contraindicated
Diloxanide Furoate Not recommended No data available
Diltiazem C Excreted in breast milk/not recommended
DimenhyDRINATE B Excreted in breast milk/not recommended
Dimethindene No data available No data available
Dimethyl Furmarate C Excretion in breast milk unknown/use caution
Dinoprostone C Excretion in breast milk unknown
DiphenhydrAMINE (Systemic) B Excreted in breast milk/contraindicated
Diphtheria, Pertussis, Tetanus Vaccine
B/C (Product Specific) Excretion in breast milk unknown/use caution
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Dipyridamole B Excreted in breast milk/use caution
Dobutamine B Excretion in breast milk unknown/use caution
DOCEtaxel D Excretion in breast milk unknown/not recommended
Docusate ADEC*: A Excretion in breast milk unknown
Domperidone ADEC*: B2 Excreted in breast milk/not recommended
Donepezil C Excretion in breast milk unknown/use caution
DOPamine C Excretion in breast milk unknown/use caution
Dornase alpha B Infant risk cannot be ruled out
Dorzolamide C Excretion in breast milk unknown/not recommended
Dorzolamide and Timolol Refer to Individual
Agents Refer to Individual Agents
Doxazosin C Excreted in breast milk/use caution
DOXOrubicin (Conventional) D Excreted in breast milk/not recommended
DOXOrubicin (Liposomal) No data available Excretion in breast milk unknown/not recommended
Doxycycline D Excreted in breast milk/not recommended
Dulaglutide Not recommended Excretion in breast milk unknown/not recommended
Duloxetine C Excreted in breast milk/use caution
Dutasteride X Excretion in breast milk unknown/contraindicated
Dydrogesterone No data available Excretion in breast milk unknown/not recommended
Econazole C Excretion in breast milk unknown/use caution
Eletriptan C Excreted in breast milk/use caution
Empagliflozon C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Enalapril D Excreted in breast milk/not recommended
Enalapril and Hydrochlorothiazide Refer to Individual
Agents Refer to Individual Agents
Enoxaparin B Excretion in breast milk unknown/not recommended
Entecavir (P) C Excretion in breast milk unknown/not recommended
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Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Epinastine C Excretion in breast milk unknown/use caution
EPINEPHrine (Systemic, Oral Inhalation)
C Excretion in breast milk unknown/use caution
Epirubicin D Excretion in breast milk unknown/not recommended
Eprosartan D Excretion in breast milk unknown/not recommended
Eprosartan/Hydrochlorothiazide D Excreted in breast milk/not recommended
Eptacog Alfa Factor VIIa (Recombinant)
C Excretion in breast milk unknown/not recommended
Eribulin D Excretion in breast milk unknown/not recommended
ERLOtinib D Excretion in breast milk unknown/not recommended
Ertapenem B Excreted in breast milk/use caution
Erythromycin (Ophthalmic) B Excretion in breast milk unknown/use caution
Erythromycin (Systemic) B Excreted in breast milk/use caution
Erythropoietin /Epoetin Alpha C Excretion in breast milk unknown/use caution
Escitalopram C Excreted in breast milk/consider risk: benefit
Esmolol C Excretion in breast milk unknown/not recommended
Esomeprazole C Excreted in breast milk/use caution
Estradiol (Systemic) X Excreted in breast milk/use caution
Estradiol (Systemic) No data available Excreted in breast milk/use caution
Etanercept B Excreted in breast milk/use caution
Ethambutol C Excreted in breast milk/use caution
Ethamsylate No data available No data available
Ethinylestradiol [Ethinyl Estradiol] and Desogestrel
X Excreted in breast milk/not recommended
Ethinylestradiol [Ethinyl Estradiol] and Drospirenone
X Excreted in breast milk/not recommended
Ethinylestradiol [Ethinyl Estradiol] and Etonogestrel
X Excreted in breast milk/not recommended
Page 17 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Ethinylestradiol [Ethinyl Estradiol] and Norelgestromin
X Excreted in breast milk/not recommended
Etomidate C Excretion in breast milk unknown/use caution
Etonogestrel MPR: Fetal risk
cannot be ruled out Excreted in breast milk/use caution
Etoposide D Excretion in breast milk unknown/not recommended
Etoricoxib C (Prior to 30 weeks
gestation)/D (≥30 weeks gestation)
Excretion in breast milk unknown/contraindicated
Everolimus D (Afinitor®)/C
(Zortress®) Excretion in breast milk unknown/not recommended
Evolocumab No data available Excreted in breast milk/not recommended
Exemestane X Excretion in breast milk unknown/not recommended
Exenatide (P) C Excretion in breast milk unknown/use caution
Ezetimibe C Excretion in breast milk unknown/not recommended
Ezetimibe and Simvastatin Refer to Individual Agents Refer to Individual Agents
Factor IX (Human) C No data available
Famciclovir B Excretion in breast milk unknown/not recommended
Fampridine C Excretion in breast milk unknown/not recommended
Fat Emulsion (Plant Based) C Excreted in breast milk/use caution
Febuxostat C Excretion in breast milk unknown/use caution
Felodipine C Excretion in breast milk unknown/not recommended
