Page 1 of 39 Department of Pharmaceutical Care Drug Use in Pregnancy & Lactation Pharmacy & Therapeutic Committee- Sep 2018 The following tables summarize safety of drug use in pregnancy and lactation. Medications of herbal origin are excluded from the list. Under the column "Drug-Pregnancy Categories", letters A, B, C, D, and X signify the FDA Pregnancy categories. These five categories indicate the potential of a systemically-absorbed drug to cause birth defects; the key differentiation among the categories rests upon the reliability of documentation and the risk: benefit ratio. FDA Pregnancy Categories: A : Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote. B : Either animal-reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters. C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus. D : There is positive evidence of human fetal risk, but the benefit from use in pregnant women may be acceptable despite the risk (If the drug is needed for life threatening situations or for serious diseases for which safer drugs can not be used or are ineffective). X : Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.
39
Embed
Drug Use in Pregnancy & Lactation · Drug Use in Pregnancy & Lactation Pharmacy & Therapeutic Committee- Sep 2018 Infant risk has been demonstrated Evidence and/or expert consensus
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
The following tables summarize safety of drug use in pregnancy and lactation.
Medications of herbal origin are excluded from the list.
Under the column "Drug-Pregnancy Categories", letters A, B, C, D, and X signify the FDA Pregnancy categories.
These five categories indicate the potential of a systemically-absorbed drug to cause birth defects; the key differentiation among the categories rests upon the reliability of documentation and the risk: benefit ratio.
FDA Pregnancy Categories:
A : Controlled studies in pregnant women fail to demonstrate a risk to the fetus in the first trimester with no evidence of risk in later trimesters. The possibility of fetal harm appears remote.
B : Either animal-reproductive studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women, or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk in later trimesters.
C : Either studies in animals have revealed adverse effects on the fetus (teratogenic or embryocidal effects or other) and there are no controlled studies in women, or studies in women and animals are not available. Drugs should be given only if the potential benefits justify the potential risk to the fetus.
D : There is positive evidence of human fetal risk, but the benefit from use in pregnant women may be acceptable despite the risk (If the drug is needed for life threatening situations or for serious diseases for which safer drugs can not be used or are ineffective).
X : Studies in animals or human beings have demonstrated fetal abnormalities or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.
Page 2 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
For drugs not FDA approved; other classification systems were used to identify the pregnancy categories, whenever possible, the two other systems used are:
1. Micromedex Pregnancy Ratings:
Fetal risk cannot be ruled out
Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during pregnancy.
Fetal risk has been demonstrated
Evidence has demonstrated fetal abnormalities or risks when used during pregnancy or in women of childbearing potential. An alternative to this drug should be prescribed during pregnancy or in women of childbearing potential.
Fetal risk is minimal The weight of an adequate body of evidence suggests this drug poses minimal risk when used in pregnant women or women of childbearing potential.
2. Australian Drug Evaluation Committee (ADEC) Pregnancy Category Definitions
A : Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.
B1 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.
B2 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.
B3 : Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have shown evidence of an increased occurrence of fetal damage, the
Page 3 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
significance of which is considered uncertain in humans.
C : Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.
D : Drugs which have caused, are suspected to have caused, or may be expected to cause an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.
X : Drugs that have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.
Note: For drugs in the B1, B2 and B3 categories, human data are lacking or inadequate and sub-categorization is therefore based on available animal data. The allocation of a B category does not imply greater safety than the C category. Drugs in category D are not absolutely contraindicated in pregnancy (e.g. anticonvulsants). Moreover, in some cases the 'D' category has been assigned on the basis of 'suspicion'.
