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    Pregnancy and Breastfeeding Risk Categories: Medications A

    Pills

    From Abacavir to Aztreonam, learn about the safety of the most common medications during pregnancy and breastfeeding with the following general overview of drugs that begin with the letter A.

    MedicationPregnancy Risk CategoryBreastfeeding Risk Category
    Abacavir
    (Ziagen)
    CL3
    Abatacept
    (Orencia)
    CL3
    Acamprosate
    (Campral)
    CL3
    Acarbose
    (Precose, Prandase, Glucobay)
    BL3
    Acebutolol
    (Sectral, Monitan)
    B (first trimester)
    D (second, third trimesters)
    L3
    Acetaminophen
    (Tylenol, Genapap, Feverall, Actamin Maximum Strength, Altenol, Aminofen, Apra, Aceta, Tempra, Paracetamol, Apo-Acetaminophen, Panadol, Dymadon, Calpol)
    BL1
    Acetaminophen + Hydrocodone
    (Lorcet, Lortab, Vicodin, Anexsia, Maxidone, Norco, Zydone, Ceta Plus)
    CL3
    Acetaminophen +Oxycodone
    (Endocet, Percocet, Roxicet, Roxilox, Tylox, Narvox, Magnacet, Perloxx, Primalev, Oxycocet)
    CL3
    Aceteminophen + Tramadol
    (Ultracet)
    CL2
    Acetazolamide
    (Dazamide, Diamox, Sequels, Acetazolam, Apo-Acetazolamide)
    CL2
    Acetohexamide
    (Dymelor, Dimelor)
    CL3
    Acitretin
    (Soriatane)
    XL5
    Acorus Calamus
    (Sweet Flag Root)
    Possibly HazardousL4
    Acyclovir
    (Zovirax, Lipsovir, Apo-Acyclovir, Aviraz, Acyclo-V, Zyclir, Aciclover)
    BL2
    Adalimumad
    (Humira)
    BL3
    Adapalene
    (Differin)
    CL3
    Adefovir
    (Hepsera)
    CL4
    Adenosine
    (Adenocard, Adenoscan)
    CL2
    AirborneHazardousL4
    Albendazole
    (Albenza, Eskazole)
    CL3
    Albuterol
    (Preventil, Ventolin, Novo-Salmol, Asmavent, Respax, Respolin, Asmol, Salbulin, Salbuvent, Salamol)
    CL1
    Albuterold + Ipratropium Bromide
    (DuoNeb, Combivent)
    CL1
    Alcaftadine Ophthalmic Solution
    (Lastacaft)
    BL3
    Alefacept
    (Amevive)
    BL3
    Alemtuzumad
    (Campath, MabCampath)
    CL4
    Alendronate Sodium
    (Fosamax)
    CL3
    Alfentanil
    (Alfenta, Rapifen)
    CL2
    Alfuzosin
    (Uroxatral)
    BL4
    Aliskiren
    (Tekturna, Valturna, Tekturna HCT)
    C (first trimester)
    D (second, third trimester)
    L3
    L5 (in premature infants)
    AllantoinProbably SafeL3
    Allergy InjectionsProbably SafeL3
    Allopurinol
    (Zyloprim, Lopurin, Alloprin, Apo-Allopurinol, Novo-Purol, Zyloprim, ALlorin, Capurate, Zygout, Aluline, Caplenal, Cosuric, Hamarin, Zyloric)
    CL2
    Almotriptan
    (Axert, Almogran)
    CL3
    Aloe VeraPossibly HazardousL3
    Alosetron
    (Lotronex)
    BL3
    Alpha-Galactosidase EnzymeProbably SafeL3
    Alprazolam
    (Xanax, Apo-Alpraz, Novo-Alprazol, Kalma, Ralozam)
    DL3
    Alteplase
    (Activase, Actilyse)
    CL3
    Altretamine
    (Hexalen)
    DL4
    Alvimopan
    (Entereg)
    BL3
    Amantadine
    (Symmetrel, Symadine, Endantanine, Gen-Amantadine, Mantadine)
    CL3
    Amikacin
    (Amikin)
    DL2
    Amiloride
    (Midamor)
    BL3
    Aminocaproic Acid
    (Amicar)
    CL4
    Aminolevulinic Acid
    (Levulan Kerastick)
    CL3
    AminopterinXL5
    Aminosalicylic Acid (ASA)
    (Paser, PAS, Tubasal, Nemasol)
    CL3
    Aminosalicylic Acid (Para)
    (Paser, PAS, Tubasal, Nemasol)
    CL3
    Amiodarone
    (Cordarone, Aratac)
    DL4 (acute use)
    L5 (chronic use)
    Amitriptyline