Fenofibrate and Derivatives C Excretion in breast milk unknown/contraindicated
FentaNYL (N) C Excreted in breast milk/not recommended
Ferric Carboxymaltose C Excreted in breast milk/use caution
Ferrous Sulfate B WHO: Compatible with breastfeeding
Fexofenadine C Excretion in breast milk unknown/use caution
Filgrastim C Excretion in breast milk unknown/use caution
Page 18 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Finasteride X Excretion in breast milk unknown/contraindicated
Fingolimod C Excretion in breast milk unknown/not recommended
Fluconazole
C (Single dose for vaginal candidiasis)/
D
Excreted in breast milk/use caution
Fludarabine D Excretion in breast milk unknown/not recommended
Fludrocortisone C Excretion in breast milk unknown/use caution
Flumazenil C Excretion in breast milk unknown/use caution
Flunarizine MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/not recommended
Fluorescein C Excreted in breast milk/use caution
FluoroURACIL (P) D Excretion in breast milk unknown/contraindicated
FLUoxetine C Excreted in breast milk/not recommended
Flutamide B Not intended for use by lactating women
Fluticasone (Nasal) C Excretion in breast milk unknown/use caution
Fluticasone (Oral Inhalation) C Excretion in breast milk unknown/use caution
Fluticasone and Salmeterol C Excretion in breast milk unknown/use caution
Fluticasone and Formetrol
Avoid unless benefit outweigh risk
Not recommended
Fluvastatin X Excretion in breast milk unknown/contraindicated
FluvoxaMINE C Excreted in breast milk/consider risk: benefit
Folic Acid A Excreted in breast milk/compatible
Follitropin (Alfa & Beta) X Excretion in breast milk unknown/not recommended
Fondaparinux B Excretion in breast milk unknown/use caution
Fosfomycin B Excreted in breast milk/not recommended
Fosinopril D Excreted in breast milk/not recommended
Page 19 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Fulvestrant D Excretion in breast milk unknown/not recommended
Furosemide C Excreted in breast milk/use caution
Fusidic Acid (Ophthalmic & Topical)
MPR: Fetal risk cannot be ruled out
Excreted in breast milk/use caution
Fusidic Acid and Hydrocortisone Refer to Individual
Agents Refer to Individual Agents
Gabapentin C Excreted in breast milk/use caution
Gadodiamide C Excretion in breast milk unknown/use caution
Gadoterate Meglumine C Excretion in breast milk unknown/use caution
Galantamine C Excretion in breast milk unknown/not recommended
Ganciclovir (Ophthalmic) C Excretion in breast milk unknown/use caution
Ganciclovir (Systemic) C Excretion in breast milk unknown/not recommended
Gatifloxacin (Systemic) C Excretion in breast milk unknown/use caution
GEMcitabine D Excretion in breast milk unknown/not recommended
Gemfibrozil C Excretion in breast milk unknown/not recommended
Gentamicin (Systemic) D Excreted in breast milk/use caution
Glibenclamide [GlyBURIDE] B/C (Product Specific) Not recommended
Glibenclamide [GlyBURIDE] and Metformin
Refer to Individual Agents
Refer to Individual Agents
Gliclazide ADEC*: C Excretion in breast milk unknown/contraindicated
Glimepiride C Excretion in breast milk unknown/not recommended
Glucagon B Excretion in breast milk unknown/use caution
Glycerol [Glycerin] C MLR: Infant risk cannot be ruled out
Glycopyrrolate B (Injection)/C (Oral
Solution)
Excretion in breast milk unknown/use caution
Golimumab B Excretion in breast milk unknown/not recommended
Page 20 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Goserelin
X (Endometriosis, Endometrial Thinning); D
(Advanced Breast Cancer)
Excretion in breast milk unknown/not recommended
Granisetron B Excretion in breast milk unknown/use caution
GuaiFENesin C Excretion in breast milk unknown
GuaiFENesin and Dextromethorphan
Refer to Individual Agents
Refer to Individual Agents
GuaiFENesin, Dextromethorphan, and Phenylephrine
Refer to Individual Agents
Refer to Individual Agents
GuaiFENesin, Pseudoephedrine, and Dextromethorphan
Refer to Individual Agents
Refer to Individual Agents
Haloperidol C Excreted in breast milk/not recommended
Heparin C Not excreted in breast milk/use caution
Hepatitis A and Hepatitis B Recombinant Vaccine
C Excretion in breast milk unknown/use caution
Hepatitis A vaccine C Excretion in breast milk unknown/use caution
Hepatitis B Immune Globulin (Human)
C Excretion in breast milk unknown/use caution
Hepatitis B Vaccine (Recombinant)
C Excretion in breast milk unknown/use caution
Human Chorionic Gonadotropin X MLR: Infant risk cannot be ruled out
Hyaluronate and Derivatives MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/not recommended
Hyaluronidase C Excretion in breast milk unknown/use caution
HydrALAZINE C Excreted in breast milk/use caution
Hydrochlorothiazide B Excreted in breast milk/not recommended
Hydrochlorothiazide and Spironolactone
Refer to Individual Agents
Refer to Individual Agents
Hydrocortisone (Systemic & Topical)
C Excreted in breast milk/use caution
Hydrocortisone, Hydroquinone, and Tretinoin
C Excretion in breast milk unknown/use caution