If there was no data under the previous three categorizations, the drug-pregnancy category is assigned as "N/A"
Data for medication use during breast feeding, are complied from FDA data, WHO data and Micromedex Lactation Ratings:
1. WHO Lactation Ratings:
Avoid breastfeeding
Avoid breastfeeding if possible. May inhibit lactation
Avoid breastfeeding if possible. Monitor infant for side effects
Compatible with breastfeeding
Compatible with breastfeeding. Monitor infant for side effects
WHO documentation states insufficient data
2. Micromedex Lactation Ratings:
Infant risk cannot be ruled out
Available evidence is inconclusive or is inadequate for determining fetal risk when used in pregnant women or women of childbearing potential. Weigh the potential benefits of drug treatment against potential risks before prescribing this drug during breastfeeding
Page 4 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Infant risk has been demonstrated
Evidence and/or expert consensus has demonstrated harmful infant effects when used during breastfeeding. An alternative to this drug should be prescribed or patients should be advised to discontinue breastfeeding.
Infant risk is minimal The weight of an adequate body of evidence and/or expert consensus suggests this drug poses minimal risk to the infant when used during breastfeeding
Milk effects are possible
Evidence suggests this drug may alter milk production or composition. If an alternative to this drug is not prescribed, monitor the infant for adverse effects and/or adequate milk intake
Abbreviations used in the tables:
AAP: American Academy of Pediatrics
APR: Australian Pregnancy Ratings
FDA: U.S. Food and Drug Administration
IU: International Unit
N/A: no data available
MLR: Micromedex Lactation Ratings
MPR: Micromedex Pregnancy Ratings
RDA: Recommended daily allowance
WHO: World Health Organization
Page 5 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Abatacept C Excretion in breast milk unknown/not recommended (Possible toxicity)
Abiraterone X Not indicated for use in women
Acarbose B Excretion in breast milk unknown/not recommended
Acetaminophen [Paracetamol] C Excreted in breast milk/use caution
Acetaminophen [Paracetamol] and Codeine
Refer to Individual Agents
Refer to Individual Agents
Acetaminophen [Paracetamol] and Codeine and Caffeine
C Excreted in breast milk/not recommended
Acetaminophen [Paracetamol] and Tramadol
C Excreted in breast milk/not recommended
Acetazolamide C Excreted in breast milk/not recommended
Acetic Acid C Excretion in breast milk unknown/use caution
Acetylcysteine B Excretion in breast milk unknown/use caution
Aciclovir [Acyclovir] (Systemic, Topical)
B Excreted in breast milk/use caution
Activated Charcoal MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/use caution
Adalimumab B Excreted in breast milk/use caution
Adapalene C Excretion in breast milk unknown/use caution
Adefovir C Excretion in breast milk unknown/not recommended
Adenosine C Excretion in breast milk unknown/not recommended
Ado-Trastuzumab D Excretion in breast milk unknown/not recommended
Aescin No data available No data available
Aflibercept C Excretion in breast milk unknown/not recommended
Agomelatine (P) ADEC*: B1 MLR: Infant risk cannot be ruled out
Albendazole C Excreted in breast milk/use caution
Albumin C MLR: Infant risk cannot be ruled out
Alendronate C Excretion in breast milk unknown/use caution
Alfacalcidol No data available Excreted in breast milk/not recommended
Page 6 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Alfuzosin B Excretion in breast milk unknown
Alirocumab No data available Excreted in breast milk/not recommended
Allopurinol C Excreted in breast milk/use caution
Alpha-Lipoic Acid No data available Excretion in breast milk unknown
ALPRAZolam (C) D Excreted in breast milk/not recommended
Alprostadil C (Muse) Not intended for use by lactating women
