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Contraindicated Drugs to Avoid During Breastfeeding: Category L5 Medications

Dextroamphetamine

From Acitretin to Vinorelbine, learn about the most common medications deemed contraindicated during breastfeeding with the following general overview of category L5 drugs.

MedicationPregnancy Risk CategoryBreastfeeding Risk Category
Acitretin
(Soriatane)
XL5
Aliskiren
(Tekturna, Valturna, Tekturna HCT)
C (first trimester)
D (second, third trimester)
L3
L5 (in premature infants)
AminopterinXL5
Amiodarone
(Cordarone, Aratac)
DL4 (acute use)
L5 (chronic use)
Anastrozole
(Arimidex)
XL5
Ascorbic Acid
(Ascorbicap, Cecon, Cevi-Bid, Ce-Vi-Sol, Vitamin C)
A (first, second trimester)
C (third trimester)
L1 (low dose)
L5 (IV dose)
Aspartame
(Nutrasweet)
BL1
L5 (in infants with PKU)
Aspirin
(Anacin, Aspergum, Empirin, Genprin, Ecotrin, Coryphen, Novasen, Entrophen, Disprin, Aspro, Cartia)
C (first, second trimester)
D (third trimester)
L3
L5 (in viral syndromes)
Bevacuzumab
(Avastin)
CL3 (intravitreal use)
L5 (systemic use)
Blue Cohosh
(Blue Ginseng, Squaw Root, Papoose Root, Yellow Ginseng)
XL5
Borage
(Borage Oil, Beebread, Bee Plant, Burrage, Starflower Ox)
XL5
Bromocriptine
(Parlodel, Kripton, Bromolactin, Apo-Bromocriptine, Bromocriptine Mesylate)
BL5
BromidesDL5
Busulfan
(Myleran, Busilvex)
DL5
Cannabis
(Marijuana, Pot, Weed, Tetrahydrocannabinol)
CL5
Capecitabine
(Xeloda)
DL5
CarbetapentaneCL5
Carboplatin
(Carboplat, Carbosin, Emorzin, Novoplat, Paraplatin, Paraplatin-AQ)
DL5
Carmustine
(BCNU, Bicnu, Carmubris, Nitrumon, Gliadel)
DL5
Chlorambucil
(Leukeran, Linfolysin, Alti-Chlorambucil)
DL5
Cisplatin
(Abiplatin, Bioplatino, Cis-Gry, C-Platin, Placis)
DL5
Cladribine
(Leustatin, Leustar, Litak)
DL5
Clobetasol
(Clebevate, Clobex, Cormax, Olux-E, Olux, Temovate E, Temovate, Clobetasol Propionate)
CL5
Cocaine
(Crack)
C (first, second trimester)
X (third trimester)
L5
Codeine
(Empirin #3 #4, Tylenol #3 #4, Actacode, Codalgin, Codral, Pandeine, Veganin, Paveral, Penntuss, Kaodene, Teropin)
CL3
L5 (in rapid metabolizers)
Comfrey
(Bruisewort, Blackwort, Slippery Root, Russian Comfrey, Knitbone)
XL5
Cyclophosphamide
(Neosar, Cytoxan, Procytox, Cycloblastin, Endoxan, Endoxana)
DL5
Cytarabine
(Cytosar)
DL5
Dactinomycin
(Cosmegen, Actinomycin D)
DL5
Danazol
(Danocrine, Cyclomen, Azol, Danol)
XL5
Daunorubicin
(Cerubidin, Daunoblastina, Daunoblastin, DaunoXome, Cerubidine)
DL5
Dehydroepiandrosterone
(DHEA)
Possibly HazardousL5
Delavirdine
(Rescriptor)
CL5
Dextroamphetamine
(Dexedrine, Amphetamine, Oxydess, Adderall, Vyvanse, Adderall XR, Dexamphetamine, Dexten, Liquadd)
CL3 (clinical doses)
L5 (if abused)
Didanosine
(Videx)
BL5
Diethylpropion
(Tepanil, Tenuate, Dospan)
BL5
Diethylstilbestrol
(DES, Honvol, Honvan, Fosfestrol, Apstil)
XL5
Disulfiram
(Antabuse)
CL5
Docetaxel
(Taxotere)
DL5
Doxepin
(Adapin, Sinequan, Triadapin, Novo-Doxepin, Deptran)
CL5
Doxorubicin
(Adriamycin, Adriblastina, Caelyx)
DL5
Drotrecogin Alfa
(Xigris)
CL5
Epirubicin
(Ellence, EpiCell, Farmorubicina, Pharmarubicin, Rubina)
DL5
Etoposide
(Toposar, Abiposid, Celltop, Eposid, Eposin, Etopofos, Etopophos, VP-16)
DL5
Etravirine
(Intelence)
BL5
Etretinate
(Tegison, Tigason)
XL5
Everolimus
(Zortress, Afinitor)
DL5
Exemestane
(Aromasin)
DL5
Gamma Hydroxybutyric Acid
(Zyrem, GBH, Gamma-OH, Somsanit, Oxybutyrate, GHB, Liquid Ecstacy)
BL5
Gold Compounds
(Ridaura, Myochrysine, Solganal, Myocrisin)
CL5
HeroinBL5
123Iodine
(Radioactive Iodine, Iodine-123, 123I, DaTscan, Ioflupane 123I)
HazardousL5
125Iodine
(Radioactive Iodine, Iodine-125, 125I)
HazardousL5
131Iodine
(Iodine-131, 131I, Radioactive Iodine, Iodotope, Hicon)
XL5
Imatinib Mesylate
(Gleevec)
DL5
Isotretinoin
(Accutane, Isotrex, Accure, Roaccutane)
XL5
Ixabepilone
(Ixempra)
DL5
Jusprin
(Acetylsalicylic Acid, Aspirin, Aspro, Dispril, Acuprin 81)
DL3
L5 (in viral syndromes)
Kava-Kava
(Awa, Kew, Tonga)
HazardousL5
Kombucha TeaHazardousL5
LeadHazardousL5
Leuprolide Acetate
(Lupron, Viadur, Prostap, Eligard)
XL5
LSD (See Lysergic Acid Diethylamide)Possibly HazardousL5
Lysergic Acid Diethylamide
(LSD)
Possibly HazardousL5
Melphalan
(Alkeran)
DL5
MercuryHazardousL5
Methamphetamine
(Desoxyephedrine, Desoxyn, Pervitin, Anadrex, Metherine)
CL5
Mitomycin
(Mutamycin, Mitomycin-C)
DL5
Mitoxantrone
(Novantrone, Onkotrone)
DL5
Neomycin
(Neo-Fradin)
DL3
L5 (on nipple)
Oxaliplatin
(Eloxatin, Eloxatine, O-Plat, Oxalip)
DL5
Paclitaxel
(Taxol, Paxene, Anzatax)
DL5
Pazopanib
(Votrient)
DL5
Pentostatin
(Nipent)
DL5
Phencyclidine
(PCP, Angel Dust)
XL5
PropylhexedrineCL5
Strontium-89 Chloride
(Metastron)
DL5
Tamoxifen
(Nolvadex, Apo-Tamox, Nolvadex, Tamofen, Tamone, Tamoxen, Genox, Eblon, Noltam)
DL5
Temozolomide
(Temodar, Temodal)
DL5
Thalidomide
(Thalomid)
XL5
Vinblastine
(Velban, Velbe, Velsar, Lemblastine)
DL5
Vincristine
(Vincasar PFS, Oncovin, Citomid, Farmistin, Ifavin, Norcristine, Vincizina)
DL5
Vinorelbine
(Navelbine, Biovelbin)
DL5