HYDROmorphone (N) C Excreted in breast milk/not recommended
Page 21 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Hydroquinone C Excretion in breast milk unknown/use caution
Hydroxycarbamide [Hydroxyurea]
D Excreted in breast milk/not recommended
Hydroxychloroquine ADEC*: D Excreted in breast milk/not recommended
Hydroxyprogesterone B Excretion in breast milk unknown/not recommended
Hyoscine Butylbromide [Scopolamine] (Systemic)
C Excreted in breast milk/use caution
Ibandronic Acid [Ibandronate] C Excretion in breast milk unknown/use caution
Ibuprofen C/D ≥30 weeks
gestation Excreted in breast milk/not recommended
Ifosfamide D Excreted in breast milk/not recommended
Imatinib D Excreted in breast milk/not recommended
Imipenem and Cilastatin C Excreted in breast milk/use caution
Imiquimod C Excretion in breast milk unknown/use caution
Immune Globulin C Excretion in breast milk unknown/use caution
Indapamide B Excretion in breast milk unknown/not recommended
Indacaterol maleate / Glycopyrronium bromide
C Excretion in breast milk unknown/use caution
Indometacin [Indomethacin]
C (<30 weeks gestation); C/D (≥30
weeks gestation [manufacturer
specific])
Excreted in breast milk/not recommended
InFLIXimab B Excretion in breast milk unknown/not recommended
Influenza Virus Vaccine (Inactivated)
B/C (Product Specific) Excretion in breast milk unknown/use caution
Insulin Aspart B Briggs: Compatible with breastfeeding
Insulin Aspart Protamine and Insulin Aspart
B Briggs: Compatible with breastfeeding
Insulin Detemir B Briggs: Compatible with breastfeeding
Insulin Degludec C Briggs: Compatible with breastfeeding
Insulin Glargine C Briggs: Compatible with breastfeeding
Insulin Glulisine C Briggs: Compatible with breastfeeding
Page 22 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Insulin Lispro/Insulin Lispro Protamine and Insulin Lispro
B Briggs: Compatible with breastfeeding
Insulin NPH B Briggs: Compatible with breastfeeding
Insulin NPH and Insulin Regular B Briggs: Compatible with breastfeeding
Insulin Regular B Briggs: Compatible with breastfeeding
Interferon Alfa-2a C/X (In combination
with Ribavirin) Excretion in breast milk unknown/not recommended
Interferon Alfa-2b C/X (In combination
with Ribavirin) Excreted in breast milk/not recommended
Interferon Beta-1a C Excreted in breast milk/use caution
Interferon Beta-1b C Excretion in breast milk unknown/not recommended
Iobitridol (P) B Briggs: No human data; probably compatible
Iodine (P) B Briggs: No human data; probably compatible
Iodixanol B Briggs: No human data; probably compatible
Iodoquinol No data available Briggs: No human data; probably compatible
Iohexol B Briggs: No human data; probably compatible
Iopamidol B Briggs: No human data; probably compatible
Iotalamate [Iothalamate] Meglumine [P]
B/C (product dependent)
Excreted in breast milk/bottle feedings are recommended for 24 hours after administration
Ipratopium (Oral Inhalation) B Excretion in breast milk unknown/use caution
Irbesartan D Excretion in breast milk unknown/not recommended
Irbesartan/Hydrochlorthiazide D Excreted in breast milk/not recommended
Irinotecan D Excretion in breast milk unknown/not recommended
Iron Sucrose B Excretion in breast milk unknown/use caution
Isoniazid C Excreted in breast milk/compatible
Isoprenaline /isoproterenol C Excretion in breast milk unknown/use caution
Page 23 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Isosorbide Dinitrate C Excretion in breast milk unknown/use caution Isosorbide mononitrate B/C (Product Specific)
ISOtretinoin X Excretion in breast milk unknown/not recommended
Itraconazole C Excreted in breast milk/not recommended
Ivabradine ADEC*: D Excretion in breast milk unknown/contraindicated
Kaolin and Pectin MPR: Fetal risk is minimal AAP: Compatible with breastfeeding
Ketamine ADEC*: A WHO: Compatible with breastfeeding
Ketoconazole (Topical) C Excretion in breast milk unknown/use caution
Ketorolac (Ophthalmic) C Excretion in breast milk unknown/use caution
Ketotifen (Ophthalmic) C Excretion in breast milk unknown/use caution
Ketotifen (Systemic) C Excreted in breast milk/not recommended
Labetalol C Excreted in breast milk/use caution
Lacosamide C Excretion in breast milk unknown/not recommended
Lactulose B Excretion in breast milk unknown/use caution
LamiVUDine C Excreted in breast milk/contraindicated
LamoTRIgine C Excreted in breast milk/use caution
Lansoprazole B Excretion in breast milk unknown/not recommended
LAPAtinib D Excretion in breast milk unknown/not recommended
Latanoprost C Excretion in breast milk unknown/use caution
Leflunomide X Excretion in breast milk unknown/not recommended
Lercanidipine No data available Excretion in breast milk unknown/contraindicated
Letrozole X Excretion in breast milk unknown/not recommended
Leucovorin Calcium [Calcium Folinate]
C Excretion in breast milk unknown/use caution
Leuprorelin [Leuprolide] X Excretion in breast milk unknown/contraindicated
Levamisole C WHO: Avoid breastfeeding