Alteplase C Excretion in breast milk unknown/use caution
Aluminum Hydroxide B MLR: Infant risk cannot be ruled out
Amantadine C Excreted in breast milk/not recommended
Ambroxol No data available Excreted in breast milk/not recommended
Amethocaine (Tetracaine) C Excretion in breast milk unknown/use caution
Amidotrizoate [Diatrizoate] Meglumine [P]
C Briggs: No human data; probably compatible
Amikacin D Excreted in breast milk/not recommended
Amiloride B Excreted in breast milk/contraindicated
Amino Acids C Excretion in breast milk unknown/use caution
Aminophylline C Excreted in breast milk/not recommended
Amiodarone D Excreted in breast milk/not recommended
Amitriptyline C Excreted in breast milk/not recommended
Amlodipine C Excretion in breast milk unknown/not recommended
Amlodipine and Atorvastatin X Excretion in breast milk unknown/contraindicated
Amlodipine and Olmesartan D Excretion in breast milk unknown/not recommended
Amlodipine and Valsartan D Excretion in breast milk unknown/not recommended
Amlodipine, Valsartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Ammonium Chloride C Briggs: No human data; probably compatible
Amoxicillin B Excreted in breast milk/use caution
Amoxicillin and Clavulanic Acid B Excreted in breast milk/use caution
Amphotericin-B B Excretion in breast milk unknown/not recommended
Page 7 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Ampicillin B Excreted in breast milk/use caution
Ampicillin and Sulbactam B Excreted in breast milk/use caution
Anastrozole X Excretion in breast milk unknown/not recommended
Anidulafungin B Excretion in breast milk unknown/use caution
Antihemophilic Factor (Human, Recombinant)
C Excretion in breast milk unknown/use caution
Apixaban B Excretion in breast milk unknown/not recommended
Apomorphine C Excretion in breast milk unknown/not recommended
ARIPiprazole (P) C Excreted in breast milk/not recommended
Ascorbic Acid (Vitamin C) C Excreted in breast milk/use caution
Aspirin (Acetylsalicylic Acid) D Excreted in breast milk/use caution
Atenolol D Excreted in breast milk/use caution
Atenolol and Chlortalidone [Chlorthalidone]
D Excretion in breast milk unknown/use caution
Atomoxetine C Excretion in breast milk unknown/use caution
AtorvaSTATin X Excretion in breast milk unknown/contraindicated
Atosiban No data available Excreted in breast milk/contraindicated
Atropine B/C (Product Specific) Excreted in breast milk/use caution
Axitinib D Excretion in breast milk unknown/not recommended
AzaCITIDine (P) D Excretion in breast milk unknown/contraindicated
AzaTHIOprine D Excreted in breast milk/not recommended
Azelaic Acid B Excretion in breast milk unknown/use caution
Azelastine C Excretion in breast milk unknown/use caution
Azithromycin (Ophthalmic) B Excretion in breast milk unknown/use caution
Azithromycin (Systemic) B Excreted in breast milk/use caution
Bacitracin and Neomycin Refer to Individual Agents Refer to Individual Agents
Baclofen C
Excreted in breast milk/not recommended
Page 8 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Barium Sulfate (P) MPR: Fetal risk is minimal MLR: Infant risk is minimal (Not absorbed systemically)
BCG C Excretion in breast milk unknown/not recommended
Beclomethasone C Excretion in breast milk unknown/use caution
Bemiparin No data available Excretion in breast milk unknown/not recommended
Bendamustine D Excretion in breast milk unknown/not recommended
Benoxinate (Oxybuprocaine) C Excreted in breast milk/use caution
Benzocaine and Phenazone C Excretion in breast milk unknown/use caution
Benzoyl Peroxide C Excretion in breast milk unknown/use caution
Paricalcitol C Excretion in breast milk unknown/not recommended
PARoxetine D/X (Product Specific) Excreted in breast milk/use caution
PAZOPanib D Excretion in breast milk unknown/not recommended
Pegfilgrastim C Excretion in breast milk unknown/use caution
Peginterferon Alfa-2a/2b C/X (In combination
