From Acitretin to Vinorelbine, learn about the most common medications deemed contraindicated during breastfeeding with the following general overview of category L5 drugs.
|Medication||Pregnancy Risk Category||Breastfeeding Risk Category|
(Tekturna, Valturna, Tekturna HCT)
|C (first trimester)|
D (second, third trimester)
L5 (in premature infants)
|D||L4 (acute use)|
L5 (chronic use)
(Ascorbicap, Cecon, Cevi-Bid, Ce-Vi-Sol, Vitamin C)
|A (first, second trimester)|
C (third trimester)
|L1 (low dose)|
L5 (IV dose)
L5 (in infants with PKU)
(Anacin, Aspergum, Empirin, Genprin, Ecotrin, Coryphen, Novasen, Entrophen, Disprin, Aspro, Cartia)
|C (first, second trimester)|
D (third trimester)
L5 (in viral syndromes)
|C||L3 (intravitreal use)|
L5 (systemic use)
(Blue Ginseng, Squaw Root, Papoose Root, Yellow Ginseng)
(Borage Oil, Beebread, Bee Plant, Burrage, Starflower Ox)
(Parlodel, Kripton, Bromolactin, Apo-Bromocriptine, Bromocriptine Mesylate)
(Marijuana, Pot, Weed, Tetrahydrocannabinol)
(Carboplat, Carbosin, Emorzin, Novoplat, Paraplatin, Paraplatin-AQ)
(BCNU, Bicnu, Carmubris, Nitrumon, Gliadel)
(Leukeran, Linfolysin, Alti-Chlorambucil)
(Abiplatin, Bioplatino, Cis-Gry, C-Platin, Placis)
(Leustatin, Leustar, Litak)
(Clebevate, Clobex, Cormax, Olux-E, Olux, Temovate E, Temovate, Clobetasol Propionate)
|C (first, second trimester)|
X (third trimester)
(Empirin #3 #4, Tylenol #3 #4, Actacode, Codalgin, Codral, Pandeine, Veganin, Paveral, Penntuss, Kaodene, Teropin)
L5 (in rapid metabolizers)
(Bruisewort, Blackwort, Slippery Root, Russian Comfrey, Knitbone)
(Neosar, Cytoxan, Procytox, Cycloblastin, Endoxan, Endoxana)
(Cosmegen, Actinomycin D)
(Danocrine, Cyclomen, Azol, Danol)
(Cerubidin, Daunoblastina, Daunoblastin, DaunoXome, Cerubidine)
(Dexedrine, Amphetamine, Oxydess, Adderall, Vyvanse, Adderall XR, Dexamphetamine, Dexten, Liquadd)
|C||L3 (clinical doses)|
L5 (if abused)
(Tepanil, Tenuate, Dospan)
(DES, Honvol, Honvan, Fosfestrol, Apstil)
(Adapin, Sinequan, Triadapin, Novo-Doxepin, Deptran)
(Adriamycin, Adriblastina, Caelyx)
(Ellence, EpiCell, Farmorubicina, Pharmarubicin, Rubina)
(Toposar, Abiposid, Celltop, Eposid, Eposin, Etopofos, Etopophos, VP-16)
|Gamma Hydroxybutyric Acid|
(Zyrem, GBH, Gamma-OH, Somsanit, Oxybutyrate, GHB, Liquid Ecstacy)
(Ridaura, Myochrysine, Solganal, Myocrisin)
(Radioactive Iodine, Iodine-123, 123I, DaTscan, Ioflupane 123I)
(Radioactive Iodine, Iodine-125, 125I)
(Iodine-131, 131I, Radioactive Iodine, Iodotope, Hicon)
(Accutane, Isotrex, Accure, Roaccutane)
(Acetylsalicylic Acid, Aspirin, Aspro, Dispril, Acuprin 81)
L5 (in viral syndromes)
(Awa, Kew, Tonga)
(Lupron, Viadur, Prostap, Eligard)
|LSD (See Lysergic Acid Diethylamide)||Possibly Hazardous||L5|
|Lysergic Acid Diethylamide|
(Desoxyephedrine, Desoxyn, Pervitin, Anadrex, Metherine)
L5 (on nipple)
(Eloxatin, Eloxatine, O-Plat, Oxalip)
(Taxol, Paxene, Anzatax)
(PCP, Angel Dust)
(Nolvadex, Apo-Tamox, Nolvadex, Tamofen, Tamone, Tamoxen, Genox, Eblon, Noltam)
(Velban, Velbe, Velsar, Lemblastine)
(Vincasar PFS, Oncovin, Citomid, Farmistin, Ifavin, Norcristine, Vincizina)
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
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.
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
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.
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).
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.
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
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