Page 24 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
LevETIRAcetam C Excreted in breast milk/not recommended
LevOCARNitine B Excretion in breast milk unknown/use caution
Levocetirizine B Excretion in breast milk unknown/not recommended
Levodopa, Carbidopa, and Entacapone
C WHO: Avoid breastfeeding
Levofloxacin C Excreted in breast milk/not recommended
Levonorgestrel X Excreted in breast milk/use caution
Levothyroxine A Excreted in breast milk/use caution
Lidocaine (Systemic) B Excreted in breast milk/use caution
Lidocaine (Topical) B Excreted in breast milk/use caution
Lidocaine and Epinephrine B Excreted in breast milk/use caution
Lidocaine and Prilocaine B Excreted in breast milk/use caution
Linagliptin B Excretion in breast milk unknown/use caution
Linezolid C Excreted in breast milk/use caution
Liothyronine A Excreted in breast milk/use caution
Liraglutide X (Saxenda)/C
(Victoza) Excretion in breast milk unknown/not recommended
Lisinopril D Excretion in breast milk unknown/not recommended
Lithium D Excreted in breast milk/not recommended
Loperamide C Excreted in breast milk/not recommended
Loratadine B AAP: Compatible with breastfeeding
Lornoxicam C/D ≥30 weeks
gestation Excretion in breast milk unknown/not recommended
Losartan D Excretion in breast milk unknown/not recommended
Losartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Loxoprofen C/D ≥30 weeks
gestation No data available
Magnesium Citrate D AAP: Compatible with breastfeeding
Magnesium Oxide D AAP: Compatible with breastfeeding
Magnesium Sulfate D Excreted in breast milk/use caution
Mannitol C Excretion in breast milk unknown/use caution
Page 25 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Measles Virus Vaccine (Live) C Excretion in breast milk unknown/use caution
Measles, Mumps, Rubella Vaccine
C Excretion in breast milk unknown/use caution
Mebendazole C Excretion in breast milk unknown/use caution
Mebeverine No data available Excretion in breast milk unknown/not recommended
Meclizine and Pyridoxine B Excretion in breast milk unknown
MedroxyPROGESTERone X WHO: Compatible with breastfeeding
Mefenamic Acid C Excreted in breast milk/not recommended
Mefloquine B Excreted in breast milk/use caution
Megestrol D (Tablet)/X (Suspension)
Excreted in breast milk/not recommended
Meloxicam C/D ≥30 weeks
gestation Excretion in breast milk unknown/not recommended
Melphalan D Excretion in breast milk unknown/not recommended
Memantine B Excretion in breast milk unknown/use caution
Meningococcal (Groups A / C / Y and W-135) Diphtheria Conjugate Vaccine
B/C (Product Specific) Excretion in breast milk unknown/use caution
Meningococcal Polysaccharide Vaccine (Groups A / C / Y and W-135)
C Excretion in breast milk unknown/use caution
Menotrophins [Menotropins] X Excretion in breast milk unknown/not recommended
Mepivacaine and Adrenaline C Excretion in breast milk unknown/use caution
Mepolizumab Fetal risk cannot be
ruled out Infant risk cannot be ruled out
Mercaptopurine D Excretion in breast milk unknown/not recommended
Meropenem B Excreted in breast milk/use caution
Mesalazine [Mesalamine] B/C (Product Specific) Excreted in breast milk/use caution
Mesna B Excretion in breast milk unknown/not recommended
MetFORMIN B Excreted in breast milk/not recommended
Page 26 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Methadone (N) C Excreted in breast milk/not recommended
Methocarbamol C Excretion in breast milk unknown/use caution
Methotrexate X (Psoriasis,
Rheumatoid arthritis) Excreted in breast milk/contraindicated
Methoxy Polyethylene Glycol-Epoetin Beta (P)
C Excretion in breast milk unknown/use caution
Methyldopa B/C (Injectable) Excreted in breast milk/use caution
Methylene Blue X WHO: Avoid breastfeeding
Methylergometrine [Methylergonovine]
C Excreted in breast milk/not recommended
Methylphenidate (C) C Excreted in breast milk/use caution
MethylPREDNISolone C Excreted in breast milk/use caution
Metoclopramide B Excreted in breast milk/use caution
Metolazone B Excreted in breast milk/not recommended
Metoprolol C Excreted in breast milk/use caution
MetroNIDAZOLE (Systemic) B Excreted in breast milk/not recommended
MetroNIDAZOLE (Topical) B Excreted in breast milk/not recommended
Miconazole (Oral) C Excretion in breast milk unknown/use caution
Miconazole (Topical) No data available Excretion in breast milk unknown/use caution
Micronized Purified Flavonoid Fraction (MPFF)
No data available Excretion in breast milk unknown/not recommended
Midazolam (C) D Excreted in breast milk/use caution
Midodrine C Excretion in breast milk unknown/use caution
Milrinone C Excretion in breast milk unknown/use caution
Minoxidil (Sytemic) C Excreted in breast milk/not recommended
Mirtazapine C Excreted in breast milk/use caution
Misoprostol X Excreted in breast milk/use caution
MitoMYcin (Systemic) X Excretion in breast milk unknown/not recommended
MitoXANtrone D Excreted in breast milk/not recommended
Modafinil C Excretion in breast milk unknown/use caution
