| DRUGS |
ADVERSE EFFECTS |
| 1. Analgesics & Antipyretics |
| Aspirin |
AVOID -possible risk of Reye's Syndrome. Regular use of high doses could impair platelet function and produce hypoprothrombinaemia if neonatal vitamin K stores are low. |
| Indomethacin |
Milk levels are similar to maternal plasma levels. One case report of possible indomethacin induced seizures in a breast-fed infant. |
| Narcotic analgesics |
Regular use of high doses can produce dependence and withdrawal effects. |
| 2. Anthelmintics |
| Thiabendazole, topical |
Excretion in breast milk is unknown, manufacturer recommends discontinuation of the drug or of nursing. |
| 3 Antibacterial Agents |
| Clindamycin |
Excreted into breast milk |
| Metronidazole |
Significant amount in milk, may give bitter taste to milk. |
| Sulfonamides & Co-trimoxazole |
Risk of haemolytic anaemia in G6PD deficient babies. Small risk of kernicterus in jaundiced infants. |
| Tetracycline |
Remote theoretical possibility of dental staining and inhibition of bone growth. |
| 4. Antidepressants / Antipsychotics Anxiolytics / Hypnotics / Sedatives |
| Benzodiazepines |
AVOID large doses and regular use; drowsiness, lethargy and failure to thrive have been reported |
| Chloral hydrate |
Drowsiness |
| Phenothiazines |
Monitor infant for excessive drowsiness and for normal growth and development |
| 5. Antifungals |
| Itraconazole |
Excreted in breast milk. Manufacturer recommends that the mother should not breast feed. |
|
Ketoconazole
|
Probably excreted in breast milk. May increase the risk of kernicterus in nursing infants. |
| 6. Antimycobacterial |
|
Clafazimine
|
As clofazimine is excreted in breast milk, infant may have skin discoloration from breast-feeding |
| 7. Antiscabetic |
|
Lindane, topical
|
Amount too small to be harmful, avoidance of breast feeding for 2 days after lindane application. |
|
Permethrin, topical
|
Excretion in milk is unknown, tumorigenic potential in some animal studies |
| 8. Antituberculous Agents |
|
Isoniazid
|
Theoretical risk of convulsions and neuropathy. Prophylactic pyridoxine should be given to mother and baby |
| 9. Contraceptive Agents |
|
Oral Contraceptives
|
AVOID combined oral contraceptives until weaning or for 6 months after birth. Progestogen-only oral contraceptive do not appear to affect established milk flow adversely but may alter composition |
| 10. Cytotoxic Drugs |
|
All
|
AVOID - probably some risk of toxicity with most cytotoxics |
| 11. Hormones |
|
Androgens
|
AVOID - may cause masculinisation in the female infant or precocious development in the male infant, high doses suppress lactation |
|
Corticosteroids, topical
|
Should not be applied to the breasts prior to nursing. |
|
Corticosteroids
|
Prolonged, continuous treatment with high doses (> lOmg prednisolone daily) could affect infant's adrenal function |
|
Cyproterone acetate
|
Significant amounts in milk. Possible risk of anti-androgen effects on the infant |
|
Oestrogens
|
AVOID adverse effects on lactation |
| 12. Immunosuppressant |
|
Cyclosporin
|
AVOID - excreted into breast milk and potentially toxic |
| 13. VITAMINS & MINERALS |
|
Vitamin A
|
Theoretical risk of toxicity in infants of mothers taking large doses |
|
Vitamin Bi (Thiamine)
|
Severely thiamine-deficient mothers should not breastfeed as toxic methylglyoxal excreted in milk |
|
Vitamin B6 ( Pyridoxine)
|
Very large doses have been reported to have a lactationinhibiting effect. Monitor infant growth |
|
Vitamin D
|
Chronic maternal ingestion of large doses may result in hypercalcaemia in infant |
| 14. Miscellaneous |
|
Acitretin/Etretinate Isotretinoin
|
AVOID |
|
Colchicine
|
Caution because of cytotoxicity |
|
Dapsone
|
Haemolytic anaemia; although significant amount in milk, risk to infant is very small |
|
Hydroxychloroquine
|
AVOID - risk of toxicity in infant |
|
Iodides
|
AVOID - concentrated in breast milk, may cause thyroid suppression, goitre |
|
Pentoxifylline
|
AVOID - potential for production of benign mammary fibroadenomas in animal studies |
|
Podophyllum, topical
|
Excretion in human milk is unknown. Manufacturer recommends discontinuation of the drug or of nursing |
|
Povidone iodine, topical
|
Sufficient iodine can be absorbed from vaginal preparations to affect infant's thyroid |
|
Sulphasalazine
|
Possible risk of haemolytic |