with Ribavirin) Excretion in breast milk unknown/not recommended
Peginterferon beta 1 A C Excretion in breast milk unknown/use caution
PEMEtrexed D Excretion in breast milk unknown/not recommended
Page 30 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
PenicillAMINE D Excretion in breast milk unknown/contraindicated
Pentoxifylline C Excreted in breast milk/not recommended
Perampanel Contraindicated Excretion in breast milk unknown/use caution
Perindopril D Excretion in breast milk unknown/use caution
Perindopril and Amlodipine D Refer to Individual Agents
PERTuzumab D Excretion in breast milk unknown/not recommended
Pethidine [Meperidine] (N) C Excreted in breast milk/not recommended
PHENobarbitone [PHENobarbital] (C)
B/D (Product Specific) Excreted in breast milk/use caution
Phenoxymethylpenicillin [Penicillin V] Potassium
B MLR: Infant risk cannot be ruled out
Phentermine (C) X Excretion in breast milk unknown/contraindicated
Phenylephrine (Ophthalmic, Systemic)
C Excretion in breast milk unknown/use caution
Phenytoin D Excreted in breast milk/not recommended
Phytomenadione [Phytonadione; Vitamin K]
C Excreted in breast milk/use caution
Pilocarpine C Excretion in breast milk unknown/not recommended
Pimecrolimus C Excretion in breast milk unknown/not recommended
Pinaverium
Animal reproduction studies and information from human pregnancies is not available. The presence of bromine in the formulation poses a theoretical risk of causing neurologic effects (sedation, hypotony) to newborns if pinaverium is used late in pregnancy, though no such cases have been reported
Excretion in breast milk unknown/not recommended
Page 31 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Pioglitazone C Excretion in breast milk unknown/not recommended
Piperacillin and Tazobactam B Excreted in breast milk/use caution
Piracetam Not recommended Excreted in breast milk/Not recommended
Pirfenidone C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Piribedil Not recommended Excretion in breast milk unknown/use caution
Pizotifen No data available Excretion in breast milk unknown/not recommended
Pneumococcal Conjugate Vaccine (13-Valent)
B Excretion in breast milk unknown/use caution
Pneumococcal Polysaccharide Vaccine (23-Valent)
C
Excretion in breast milk unknown/use caution
Policresulen
It may be used during pregnancy and breast feeding only if strictly
indicated. There have not been
any studies of the risks associated with use during pregnancy
in humans, but animal studies have
not yield any evidence of fetal
malformation. It is not known whether the active substance
passes into milk.
It may be used during pregnancy and breast feeding only if strictly indicated. There have not been any studies of the risks associated with use during pregnancy in humans, but animal studies have not yield any evidence of fetal malformation. It is not known whether the active substance passes into milk.
Polidocanol C Excretion in breast milk unknown/not recommended
Poliovirus Vaccine (Live/Trivalent/Oral)
C MLR: Infant risk cannot be ruled out
Page 32 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Polyethylene Glycol 3350 C Excretion in breast milk unknown/use caution
Potassium Acetate C MLR: Infant risk cannot be ruled out
Potassium Chloride C Excreted in breast milk/not recommended
Potassium Iodide and Iodine D (Potassium Iodide) Excreted in breast milk/use caution (AAP rates compatible)
Potassium Phosphate C Excreted in breast milk/use caution (AAP rates compatible)
Povidone-Iodine (Ophthalmic) C Excretion in breast milk unknown/not recommended
Povidone-Iodine (Topical) No data available Excreted in breast milk/use caution
Pralidoxime (PAM) C Excretion in breast milk unknown/use caution
Pramipexole C Excretion in breast milk unknown/not recommended
PrednisoLONE (Ophthalmic) C Excretion in breast milk unknown/use caution
PrednisoLONE (Systemic) C/D (Product Specific) Excreted in breast milk/use caution