Page 27 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Mometasone (Nasal) C Excretion in breast milk unknown/use caution Mometasone (Topical) C
Montelukast B Excretion in breast milk unknown/use caution
Morphine (N) C Excreted in breast milk/use caution (AAP rates compatible)
Moxifloxacin (Ophthalmic) C Excretion in breast milk unknown/use caution
Moxifloxacin (Systemic) C Excretion in breast milk unknown/not recommended
Moxonidine No data available Excreted in breast milk/Contraindicated
Mupirocin B Excretion in breast milk unknown/use caution
Mycophenolate D Excretion in breast milk unknown/not recommended
Naloxone B/C (Product Specific) Excretion in breast milk unknown/use caution
Naphazoline and Pheniramine C Excretion in breast milk unknown/use caution
Naproxen C Excreted in breast milk/not recommended
Natalizumab C Excreted in breast milk/use caution
Nebivolol C Excretion in breast milk unknown/not recommended
Neomycin D Excretion in breast milk unknown/not recommended
Neostigmine C Excretion in breast milk unknown/use caution
Netupitant and Palonosetron C Discontinue breastfeeding or to discontinue the drug
NIFEdipine C Excreted in breast milk/not recommended
NiMODipine C Excreted in breast milk/not recommended
Nintedanib D Excreted in breast milk/not recommended
Nitrofurantoin B (Contraindicated at
term) Excreted in breast milk/not recommended (infants <1 month)
Nitroglycerin B/C (Product Specific) Excretion in breast milk unknown/use caution
Nivolumab (P) MPR: Fetal risk has been demonstrated
MLR: Infant risk cannot be ruled out
Norepinephrine C Excretion in breast milk unknown/use caution
Page 28 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Norethisterone X Excreted in breast milk/use caution
Norfloxacin C Excretion in breast milk unknown/not recommended
Nystatin (Oral, Topical) C Excretion in breast milk unknown/use caution
Ocrelizumab
An effective contraception should
be used during therapy and for 6
months after the last infusion.
Contraindicated
Octreotide B Excreted in breast milk/use caution
Oestrogens [Estrogens] (Conjugated/Equine, Systemic)
X Excreted in breast milk/use caution
Ofloxacin (Ophthalmic) C Excretion in breast milk unknown/not recommended
Ofloxacin (Systemic) C Excreted in breast milk/not recommended
OLANZapine C Excreted in breast milk/not recommended
Olmesartan D Excretion in breast milk unknown/not recommended
Olmesartan/Hydrochlorothiazide D Excreted in breast milk/not recommended
Olopatadine (Ophthalmic) C Excretion in breast milk unknown/use caution
Omalizumab (P) No data available No data available
Ombitasvir/Paritaprevir/Ritonavir (P)
B Excretion in breast milk unknown/not recommended
Omega-3 Fatty Acids C Excreted in breast milk/use caution
Omeprazole C Excreted in breast milk/use caution
Omeprazole and Sodium Bicarbonate
Refer to Individual Agents
Refer to Individual Agents
OnabotulinumtoxinA [Botulinum Toxin Type A]
C Excretion in breast milk unknown/use caution
Ondansetron B Excretion in breast milk unknown/use caution
Orlistat X Excretion in breast milk unknown/use caution
Oseltamivir C Excreted in breast milk/use caution
Oxaliplatin D Excretion in breast milk unknown/not recommended
Page 29 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
OXcarbazepine C Excreted in breast milk/not recommended
Oxybutynin B Excretion in breast milk unknown/use caution
OxyCODONE B/C (Product Specific) Excreted in breast milk/not recommended
OxyCODONE and Paracetamol [Acetaminophen]
Refer to Individual Agents
Refer to Individual Agents
Oxymorphone (N) C Excretion in breast milk unknown/use caution
Oxytocin C (Product Specific) Excretion in breast milk unknown/use caution
PACLItaxel (Conventional) D Excreted in breast milk/not recommended
PACLitaxel (Protein Bound) D Excreted in breast milk/not recommended
Palivizumab C No data available
Pancrelipase C Excretion in breast milk unknown/use caution
Panitumumab C Excretion in breast milk unknown/not recommended
Pantoprazole B Excreted in breast milk/not recommended
Papaverine C Excretion in breast milk unknown/use caution
Papillomavirus (Types 16, 18) Vaccine (Human, Recombinant)
B Excretion in breast milk unknown/use caution
Papillomavirus (Types 6, 11, 16, 18) Vaccine (Human, Recombinant)
B Excretion in breast milk unknown/use caution
Paricalcitol C Excretion in breast milk unknown/not recommended
PARoxetine D/X (Product Specific) Excreted in breast milk/use caution
PAZOPanib D Excretion in breast milk unknown/not recommended
Pegfilgrastim C Excretion in breast milk unknown/use caution
Peginterferon Alfa-2a/2b C/X (In combination
with Ribavirin) Excretion in breast milk unknown/not recommended
Peginterferon beta 1 A C Excretion in breast milk unknown/use caution
PEMEtrexed D Excretion in breast milk unknown/not recommended
Page 30 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
PenicillAMINE D Excretion in breast milk unknown/contraindicated
Pentoxifylline C Excreted in breast milk/not recommended
Perampanel Contraindicated Excretion in breast milk unknown/use caution
