Drugs and their categories in pregnancy and breasfeeding

Drugs and their categories in pregnancy and breastfeeding

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Drug	Pregnancy category	Compatibility with breastfeeding
abacavir	B3	insufficient data [Note 1]
abciximab	C	caution, insufficient data [Note 12]
acamprosate	B2	insufficient data
acarbose	B3	caution, insufficient data
acetazolamide	B3	compatible
acetylcysteine	B2	avoid, insufficient data
aciclovir	B3	compatible
acitretin	X	avoid
activated charcoal	unlisted	compatible
adalimumab	C	caution, insufficient data
adapalene	D	caution, insufficient data
adefovir	B3	avoid, insufficient data
adenosine	B2	caution, insufficient data
adrenaline	A	compatible
albendazole	D	compatible
alclometasone dipropionate	unlisted	compatible; avoid use on nipples
alendronate	B3	compatible
alfentanil	C	compatible in occasional doses
allopurinol	B2	compatible
alpha-hydroxy acids	unlisted	compatible
alprazolam	C	compatible in single dose - caution with chronic use; if used in latter situation, monitor infant for drowsiness
alprostadil	unlisted	no data
alteplase	B1	avoid, insufficient data
aluminium chloride	unlisted	compatible
aluminium diacetate	unlisted	compatible
aluminium hydroxide	A	compatible
amantadine	B3	avoid, may suppress lactation
amethocaine	unlisted	caution, insufficient data [Note 11]
amikacin	D	compatible
amiloride	C	avoid, insufficient data
aminoglutethimide	D	avoid, insufficient data
aminophylline	A	use with caution, monitor infant for irritability
amiodarone	C	avoid
amisulpride	B3	insufficient data
amitriptyline	C [Note 6]	compatible
amlodipine	C	caution, insufficient data
amorolfine	B3	insufficient data
amoxycillin	A	compatible; may cause diarrhoea in infant
amoxycillin+clavulanate	B1	caution, no data for clavulanate; may cause diarrhoea in infant
amphotericin	IV use: B3 or B2 (depending on formulation) oral use: B2	IV use: caution, insufficient data, low oral absorption by infant oral use: compatible
ampicillin	A	compatible; may cause diarrhoea in infant
anakinra	B1	avoid, insufficient data
antacids	A	compatible
antivenom, black snake	unlisted	caution, insufficient data [Note 12]
antivenom, box jellyfish	unlisted	caution, insufficient data [Note 12]
antivenom, brown snake	unlisted	caution, insufficient data [Note 12]
antivenom, death adder	unlisted	caution, insufficient data [Note 12]
antivenom, funnel-web spider	unlisted	caution, insufficient data [Note 12]
antivenom, polyvalent snake	unlisted	caution, insufficient data [Note 12]
antivenom, red-back spider	unlisted	caution, insufficient data [Note 12]
antivenom, sea snake	unlisted	caution, insufficient data [Note 12]
antivenom, stonefish	unlisted	caution, insufficient data [Note 12]
antivenom, taipan	unlisted	caution, insufficient data [Note 12]
antivenom, tiger snake	unlisted	caution, insufficient data [Note 12]
apomorphine	B3	avoid, insufficient data
apraclonidine	B3	caution, insufficient data [Note 11]
aprepitant	B1	caution, insufficient data
aripiprazole	B3	insufficient data
artemether+lumefantrine	D (contraindicated in first trimester)	avoid, insufficient data
artesunate	unlisted (do not withhold in severe malaria)	do not withhold in severe malaria
articaine with adrenaline	B3	caution, insufficient data
aspirin	C	compatible in occasional doses; avoid long-term therapy, if possible, particularly in the neonatal period
atazanavir	B2	insufficient data [Note 1]
atenolol	C [Note 13]	compatible
atorvastatin	D	avoid, insufficient data
atovaquone	B2	avoid, insufficient data
atovaquone+proguanil	B2	avoid, insufficient data
atropine	A	compatible
auranofin	B3	avoid
azatadine	B2	caution, insufficient data
azathioprine	D	caution, monitor infant's immune function
azelaic acid	B1	compatible
azelastine	B3	avoid, insufficient data
azithromycin	B1	compatible; may cause diarrhoea in infant

Note 1: In Australia, breastfeeding is not recommended for HIV-positive women because of the possibility of HIV transmission.

Note 2: Human data are inadequate and the safety of these medications in pregnancy is uncertain.

Note 3: Antiandrogens have the potential to feminise the male fetus, avoid in pregnancy.

Note 4: Tetracyclines are safe for use during the first 18 weeks of pregnancy (16 weeks postconception) after which they may affect the formation of the baby's teeth and cause discolouration.

Note 6: Tricyclic antidepressants have been taken by a large number of pregnant women without any proven increase in the frequency of fetal malformation. In full-term neonates, reversible adverse effects have occasionally been observed, but very rarely cause significant problems.

Note 7: Although theophylline has a Category A rating, it does cross the placental barrier. The effect on fetal development is not known. Theophylline clearance is significantly decreased in premature infants. Therefore, if this drug is administered to the mother near the time of delivery, the neonate should be monitored closely for the pharmacological effects of theophylline. Hence the use of theophylline in pregnant women should be balanced against the risk of uncontrolled asthma.

Note 8: See also: Cleland LG, James MJ, Proudman SM. Fish oil: what the prescriber needs to know. Arthritis Research and Therapy 2006;8(1):202-11.

Note 9: See leflunomide regarding preconception advice and cholestyramine washout.

Note 10: If an NSAID is required in a breastfeeding patient, diclofenac or ibuprofen is preferred.

Note 11: Absorption of eye drops into the maternal circulation is generally low, although there are occasional reports of systemic effects. Nevertheless, significant transfer into milk is unlikely.

Note 12: Large molecular weight proteins/polypeptides are unlikely to transfer into milk. In the absence of specific information, adverse effects in the infant are unlikely.

Note 13: Early reports of pregnancy outcomes in women treated with beta blockers in pregnancy, particularly dealing with propranolol, described a relatively high incidence of fetal growth restriction. This appears to be the basis for the C classification of the class of drugs. Since these findings were not from randomised studies, but were clinical descriptions of women who had underlying disorders known to be associated with an increased rate of both intrauterine fetal growth restriction and death, it is not possible to determine whether the described outcomes were due to the therapy or to the disorder for which therapy was prescribed. Subsequent evidence has indicated fetal growth restriction in hypertensive pregnant women treated with atenolol, but better fetal growth in women treated with another beta blocker, oxprenolol, than in women treated with methyldopa. This has been attributed to the intrinsic sympathomimetic activity inherent in this drug. No other fetal or neonatal problems have been attributed to beta-blocker therapy in pregnancy, and they are widely prescribed for the treatment of hypertension in this situation.

Key references for this chapter