Drugs and their categories in pregnancy and breastfeeding

A | B | C | D | E | F | G | H | I | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Z

Drug	TGA pregnancy category	Compatibility with breastfeeding
abacavir	B3	avoid, insufficient data [NB1]
abatacept	C	avoid, insufficient data
abciximab	C	caution, insufficient data [NB8]
acamprosate	B2	caution, insufficient data
acarbose	B3	caution, insufficient data
acetazolamide	B3	compatible
acetylcysteine	B2	avoid, insufficient data
aciclovir	B3	compatible
acitretin	X	avoid
activated charcoal	unlisted (see product information)	compatible
adalimumab	C	caution, insufficient data
adapalene	D	caution, insufficient data
adefovir	B3	avoid, insufficient data
adenosine	B2	caution, insufficient data
adrenaline	A	compatible
albendazole	D	compatible
alendronate	B3	compatible
alfentanil	C	compatible, occasional doses
allopurinol	B2	compatible
alpha-hydroxy acids	unlisted	compatible
alprazolam	C	compatible; single dose only. Caution with chronic use, monitor infant for drowsiness
alprostadil	unlisted (see product information)	avoid, insufficient data
alteplase	B1	avoid, insufficient data
aluminium chloride	unlisted	compatible
aluminium hydroxide	A	compatible
amantadine	B3	avoid; may suppress lactation
ambrisentan	X	avoid, insufficient data
amethocaine	B2	caution [NB7]
amikacin	D	compatible; may cause diarrhoea in infant
amiloride	C	avoid, insufficient data
amiodarone	C	avoid
amisulpride	B3	caution, insufficient data
amitriptyline	C [NB5]	compatible
amlodipine	C	caution, insufficient data
ammonium chloride	A	compatible
amorolfine	B3	caution, insufficient data
amoxycillin	A	compatible; may cause diarrhoea in infant
amoxycillin+clavulanate	B1	compatible; may cause diarrhoea in infant
amphotericin	B3	IV use: compatible; absorption by infant unlikely oral use: compatible
ampicillin	A	compatible; may cause diarrhoea in infant
anakinra	B1	avoid, insufficient data
anidulafungin	B3	caution, insufficient data
antacids	A	compatible
antivenom, black snake	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, box jellyfish	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, brown snake	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, death adder	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, funnel-web spider	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, polyvalent snake	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, red-back spider	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, sea snake	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, stonefish	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, taipan	unlisted (see product information)	caution, insufficient data [NB8]
antivenom, tiger snake	unlisted (see product information)	caution, insufficient data [NB8]
apomorphine	B3	avoid, insufficient data; may suppress lactation
apraclonidine	B3	caution, insufficient data [NB7]
aprepitant	B1	caution, insufficient data
aripiprazole	C	caution, insufficient data
artemether+lumefantrine	D (contraindicated in first trimester)	avoid, insufficient data
artesunate	unlisted (see product information) (do not withhold in severe malaria)	caution, insufficient data
articaine with adrenaline	B3	caution, insufficient data
aspirin	C	compatible in occasional doses; avoid long-term therapy, if possible, particularly in the neonatal period
atazanavir	B2	avoid, insufficient data [NB1]
atenolol	C [NB9]	compatible
atomoxetine	B3	avoid, insufficient data
atorvastatin	D	avoid, insufficient data
atovaquone	B2	caution, insufficient data
atovaquone+proguanil	B2	caution, insufficient data
atropine	A	caution, insufficient data
azathioprine	D	compatible
azelaic acid	B1	compatible
azelastine	B3	avoid, insufficient data
azithromycin	B1	compatible; may cause diarrhoea in infant
aztreonam	B1	compatible; may cause diarrhoea in infant

Therapeutic Goods Administration (TGA) pregnancy classification is from the Prescribing medicines in pregnancy database at the TGA website.

Definitions for compatibility with breastfeeding:

compatible—there are sufficient data available to demonstrate an acceptably low relative infant dose and/or no significant plasma concentrations and/or no adverse effects in breastfed infants

caution—there are insufficient data showing low relative infant dose and/or no significant plasma concentrations and/or no adverse effects in breastfed infants

avoid, insufficient data—there are no data on transfer into milk, or on plasma concentrations or adverse effects in the breastfed infant

avoid—significant plasma concentrations in exposed infants, or adverse effects in breastfed infants reported or predictable from the properties of the molecule.

Footnotes

NB1:	In Australia, breastfeeding is not recommended for HIV-positive women because of the possibility of HIV transmission and because suitable formula milk is readily available. In countries in which no acceptable, feasible, sustainable and safe replacement feeding is available, exclusive breastfeeding for 6 months is recommended for HIV-infected mothers to reduce the risk of HIV transmission from the mother to the infant compared with mixed feeding. The amount of drug transferred via milk in these cases is also of interest as it may exert antiviral actions in the infant.
NB2:	For further information on use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy, see General information on drug use in pregnancy: psychotropic drugs.
NB3:	Antiandrogens have the potential to feminise the male fetus, avoid in pregnancy.
NB4:	Tetracyclines are safe for use during the first 18 weeks of pregnancy (16 weeks postconception) after which they may affect the formation of the baby's teeth and cause discolouration.
NB5:	For further information on use of tricyclic antidepressants (TCAs) in pregnancy, see General information on drug use in pregnancy: psychotropic drugs.
NB6:	If an NSAID is required in a breastfeeding patient, diclofenac or ibuprofen is preferred.
NB7:	Absorption of eye drops into the maternal circulation is generally low, although there are occasional reports of systemic effects. Nevertheless, significant transfer into milk is unlikely.
NB8:	Large molecular weight proteins/polypeptides are unlikely to transfer into milk. In the absence of specific information, adverse effects in the infant are unlikely.
NB9:	Early reports of pregnancy outcomes in women treated with beta blockers in pregnancy, particularly dealing with propranolol, described a relatively high incidence of fetal growth restriction. This appears to be the basis for the C classification of the class of drugs. Since these findings were not from randomised studies, but were clinical descriptions of women who had underlying disorders known to be associated with an increased rate of both intrauterine fetal growth restriction and death, it is not possible to determine whether the described outcomes were due to the therapy or to the disorder for which therapy was prescribed. Subsequent evidence has indicated fetal growth restriction in hypertensive pregnant women treated with atenolol, but better fetal growth in women treated with another beta blocker, oxprenolol, than in women treated with methyldopa. This has been attributed to the intrinsic sympathomimetic activity inherent in this drug. No other fetal or neonatal problems have been attributed to beta-blocker therapy in pregnancy, and they are widely prescribed for the treatment of hypertension in this situation.
NB10:	Observational studies in humans have reported cardiovascular malformations after exposure to medicinal products containing erythromycin in early pregnancy.
NB11	For further information on use of antiepileptic drugs in pregnancy, see Antiepileptic drug therapy in women.

Key references for this chapter