Pregabalin C Excretion in breast milk unknown/not recommended
Primidone D Excreted in breast milk/not recommended
Procainamide C Excreted in breast milk/not recommended
Prochlorperazine ADEC*: C Excretion in breast milk unknown
Progesterone B (Oral) Excreted in breast milk/use caution
Promethazine C Excretion in breast milk unknown/not recommended
Propofol B Excreted in breast milk/not recommended
Propranolol C Excreted in breast milk/use caution
Propylthiouracil D Excreted in breast milk/use caution
Protamine C Excretion in breast milk unknown/use caution
Protirelin C Excretion in breast milk unknown/use caution
Pseudoephedrine ADEC*: B2 Excreted in breast milk/use caution (AAP rates compatible)
Psyllium Safe (Not absorbed
systematically) AAP: Compatible with breastfeeding
Pylera (Bismuth, Metronidazole, Tetracycline)
Contraindicated Excreted in breast milk/not recommended
Pyrazinamide C Excreted in breast milk/use caution
Page 33 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Pyridostigmine B/C (Product Specific) Excreted in breast milk/use caution
Pyridoxine (Vitamin B6) A Excreted in breast milk/compatible
QUEtiapine C Excreted in breast milk/not recommended
QuiNINE C Excreted in breast milk/use caution (AAP rates compatible)
RABEprazole C Excretion in breast milk unknown/use caution
Rabies Vaccine C Excretion in breast milk unknown
Raloxifene X Excretion in breast milk unknown/contraindicated
Ramipril D Excretion in breast milk unknown/not recommended
Ranibizumab C Excretion in breast milk unknown/use caution
Ranitidine B Excreted in breast milk/use caution
Rasburicase C Excretion in breast milk unknown/not recommended
Regorafenib (P) D Excretion in breast milk unknown/contraindicated
Remifentanil (N) C Excretion in breast milk unknown/use caution
Repaglinide C Excretion in breast milk unknown/not recommended
Rho(D) Immune Globulin C Excretion in breast milk unknown/use caution
Ribavirin X Excretion in breast milk unknown/not recommended
Riboflavin, Ophthalmic No data available No data available
Rifampin C Excreted in breast milk/not recommended
Rifampin and Isoniazid Refer to Individual
Agents Refer to Individual Agents
Rimexolone C Excretion in breast milk unknown/not recommended
RisperiDONE C Excreted in breast milk/not recommended
RiTUXimab C Excretion in breast milk unknown/not recommended
Rivaroxaban C Excretion in breast milk unknown/not recommended
Rivastigmine B Excretion in breast milk unknown/not recommended
Page 34 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
RIZAtriptan (P) C Excretion in breast milk unknown/use caution
Rocuronium C MLR: Infant risk cannot be ruled out
Rosuvastatin X Excretion in breast milk unknown/contraindicated
Rotavirus Vaccine C AAP: Compatible with breastfeeding
Rotigotine C Excretion in breast milk unknown/use caution
Salbutamol /Albuterol C Excretion in breast milk unknown/not recommended
Salicylic Acid C Not recommended
Saxagliptin B Excretion in breast milk unknown/use caution
Saxagliptin and MetFORMIN Refer to Individual
Agents Refer to Individual Agents
Secukinumab B Infant risk cannot be ruled out
Selegiline C Excretion in breast milk unknown/not recommended
Senna C AltMedDex®; Micromedex®: Compatible
Sertaconazole C Excretion in breast milk unknown/use caution
Sertraline C Excreted in breast milk/use caution
Sevelamer C MLR: Infant risk is minimal
Sevoflurane B MLR: Infant risk cannot be ruled out (for 24 hours after anesthesia)
Sildenafil B Excretion in breast milk unknown/use caution
Silver Sulfadiazine B Excretion in breast milk unknown/not recommended
Silymarin No data available No data available
Simeticone [Simethicone] Safe (Not absorbed
systematically) AAP: Compatible with breastfeeding
Simvastatin X Excretion in breast milk unknown/contraindicated
SitaGLIPtin B Excretion in breast milk unknown/use caution
Sitagliptin and Metformin Refer to Individual
Agents Refer to Individual Agents