Perindopril D Excretion in breast milk unknown/use caution
Perindopril and Amlodipine D Refer to Individual Agents
PERTuzumab D Excretion in breast milk unknown/not recommended
Pethidine [Meperidine] (N) C Excreted in breast milk/not recommended
PHENobarbitone [PHENobarbital] (C)
B/D (Product Specific) Excreted in breast milk/use caution
Phenoxymethylpenicillin [Penicillin V] Potassium
B MLR: Infant risk cannot be ruled out
Phentermine (C) X Excretion in breast milk unknown/contraindicated
Phenylephrine (Ophthalmic, Systemic)
C Excretion in breast milk unknown/use caution
Phenytoin D Excreted in breast milk/not recommended
Phytomenadione [Phytonadione; Vitamin K]
C Excreted in breast milk/use caution
Pilocarpine C Excretion in breast milk unknown/not recommended
Pimecrolimus C Excretion in breast milk unknown/not recommended
Pinaverium
Animal reproduction studies and information from human pregnancies is not available. The presence of bromine in the formulation poses a theoretical risk of causing neurologic effects (sedation, hypotony) to newborns if pinaverium is used late in pregnancy, though no such cases have been reported
Excretion in breast milk unknown/not recommended
Page 31 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Pioglitazone C Excretion in breast milk unknown/not recommended
Piperacillin and Tazobactam B Excreted in breast milk/use caution
Piracetam Not recommended Excreted in breast milk/Not recommended
Pirfenidone C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Piribedil Not recommended Excretion in breast milk unknown/use caution
Pizotifen No data available Excretion in breast milk unknown/not recommended
Pneumococcal Conjugate Vaccine (13-Valent)
B Excretion in breast milk unknown/use caution
Pneumococcal Polysaccharide Vaccine (23-Valent)
C
Excretion in breast milk unknown/use caution
Policresulen
It may be used during pregnancy and breast feeding only if strictly
indicated. There have not been
any studies of the risks associated with use during pregnancy
in humans, but animal studies have
not yield any evidence of fetal
malformation. It is not known whether the active substance
passes into milk.
It may be used during pregnancy and breast feeding only if strictly indicated. There have not been any studies of the risks associated with use during pregnancy in humans, but animal studies have not yield any evidence of fetal malformation. It is not known whether the active substance passes into milk.
Polidocanol C Excretion in breast milk unknown/not recommended
Poliovirus Vaccine (Live/Trivalent/Oral)
C MLR: Infant risk cannot be ruled out
Page 32 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Polyethylene Glycol 3350 C Excretion in breast milk unknown/use caution
Potassium Acetate C MLR: Infant risk cannot be ruled out
Potassium Chloride C Excreted in breast milk/not recommended
Potassium Iodide and Iodine D (Potassium Iodide) Excreted in breast milk/use caution (AAP rates compatible)
Potassium Phosphate C Excreted in breast milk/use caution (AAP rates compatible)
Povidone-Iodine (Ophthalmic) C Excretion in breast milk unknown/not recommended
Povidone-Iodine (Topical) No data available Excreted in breast milk/use caution
Pralidoxime (PAM) C Excretion in breast milk unknown/use caution
Pramipexole C Excretion in breast milk unknown/not recommended
PrednisoLONE (Ophthalmic) C Excretion in breast milk unknown/use caution
PrednisoLONE (Systemic) C/D (Product Specific) Excreted in breast milk/use caution
Pregabalin C Excretion in breast milk unknown/not recommended
Primidone D Excreted in breast milk/not recommended
Procainamide C Excreted in breast milk/not recommended
Prochlorperazine ADEC*: C Excretion in breast milk unknown
Progesterone B (Oral) Excreted in breast milk/use caution
Promethazine C Excretion in breast milk unknown/not recommended
Propofol B Excreted in breast milk/not recommended
Propranolol C Excreted in breast milk/use caution
Propylthiouracil D Excreted in breast milk/use caution
Protamine C Excretion in breast milk unknown/use caution
Protirelin C Excretion in breast milk unknown/use caution
Pseudoephedrine ADEC*: B2 Excreted in breast milk/use caution (AAP rates compatible)
Psyllium Safe (Not absorbed
systematically) AAP: Compatible with breastfeeding
Pylera (Bismuth, Metronidazole, Tetracycline)
Contraindicated Excreted in breast milk/not recommended
Pyrazinamide C Excreted in breast milk/use caution
Page 33 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Pyridostigmine B/C (Product Specific) Excreted in breast milk/use caution
Pyridoxine (Vitamin B6) A Excreted in breast milk/compatible
QUEtiapine C Excreted in breast milk/not recommended
QuiNINE C Excreted in breast milk/use caution (AAP rates compatible)
RABEprazole C Excretion in breast milk unknown/use caution
Rabies Vaccine C Excretion in breast milk unknown
Raloxifene X Excretion in breast milk unknown/contraindicated
Ramipril D Excretion in breast milk unknown/not recommended