    (Elavil, Endep, Apo-Amitriptyline, Novo-Tryptin, Amitrol, Endep, Mutabon D, Domical, Lentizol)
    CL2
    Amitriptyline + Perphenazine
    (Triavil, Etrafon, Etrafon 2-10, Etrafon A, Mutabon DElavil Plus, Entrafon)
    CL3
    Amlodipine + Benazepril
    (Lotrel)
    DL3
    Amlodipine + Hydrochlorothiazide + Olmesartan
    (Tribenzor)
    DL3
    Amlodipine + Olmesartan
    (Azor)
    C (first trimester)
    D (second, third trimesters)
    L3
    Amlodipine Besylate
    (Norvasc, Istin)
    CL3
    Amoxapine
    (Asendin, Asendis)
    CL2
    Amoxicillin
    (Larotid, Amoxil, Apo-Amoxi, Novamoxin, Alphamox, Moxacin, Cilamox, Betamox)
    BL1
    Amoxicillin + Clarithromycin + Lansoprazole
    (Prevpac)
    CL3
    Amoxicillin + Clavulanate
    (Augmentin, Clavulin, Augmentin ES-600. Augmentin XR, Amoclan, Alti-Amoxi Clav, Apo-Amoxi Clav)
    BL1
    Amphotericin B
    (Fungizone, Amphotec, Ambisome, Resteclin, Abelcet, Fungilin, Amphocel)
    BL3
    Ampicillin
    (Polycillin, Omnipen, Apo-Ampi, Novo-Ampicillin, NuAmpi, Penbriton, Ampicyn, Austrapen, Amfipen, Britcin, Vidopen)
    BL1
    Ampicillin + Sulbactam
    (Unasyn, Dicapen)
    BL1
    Amprenavar
    (Agnerase)
    CL3
    Anagrelide
    (Agrylin)
    CL4
    Anakinra
    (Kineret)
    BL3
    Anastrozole
    (Arimidex)
    XL5
    Anidulafungin
    (Eraxis)
    CL3
    Anthralin
    (Anthra-Derm, Drithocreme, Dritho-Scalp, Micanol, Anthraforte, Anthranol, Anthrascalp, Dithranol, Alphodith)
    CL3
    Anthrax VaccineDL3
    Antihemophilic Factor-Von Willebrand Factor Complex
    (Alphanate, Humate-P)
    CL3
    AntipyrineCL4
    Aprepitant
    (Emend)
    BL3
    Arformoterol
    (Brovana, Arformoterol Tartrate)
    CL3
    ArgatrobanBL4
    Arginine
    (L-Arginine, Arginine, Juven)
    BL3
    Aripiprazole
    (Abilify, Abilitat)
    CL3
    Armodafinil
    (Nuvigil)
    CL4
    ArticaineCL3
    Articaine + Epinephrine
    (Septocaine, Astracaine, Septanest)
    CL3
    Ascorbic Acid
    (Ascorbicap, Cecon, Cevi-Bid, Ce-Vi-Sol, Vitamin C)
    A (first, second trimester)
    C (third trimester)
    L1 (low dose)
    L5 (IV dose)
    Asenapine
    (Saphris)
    CL3
    Asparaginase
    (Elspar, L-asparaginase, Colaspase, L-ASP, Crasnitin)
    CL3
    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)
    Aspirin + Oxycodone
    (Percodan, Endodan)
    DL3
    Atenolol
    (Tenorectic, Tenormin, Apo-Atenolol, Anselol, Noten, Tenlol, Tensig, Antipress)
    DL3
    Atomoxetine
    (Strattera)
    CL4
    Atorvastatin
    (Lipitor, Caduet, Atorvastatin Calcium)
    XL3
    Atovaquone
    (Mepron, Meprone)
    CL3
    Atovaquoone + Proguanil
    (Malarone)
    CL3
    Atropine
    (Belladonna, Atropine Minims, Atropisol, Isopto-Atropine, Atropt, Eyesule)
    CL3
    Atropine + Diphenoxylate
    (Lomocot, Lomotil, Lonox, Vi-Atro, Lofene)
    CL3
    Azapropazone
    (Rheumox)
    C (first, second trimesters)
    D (third trimester)
    L2
    Azathioprine
    (Imuran, Thioprine)
    DL3
    Azelaic Acid
    (Azelex, Finevin, Finacea, Skinoren)
    BL3
    Azelastine
    (Asteline, Optivar,, Astepro, Aptivar, Azep, Rhinolast, Optilast)
    CL3
    Azithromycin
    (Zithromax)
    BL2
    Aztreonam
    (Azactam)
    BL2

     

    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

    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

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    Pills: http://commons.wikimedia.org/wiki/File:Pills.JPG

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