Sodium Acetate C Excreted in breast milk/compatible
Sodium Bicarbonate C Excreted in breast milk/compatible
Page 35 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Sodium Chloride C Excreted in breast milk/use caution
Sodium Cromoglicate [Cromolyn] (Ophthalmic)
B Excretion in breast milk unknown/use caution
Sodium Phosphate C Excreted in breast milk/compatible
Sodium Polystyrene Sulfonate C Excretion in breast milk unknown/use caution
Sodium Stibogluconate X Excretion in breast milk unknown/contraindicated
Sofosbuvir/Ledipasvir (P) B MLR: Infant risk cannot be ruled out
Solifenacin C Excretion in breast milk unknown/not recommended
Somatropin B/C (Depending upon
manufacturer) Excretion in breast milk unknown/use caution
SORAfenib D Excretion in breast milk unknown/not recommended
Sotalol B Excreted in breast milk/not recommended
Spironolactone C Excreted in breast milk/not recommended
Streptomycin D Excreted in breast milk/not recommended
Sucralfate B Excretion in breast milk unknown/use caution
SUFentanil (N) C Excretion in breast milk unknown/use caution
Sugammadex No data available Excretion in breast milk unknown
SulfADIAZINE C Excreted in breast milk/contraindicated
SulfaSALAzine B Excreted in breast milk/use caution
Sulpiride Not recommended Excreted in breast milk/not recommended
SUMAtriptan C Excreted in breast milk/not recommended
SUNItinib D Excretion in breast milk unknown/not recommended
Suxamethonium [Succinylcholine]
C Excretion in breast milk unknown/use caution
TACrolimus (Systemic, Topical) C Excreted in breast milk/not recommended
Tadalafil B Excretion in breast milk unknown/use caution
Tafacitinib C Excretion in breast milk unknown/ Decision shall be made either to discontinue breastfeeding or to discontinue the drug
Talc (Sterile) B Excretion in breast milk unknown
Page 36 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Tamoxifen D Excretion in breast milk unknown/not recommended
Tamsulosin B MLR: Infant risk cannot be ruled out
Teicoplanin Not recommended Excretion in breast milk unknown/use caution
Telaprevir B/X (in combination
with ribavirin) Excretion in breast milk unknown/not recommended
Telmisartan D Excretion in breast milk unknown/not recommended
Telmisartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
TEMOzolomide D Excretion in breast milk unknown/not recommended
Temsirolimus D Excretion in breast milk unknown/not recommended
Tenofovir B Excreted in breast milk/contraindicated
Terbinafine (Systemic) B Excreted in breast milk/not recommended
Teriflunomide X Excretion in breast milk unknown/not recommended
Teriparatide C Excretion in breast milk unknown/not recommended
Testosterone X Excreted in breast milk/contraindicated
Tetanus Toxoid (Adsorbed) C Excretion in breast milk unknown/use caution
Tetracaine [Amethocaine] C Excretion in breast milk unknown/use caution
Tetracosactide [Tetracosactrin, Cosyntropin]
C Excretion in breast milk unknown/use caution
Tetrastarch C Excretion in breast milk unknown/use caution
Thalidomide X Excretion in breast milk unknown/not recommended
Theophylline C Excreted in breast milk/compatible
Thiamine A Excreted in breast milk/use caution
Thyrotropin Alfa C Excretion in breast milk unknown/use caution
Tibolone X Excretion in breast milk unknown/contraindicated
Ticagrelor C MLR: Infant risk cannot be ruled out
Page 37 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Tigecycline D Excretion in breast milk unknown/use caution
Timolol C Excreted in breast milk/consider risk: benefit
Tinidazole C Excreted in breast milk/contraindicated
Tinzaparin B Excretion in breast milk unknown/use caution
Tiotropium C Excretion in breast milk unknown/use caution
Tirofiban B Excretion in breast milk unknown/not recommended
TiZANidine C Excretion in breast milk unknown
Tobramycin (Ophthalmic) B Not recommended
Tobramycin and Dexamethasone (Ophthalmic)
C Excretion in breast milk unknown/use caution