Ranibizumab C Excretion in breast milk unknown/use caution
Ranitidine B Excreted in breast milk/use caution
Rasburicase C Excretion in breast milk unknown/not recommended
Regorafenib (P) D Excretion in breast milk unknown/contraindicated
Remifentanil (N) C Excretion in breast milk unknown/use caution
Repaglinide C Excretion in breast milk unknown/not recommended
Rho(D) Immune Globulin C Excretion in breast milk unknown/use caution
Ribavirin X Excretion in breast milk unknown/not recommended
Riboflavin, Ophthalmic No data available No data available
Rifampin C Excreted in breast milk/not recommended
Rifampin and Isoniazid Refer to Individual
Agents Refer to Individual Agents
Rimexolone C Excretion in breast milk unknown/not recommended
RisperiDONE C Excreted in breast milk/not recommended
RiTUXimab C Excretion in breast milk unknown/not recommended
Rivaroxaban C Excretion in breast milk unknown/not recommended
Rivastigmine B Excretion in breast milk unknown/not recommended
Page 34 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
RIZAtriptan (P) C Excretion in breast milk unknown/use caution
Rocuronium C MLR: Infant risk cannot be ruled out
Rosuvastatin X Excretion in breast milk unknown/contraindicated
Rotavirus Vaccine C AAP: Compatible with breastfeeding
Rotigotine C Excretion in breast milk unknown/use caution
Salbutamol /Albuterol C Excretion in breast milk unknown/not recommended
Salicylic Acid C Not recommended
Saxagliptin B Excretion in breast milk unknown/use caution
Saxagliptin and MetFORMIN Refer to Individual
Agents Refer to Individual Agents
Secukinumab B Infant risk cannot be ruled out
Selegiline C Excretion in breast milk unknown/not recommended
Senna C AltMedDex®; Micromedex®: Compatible
Sertaconazole C Excretion in breast milk unknown/use caution
Sertraline C Excreted in breast milk/use caution
Sevelamer C MLR: Infant risk is minimal
Sevoflurane B MLR: Infant risk cannot be ruled out (for 24 hours after anesthesia)
Sildenafil B Excretion in breast milk unknown/use caution
Silver Sulfadiazine B Excretion in breast milk unknown/not recommended
Silymarin No data available No data available
Simeticone [Simethicone] Safe (Not absorbed
systematically) AAP: Compatible with breastfeeding
Simvastatin X Excretion in breast milk unknown/contraindicated
SitaGLIPtin B Excretion in breast milk unknown/use caution
Sitagliptin and Metformin Refer to Individual
Agents Refer to Individual Agents
Sodium Acetate C Excreted in breast milk/compatible
Sodium Bicarbonate C Excreted in breast milk/compatible
Page 35 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Sodium Chloride C Excreted in breast milk/use caution
Sodium Cromoglicate [Cromolyn] (Ophthalmic)
B Excretion in breast milk unknown/use caution
Sodium Phosphate C Excreted in breast milk/compatible
Sodium Polystyrene Sulfonate C Excretion in breast milk unknown/use caution
Sodium Stibogluconate X Excretion in breast milk unknown/contraindicated
Sofosbuvir/Ledipasvir (P) B MLR: Infant risk cannot be ruled out
Solifenacin C Excretion in breast milk unknown/not recommended
Somatropin B/C (Depending upon
manufacturer) Excretion in breast milk unknown/use caution
SORAfenib D Excretion in breast milk unknown/not recommended
Sotalol B Excreted in breast milk/not recommended
Spironolactone C Excreted in breast milk/not recommended
Streptomycin D Excreted in breast milk/not recommended
Sucralfate B Excretion in breast milk unknown/use caution
SUFentanil (N) C Excretion in breast milk unknown/use caution
Sugammadex No data available Excretion in breast milk unknown
SulfADIAZINE C Excreted in breast milk/contraindicated
SulfaSALAzine B Excreted in breast milk/use caution
Sulpiride Not recommended Excreted in breast milk/not recommended
SUMAtriptan C Excreted in breast milk/not recommended
SUNItinib D Excretion in breast milk unknown/not recommended
Suxamethonium [Succinylcholine]
C Excretion in breast milk unknown/use caution
TACrolimus (Systemic, Topical) C Excreted in breast milk/not recommended
Tadalafil B Excretion in breast milk unknown/use caution
Tafacitinib C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Talc (Sterile) B Excretion in breast milk unknown
Page 36 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Tamoxifen D Excretion in breast milk unknown/not recommended
Tamsulosin B MLR: Infant risk cannot be ruled out
Teicoplanin Not recommended Excretion in breast milk unknown/use caution
Telaprevir B/X (in combination
with ribavirin) Excretion in breast milk unknown/not recommended
Telmisartan D Excretion in breast milk unknown/not recommended
Telmisartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
TEMOzolomide D Excretion in breast milk unknown/not recommended
Temsirolimus D Excretion in breast milk unknown/not recommended
Tenofovir B Excreted in breast milk/contraindicated
Terbinafine (Systemic) B Excreted in breast milk/not recommended
Teriflunomide X Excretion in breast milk unknown/not recommended
Teriparatide C Excretion in breast milk unknown/not recommended