 

Pregnancy Risk Categories

A. Controlled Studies Show No Risk

Adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester of pregnancy.

B. No Evidence of Risk in Humans

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Adequate, well-controlled studies in pregnant women have not shown increased risk of fetal abnormalities despite adverse findings in animals, or, in the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is remote but remains a possibility.

C. Risk Cannot Be Ruled Out

Adequate,well-controlled human studies are lacking, and animal studies have shown a risk to the fetus or are lacking as well. There is a chance of fetal harm if the drug is administered during pregnancy, but the potential benefits may outweigh the potential risks.

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D. Positive Evidence of Risk

Studies in humans, or investigational or post-marketing data, have demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or serious disease for which safer drugs cannot be used or are ineffective.

X. Contraindicated in Pregnancy

Studies in animals or humans, or investigational or post-marketing reports, have demonstrated positive evidence of fetal abnormalities or risks which clearly outweighs any possible benefit to the patient.

Breastfeeding Risk Categories

L1. Safest

Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote, or the product is not orally bioavailable in an infant.

L2. Safer

Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; and/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.

L3. Moderately Safe

There are no controlled studies in breastfeeding women; however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.

L4. Possibly Hazardous

There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

L5. Contraindicated

Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Disclaimer: The information provided in this article is not meant to replace the professional medical advice from your health care provider. For detailed information on specific medications or for information on medications not listed, please consult your health care provider.

References

Hale, Thomas W. 2008. Medications and mothers’ milk, 13th edn. Amarillo, Texas: Hale Publishing.
Hale, Thomas W. 2010. Medications and mothers’ milk, 14th edn. Amarillo, Texas: Hale Publishing.
Hale, Thomas W. 2012. Medications and mothers’ milk, 15th edn. Amarillo, Texas: Hale Publishing.
Safe Fetus: http://safefetus.com/index.php
Search Medica RX: http://www.mims.com/USA

Image Credits

Dextroamphetamine: http://commons.wikimedia.org/wiki/File:Dextroamphetamine.jpg

Written by Heather Johnson

Heather is a writer, librarian, linguist, wife, and mother who loves her husband, children, dogs, and cats. She has a bachelor's degree in English with a minor in creative writing and master's degrees in library and information science and English studies with a concentration in linguistics.

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