Tocilizumab C Excretion in breast milk unknown/not recommended
Tofacitinib Not recommended Excretion in breast milk unknown/not recommended
Tolterodine C Excretion in breast milk unknown/not recommended
Topiramate D Excreted in breast milk/use caution
Topotecan D Excretion in breast milk unknown/not recommended
Trace Elements Refer to Individual
Agents Refer to Individual Agents
TraMADol (C) C Excreted in breast milk/not recommended
Tranexamic Acid B Excreted in breast milk/use caution
Trastuzumab D Excretion in breast milk unknown/not recommended
Travoprost C Excretion in breast milk unknown/use caution
Tretinoin (Topical) D Excretion in breast milk unknown/use caution
Triamcinolone (Systemic) C Excreted in breast milk/use caution
Triamcinolone (Topical) C Excretion in breast milk unknown/use caution
Trihexyphenidyl C Excretion in breast milk unknown/use caution
Trimetazidine No data available Excretion in breast milk unknown/not recommended
Page 38 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Trimethoprim C Excreted in breast milk/use caution
Triprolidine ADEC*: A MLR: Infant risk is minimal
Triptorelin (LHRH) X Excretion in breast milk unknown/not indicated for use in women
Tropicamide C Excretion in breast milk unknown/use caution
Trospium C Excretion in breast milk unknown/use caution
Trypan Blue C Excretion in breast milk unknown/use caution
Tuberculin Test C No data available
Typhoid Vaccine C Excretion in breast milk unknown/use caution
Umeclindium bromide and Vilanterol
C Excretion in breast milk unknown/use caution
Urea B/C (Product Specific) Excretion in breast milk unknown/use caution
Ursodiol B Excretion in breast milk unknown/use caution
Ustekinmab B Excretion in breast milk unknown/use caution
ValACIclovir [ValACYclovir] B Excreted in breast milk/use caution
ValGANciclovir C Excretion in breast milk unknown/not recommended
Valproic Acid and Derivatives X (Migraine
prophylaxis)/D (All other indications)
Excreted in breast milk/use caution
Valsartan D Excretion in breast milk unknown/not recommended
Valsartan and Hydrochlorothiazide
Refer to Individual Agents
Refer to Individual Agents
Valsartan and Sacubitril Discontinue as soon
as possible once pregnancy is detected
Excretion in breast milk unknown/not recommended
Vancomycin B (Oral)/C (Injection) Excreted in breast milk/not recommended
Varenicline C Excretion in breast milk unknown/not recommended
Varicella Zoster Vaccine MPR: Fetal risk
cannot be ruled out Excretion in breast milk unknown/use caution
Vasopressin C Excretion in breast milk unknown/use caution
Page 39 of 39
Department of Pharmaceutical Care
Drug Use in Pregnancy &
Lactation
Pharmacy & Therapeutic Committee- Sep 2018
Generic Name Pregnancy Category Breast Feeding Considerations
Vedolizumab B Infant risk cannot be ruled out
Venlafaxine C Excreted in breast milk/not recommended
Verapamil C Excreted in breast milk/not recommended
Vigabatrin C Excreted in breast milk/not recommended
VILDAgliptin Not recommended Excretion in breast milk unknown/not recommended
VILDAgliptin and MetFORMIN Refer to Individual
Agents Refer to Individual Agents
VinBLAStine D Excretion in breast milk unknown/not recommended
VinCRIStine D Excretion in breast milk unknown/not recommended
Vinorelbine D Excretion in breast milk unknown/not recommended
Vitamin B - Complex A Excreted in breast milk/use caution (AAP rates compatible)
Vitamin E A MLR: Infant risk cannot be ruled out
Voriconazole D Excretion in breast milk unknown/not recommended
Vortioxetine C Data not available
Warfarin D (Mechanical Heart
Valves)/X (Other Indications)
Not excreted in breast milk/use caution
Xylometazoline C MLR: Infant risk cannot be ruled out
Zaleplon C Excreted in breast milk/not recommended
Zinc Sulfate C Excreted in breast milk/compatible
Zoledronic acid D Excretion in breast milk unknown/not recommended
Zolpidem (C) C Excreted in breast milk/use caution