Testosterone X Excreted in breast milk/contraindicated
Tetanus Toxoid (Adsorbed) C Excretion in breast milk unknown/use caution
Tetracaine [Amethocaine] C Excretion in breast milk unknown/use caution
Tetracosactide [Tetracosactrin, Cosyntropin]
C Excretion in breast milk unknown/use caution
Tetrastarch C Excretion in breast milk unknown/use caution
Thalidomide X Excretion in breast milk unknown/not recommended
Theophylline C Excreted in breast milk/compatible
Thiamine A Excreted in breast milk/use caution
Thyrotropin Alfa C Excretion in breast milk unknown/use caution
Tibolone X Excretion in breast milk unknown/contraindicated
Ticagrelor C MLR: Infant risk cannot be ruled out
Page 37 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Tigecycline D Excretion in breast milk unknown/use caution
Timolol C Excreted in breast milk/consider risk: benefit
Tinidazole C Excreted in breast milk/contraindicated
Tinzaparin B Excretion in breast milk unknown/use caution
Tiotropium C Excretion in breast milk unknown/use caution
Tirofiban B Excretion in breast milk unknown/not recommended
TiZANidine C Excretion in breast milk unknown
Tobramycin (Ophthalmic) B Not recommended
Tobramycin and Dexamethasone (Ophthalmic)
C Excretion in breast milk unknown/use caution
Tocilizumab C Excretion in breast milk unknown/not recommended
Tofacitinib Not recommended Excretion in breast milk unknown/not recommended
Tolterodine C Excretion in breast milk unknown/not recommended
Topiramate D Excreted in breast milk/use caution
Topotecan D Excretion in breast milk unknown/not recommended
Trace Elements Refer to Individual
Agents Refer to Individual Agents
TraMADol (C) C Excreted in breast milk/not recommended
Tranexamic Acid B Excreted in breast milk/use caution
Trastuzumab D Excretion in breast milk unknown/not recommended
Travoprost C Excretion in breast milk unknown/use caution
Tretinoin (Topical) D Excretion in breast milk unknown/use caution
Triamcinolone (Systemic) C Excreted in breast milk/use caution
Triamcinolone (Topical) C Excretion in breast milk unknown/use caution
Trihexyphenidyl C Excretion in breast milk unknown/use caution
Trimetazidine No data available Excretion in breast milk unknown/not recommended
Page 38 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Trimethoprim C Excreted in breast milk/use caution
Triprolidine ADEC*: A MLR: Infant risk is minimal
Triptorelin (LHRH) X Excretion in breast milk unknown/not indicated for use in women
Tropicamide C Excretion in breast milk unknown/use caution
Trospium C Excretion in breast milk unknown/use caution
Trypan Blue C Excretion in breast milk unknown/use caution
Tuberculin Test C No data available
Typhoid Vaccine C Excretion in breast milk unknown/use caution
Umeclindium bromide and Vilanterol
C Excretion in breast milk unknown/use caution
Urea B/C (Product Specific) Excretion in breast milk unknown/use caution
Ursodiol B Excretion in breast milk unknown/use caution
Ustekinmab B Excretion in breast milk unknown/use caution
ValACIclovir [ValACYclovir] B Excreted in breast milk/use caution
ValGANciclovir C Excretion in breast milk unknown/not recommended
Valproic Acid and Derivatives X (Migraine
prophylaxis)/D (All other indications)
Excreted in breast milk/use caution
Valsartan D Excretion in breast milk unknown/not recommended
Valsartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Valsartan and Sacubitril Discontinue as soon
as possible once pregnancy is detected
Excretion in breast milk unknown/not recommended
Vancomycin B (Oral)/C (Injection) Excreted in breast milk/not recommended
Varenicline C Excretion in breast milk unknown/not recommended
Varicella Zoster Vaccine MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/use caution
Vasopressin C Excretion in breast milk unknown/use caution
Page 39 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Vedolizumab B Infant risk cannot be ruled out
Venlafaxine C Excreted in breast milk/not recommended
Verapamil C Excreted in breast milk/not recommended
Vigabatrin C Excreted in breast milk/not recommended
VILDAgliptin Not recommended Excretion in breast milk unknown/not recommended
VILDAgliptin and MetFORMIN Refer to Individual
Agents Refer to Individual Agents
VinBLAStine D Excretion in breast milk unknown/not recommended
VinCRIStine D Excretion in breast milk unknown/not recommended
Vinorelbine D Excretion in breast milk unknown/not recommended
Vitamin B - Complex A Excreted in breast milk/use caution (AAP rates compatible)
Vitamin E A MLR: Infant risk cannot be ruled out
Voriconazole D Excretion in breast milk unknown/not recommended
Vortioxetine C Data not available
Warfarin D (Mechanical Heart
Valves)/X (Other Indications)
Not excreted in breast milk/use caution
Xylometazoline C MLR: Infant risk cannot be ruled out
Zaleplon C Excreted in breast milk/not recommended
Zinc Sulfate C Excreted in breast milk/compatible
Zoledronic acid D Excretion in breast milk unknown/not recommended
Zolpidem (C) C Excreted in breast milk/use caution