Матерям, які годують грудьми, деякі лікарські препарати протипоказані

Anticoagulants

Dicumarol

Warfarin

May be given cautiously but, in very large doses, may cause hemorrhage (heparin is not excreted in milk)

Cytotoxic medications

Cyclophosphamide

Cyclosporine

Doxorubicin

Methotrexate

May interfere with cellular metabolism of a breastfeeding infant, causing possible immunosuppression and neutropenia

Unknown effect on growth and unknown association with carcinogenesis

Psychoactive medications

Anxiolytics, including benzodiazepines (alprazolam, diazepam, lorazepam, midazolam, prazepam, quazepam, temazepam) and perphenazine

Antidepressants (tricyclics, selective serotonin reuptake inhibitors, bupropion)

Antipsychotics (chlorpromazine, chlorprothixene, clozapine, haloperidol, mesoridazine, trifluoperazine)

For most psychoactive medications, unknown effect on infants, but because medications and metabolites appear in breast milk and in infant plasma and tissues, possible alteration of short-term and long-term central nervous system function

Fluoxetine: Linked to colic, irritability, feeding problems and sleep disorders, and slow weight gain

Chlorpromazine: Possible drowsiness, lethargy, decline in developmental scores

Haloperidol: Decline in developmental scores

Individual medications that are detectable in breast milk and pose theoretical risk

Amiodarone

Possible hypothyroidism

Chloramphenicol

Possible idiosyncratic bone marrow suppression

Clofazimine

Potential for transfer of high percentage of maternal dose

Possible increase in skin pigmentation

Corticosteroids

With large maternal doses given for weeks or months, can produce high concentrations in milk and may suppress growth and interfere with endogenous corticosteroid production in the infant

Lamotrigine

Potential for therapeutic serum concentrations in the infant

Metoclopramide

None described

Metronidazole

Tinidazole

In vitro mutagens

May stop breastfeeding for 12–24 hours to allow excretion of dose when a mother is given a single dose of 2 g

Safe after the infant is 6 months old

Sulfapyridine

Sulfisoxazole

Caution required if infants have jaundice or G6PD deficiency or are ill, stressed, or premature

Individual medications that are detectable in breast milk and have documented risk

Acebutolol

Hypotension, bradycardia, tachypnea

Aminosalicylic acid

Diarrhea

Aspirin (salicylates)

Metabolic acidosis

With large maternal doses and sustained use, may produce plasma concentrations that increase risk of hyperbilirubinemia (salicylates compete for albumin-binding sites) and hemolysis only in G6PD-deficient infants who are < 1 month

Atenolol

Cyanosis, bradycardia

Bromocriptine

Suppresses lactation

May be hazardous to the mother

Clemastine

Drowsiness, irritability, refusal to feed, high-pitched cry, neck stiffness

Ergotamine

Vomiting, diarrhea, seizures (with doses used in migraine medications)

Estradiol

Withdrawal vaginal bleeding

Iodides

Iodine

Goiter

Lithium

One third to one half therapeutic blood concentration in infants

Phenobarbital

Sedation, infantile spasms after weaning, methemoglobinemia

Phenytoin

Methemoglobinemia

Primidone

Sedation, feeding problems

Sulfasalazine (salicylazosulfapyridine)

Bloody diarrhea

Nitrofurantoin, sulfapyridine, sulfisoxazole

Hemolysis in infants with G6PD deficiency; safe in others

Drugs of abuse*

Amphetamine

Irritability, poor sleeping pattern

Alcohol

With < 1 g/kg daily, decreased milk ejection reflex

With large amounts, drowsiness, diaphoresis, deep sleep, weakness, decrease in linear growth, abnormal weight gain in the infant

Cocaine

Cocaine intoxication: Irritability, vomiting, diarrhea, tremulousness, seizures

Heroin

Tremors, restlessness, vomiting, poor feeding

Marijuana

Components detectable in breast milk but effects uncertain

Phencyclidine

Hallucinogen